Practice‐Based Differences in Pediatric Discoid Lupus Erythematosus

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 of children with DLE.

Objectives

We compared practice patterns among pediatric dermatologists/rheumatologists treating pediatric DLE.

Methods

An online survey was sent to 292 pediatric rheumatologists in the Childhood Arthritis & Rheumatology Research Alliance (CARRA) and 200 pediatric dermatologists in the Pediatric Dermatology Research Alliance (PeDRA). Consensus was defined as >70% agreement.

Results

Survey response rates were 38% (dermatology, n = 76/200) and 21% (rheumatology, n = 60/292). Both specialties agreed that screening labs should include complete blood counts with differential, urinalysis, complements, 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 pediatric dermatologists/rheumatologists treating DLE. Knowledge gaps include risk factors for SLE, optimal screening and treatment of refractory skin disease.

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