title: Skin manifestations of systemic lupus erythematosus refractory to multiple treatment modalities: poor results with mycophenolate mofetil.
abstract: OBJECTIVE
  Skin disease can be one of the most refractory clinical manifestations of systemic lupus erythematosus (SLE). The standard therapy consists of sunscreens, topical corticosteroids and antimalarials. However in difficult cases a variety of other drugs have been tried. Here we describe our clinical experience with mycophenolate mofetil (MMF) in patients with cutaneous manifestations of SLE.
  
  
  METHODS
  Seven patients with SLE and skin involvement (including acute cutaneous lupus, subacute cutaneous lupus, discoid lupus erythematosus, vasculitis, urticarial rash and chilblain lupus) who had received treatment with MMF were included. The clinical characteristics, serologicalfindings and response to treatment were recalledfrom retrospective review of the files.
  
  
  RESULTS
  Our results showed no response in 5 patients, partial response in 1 patient and initial response but skin flare whilst on MMF in 1 patient. The median dose of MMF was 2 g (range 2-3 g). Adverse events on MMF were mild, mainly gastrointestinal and occurred in 5 patients. No patients discontinued MMF due to adverse events.
  
  
  CONCLUSIONS
  MMF appears not to be particularly effective in the treatment of skin disease in SLE. It should be noted that our group of patients had previously failed to respond to a median of 4 (range 2-10) different drugs used to treat SLE skin disease. Thus, the patients in the study could be considered at the severe end of skin disease spectrum.
authors.affiliation: Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, Lambeth Palace Road, London, United Kingdom. ceciliapisoni@yahoo.com.ar
authors.forename: C N
authors.initials: CN
authors.lastname: Pisoni
authors.forename: G
authors.initials: G
authors.lastname: Obermoser
authors.forename: M J
authors.initials: MJ
authors.lastname: Cuadrado
authors.forename: F J
authors.initials: FJ
authors.lastname: Sanchez
authors.forename: Y
authors.initials: Y
authors.lastname: Karim
authors.forename: N T
authors.initials: NT
authors.lastname: Sepp
authors.forename: M A
authors.initials: MA
authors.lastname: Khamashta
authors.forename: G R V
authors.initials: GR
authors.lastname: Hughes
mesh_terms: D000293:Adolescent; D000328:Adult; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008178:Lupus Erythematosus, Cutaneous / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D003879:Dermatologic Agents; D009173:Mycophenolic Acid