We report an encouraging response to treatment with methotrexate in a single patient with severe discoid lupus erythematosus who did not respond to conventional therapy.
Report of a Case.
A 61-year-old white woman presented 7 years ago with a 39-year history of severe scarring discoid lupus erythematosus. Previous treatments included topical and intralesional steroid therapy and lowdose prednisone.Examination revealed numerous large erythematous infiltrated scaly plaques with focal areas of atrophy on the face (Figure 1). There was extensive scarring from previous lesions. Aside from arthralgia, there was no evidence of systemic lupus erythematosus. Initial laboratory investigations included a normal hemogram, an elevated sedimentation rate, normal renal function, negative rheumatoid factor, antinuclear antibodies, anti-DNA, and RNP and Sm antibodies. Complement studies were normal. Findings from a skin biopsy specimen were consistent with discoid lupus erythematosus. Direct immunofluorescence studies showed negative findings.Initial therapy consisted of chloroquine (250 mg, orally twice