@article{oai:dmu.repo.nii.ac.jp:02000051,
 author = {Suryawati, Nyoman and Puspawati, Ni Made Dwi and Nukana, Ratih Purnamasari and Saputra, Herman},
 issue = {2},
 journal = {Dokkyo Medical Journal},
 month = {Jun},
 note = {Introduction: Generalized discoid lupus erythematosus (DLE) is a rare skin manifestation; however, about 15-28% of cases may develop into Systemic Lupus Erythematosus (SLE). Generalized DLE with SLE showed a poorer prognosis and required holistic therapy.

Case Report: A 20-year-old female complained of red rash on the skin, worsen with sun exposure in the past two years. She complained of joint pain, fever, decreased appetite, and fatigue, twenty months after the skin rash onset. Skin examination on the scalp, face, trunk, hands and feet showed erythematous to hypopigmentation patches, atrophic skin, and erosions covered with crusts. Laboratory investigations revealed anemia, high titers of ANA, and anti-dsDNA. Histopathological results were consistent with lupus erythematosus. Consultation with an ophthalmologist showed no contraindications to hydroxychloroquine. She was diagnosed with generalized DLE with moderate SLE and showed an excellent response to hydroxychloroquine, methotrexate, both systemic and topical corticosteroids, and sunscreen.

Discussion: Generalized cutaneous lupus can be treated with a topical therapy such as corticosteroid, sunscreen, and systemic therapy such as hydroxychloroquine and corticosteroid. Methotrexate, as a steroid-sparing agent, has a role in treating moderate to severe SLE and lupus arthritis.

Conclusion: Early recognition of SLE in a patient with cutaneous lupus and adequate therapy in generalized DLE is essential. Combination therapy showed better efficacy than monotherapy in generalized cutaneous lupus accompanied by SLE.},
 pages = {175--181},
 title = {Generalized Discoid Lupus Erythematosus with Systemic Lupus Erythematosus: A Therapeutic Challenge},
 volume = {2},
 year = {2023}
}