title: Clinical features and efficacy of antimalarial treatment for reticular erythematous mucinosis: a case series of 11 patients.
abstract: BACKGROUND
  Reticular erythematous mucinosis (REM syndrome) is a rare cutaneous disease that predominantly affects the chest and upper back area of middle-aged women. Although antimalarial treatment is generally considered the most effective approach, only a few case reports exist on its use in REM syndrome.
  
  
  METHODS
  A total of 11 patients with REM syndrome (10 women and 1 man), mean age, 44 years (age range, 37-54 years), were included in this retrospective analysis. Ten of the 11 patients were cigarette smokers (91%), and 6 had concomitant autoimmune diseases (55%). Since no clinical score exists for REM syndrome, we used the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) to evaluate the efficacy of antimalarial treatment. Overall, a significant decrease in the clinical score was observed from a median of 4 (range, 2-8) before initiation of treatment to 0 (range, 0-4) after 3 months of antimalarial therapy and to 0 (range, 0-4) after 12 months of therapy (P < .001). Two patients withdrew from the study owing to adverse gastrointestinal tract effects (nausea and vomiting); 2 relapsed after finishing their antimalarial regimens; 3 patients were free of disease 2 years after the end of treatment; and 4 patients were lost to follow-up.
  
  
  CONCLUSIONS
  Antimalarial agents significantly improve or completely clear the skin lesions of patients with REM syndrome and should be considered as a first-line therapy for this rare disease.
authors.affiliation: Connective Tissue Disease Research Unit, Department of Dermatology, Venereology, and Allergology, Ruhr-University Bochum, Bochum, Germany. a.kreuter@derma.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Kreuter
authors.forename: Nina
authors.initials: N
authors.lastname: Scola
authors.forename: Christian
authors.initials: C
authors.lastname: Tigges
authors.forename: Peter
authors.initials: P
authors.lastname: Altmeyer
authors.forename: Thilo
authors.initials: T
authors.lastname: Gambichler
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D002738:Chloroquine / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D004890:Erythema / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017520:Mucinoses / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D013256:Steroids / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D013256:Steroids; D002738:Chloroquine