Patients with cutaneous lupus erythematosus who smoke are less responsive to antimalarial treatment

Background: Reports suggest that cigarette smoking might interfere with the effectiveness of antimalarial therapy as first-line treatment for cutaneous lupus erythematosus. Patients refractory to this treatment often must be treated with potentially more toxic regimens. Objective: Our purpose was to examine the effects of cigarette smoking on the therapeutic response to antimalarial agents in patients with discoid lupus erythematosus (DLE) and subacute cutaneous lupus erythematosus (SCLE). Methods: A total of 61 patients (47 DLE, 14 SCLE) were selected on the basis of the following criteria: (1) skin biopsy was consistent with cutaneous LE, (2) a smoking history was available, and (3) an adequate trial of antimalarial therapy was completed. Patients were classified as antimalarial responders or nonresponders on the basis of descriptions in their medical records. Two-by-two table analysis was performed comparing response rates in smokers versus nonsmokers. Results: A significant difference (P<.0002) in the antimalarial response rate was observed for smokers (40%) versus nonsmokers (90%). Conclusion: These results indicate that patients with cutaneous LE who smoke are significantly less likely to respond to antimalarial therapy.