Well if you haven’t had enough reason to stop smoking yet, this recent paper suggests a relationship between smoking and poor treatment response of patients with cutaneous lupus. It is not known whether smoking directly decreases the efficacy of hydroxycloroquine or whether smokers tend not to improve so well as they tend to be outdoors to smoke (which makes lupus worse) and possibly also less compliant with their medications. But the bottom line is that if the patient is a smoker, dermatologists need to be aware that they are less likely to respond to treatment with hydroxychloroquine.

Hydroxychloroquine and smoking in patients with cutaneous lupus erythematosus

1. N. Ezra¹,
2. J. Jorizzo²

Article first published online: 14 MAY 2012

Summary

Antimalarials, such as chloroquine and hydroxychloroquine, have been used to treat cutaneous and systemic lupus erythematosus for decades with excellent therapeutic efficacy. Smoking seems to inhibit the therapeutic efficacy of antimalarials when treating cutaneous lupus erythematosus (CLE), but the reason behind this observation is unclear. In addition, antimalarials have been associated with several potentially serious adverse effects, including irreversible loss of vision. The aim of this literature review is to discuss the evidence for how cigarette smoking interferes with antimalarial efficacy in the treatment of CLE. Evidence-based data with long-term follow-up will allow determination of the aetiology for diminished antimalarial response, and enable selection of the best treatment to maximize long-term remission in CLE.

DOI: 10.1111/j.1365-2230.2011.04266.x

© The Author(s). CED © 2012 British Association of Dermatologists

Issue

Clinical and Experimental Dermatology

Volume 37, Issue 4, pages 327–334, June 2012