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An update on the use of hydroxychloroquine in cutaneous lupus erythematosus: A systematic review


Shipman WD1, Vernice NA2, Demetres M3, Jorizzo JL4.

Author informationJ Am Acad Dermatol. 2019 Jul 12. pii: S0190-9622(19)32387-4. doi: 10.1016/j.jaad.2019.07.027. [Epub ahead of print]

Author Information

1 Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program, New York, NY 10065; Department of Dermatology, Weill Cornell Medicine, New York, NY 10065. Electronic address: wds2001@med.cornell.edu.

2 Department of Dermatology, Weill Cornell Medicine, New York, NY 10065.

3 Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY 10065.

4 Department of Dermatology, Weill Cornell Medicine, New York, NY 10065; Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27109.



Hydroxychloroquine is widely used for the treatment of cutaneous lupus erythematosus (CLE). Although new recommendations exist for hydroxychloroquine dosing, there is still uncertainty about the dosage that will elicit a satisfactory response in CLE while limiting adverse effects, specifically retinopathy.


To summarize hydroxychloroquine dosages, outcomes, and adverse effects in the treatment of CLE, focusing on retinopathy.


A comprehensive literature search from inception - December 2018 was performed in Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library (Wiley). Studies were then screened against predefined inclusion/exclusion criteria.


Twelve studies were selected and included 5 retrospective studies, 3 prospective studies, 2 case series, and 2 randomized controlled trials. These studies show that a hydroxychloroquine dosage up to 400 mg/day is effective for most CLE patients (range of effectiveness: 50-97%), with few adverse effects. One incidence of retinopathy, after a very high cumulative dose, was reported across all 12 studies (852 total patients).


Since retinopathy and other serious adverse effects may not appear until much later, many of these studies are limited by short follow-up time.


This evidence suggests that hydroxychloroquine for CLE is effective at 400 mg/day with an exceedingly low incidence of retinopathy and other adverse effects.