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Br J Dermatol. 2019 Oct;181(4):805-810. doi: 10.1111/bjd.17780. Epub 2019 Jun 23.

Practice-based differences in paediatric discoid lupus erythematosus.

Author information

1
Department of Dermatology and Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A.
2
Department of Biostatistics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A.
3
Department of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI, U.S.A.
4
Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A.
5
Department of Pediatrics, University of Colorado, Denver, CO, U.S.A.
6
Department of Pediatrics and Dermatology, Baylor College of Medicine, Houston, TX, U.S.A.
7
Department of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A.
8
Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, U.S.A.
9
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, U.S.A.
10
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A.
11
Department of Pediatrics, University of California San Francisco, San Francisco, CA, U.S.A.
12
Department of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A.

Abstract

BACKGROUND:

Children with discoid lupus erythematosus (DLE) are at risk for disfigurement and progression to systemic lupus erythematosus (SLE). Consensus is lacking regarding optimal care for children with DLE.

OBJECTIVES:

The aim of this study was to compare practice patterns among paediatric dermatologists/rheumatologists treating paediatric DLE.

METHODS:

An online survey was sent to 292 paediatric rheumatologists in the Childhood Arthritis and Rheumatology Research Alliance and 200 paediatric dermatologists in the Pediatric Dermatology Research Alliance. Consensus was defined as ≥ 70% agreement.

RESULTS:

Survey response rates were 38% (76 of 200) for dermatology and 21% (60 of 292) for rheumatology. Both specialties agreed that screening labs should include complete blood counts with differential, urinalysis, complement levels, erythrocyte sedimentation rate, antinuclear antibody and other autoantibodies, hepatic function and renal function/electrolytes. Both specialties agreed that arthritis or nephritis should prompt intensified evaluation for SLE. No other patient features achieved consensus as disease-modifying risk factors. Hydroxychloroquine was agreed upon as first-line systemic therapy, but consensus was lacking for second- or third-line treatment.

CONCLUSIONS:

We found few areas of consensus and significant practice differences between paediatric dermatologists and rheumatologists treating DLE. Knowledge gaps include risk factors for SLE, optimal screening and treatment of refractory skin disease.

PMID:
30768778
DOI:
10.1111/bjd.17780

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