Intravenous immunoglobulin for recalcitrant subacute cutaneous lupus erythematosus.

Sir, Subacute cutaneous lupus erythematosus (SCLE), first described by Sontheimer et al. (1) in 1979, represents a distinct subtype of lupus erythematosus (LE) with specific clinical and serological features. Characteristically, skin lesions appear in a non-scarring papulosquamous, annular, polycyclic or psoriasiform pattern primarily located in the sun-exposed areas such as the upper back and chest. Systemic involvement in SCLE is relatively rare, but the majority of patients have musculoskeletal complaints such as arthralgias. Antinuclear antibodies (ANA) are present in 60–80% of cases, with circulating anti-Ro(SS-A) antibodies as the most characteristic feature (2). Antimalarials are considered to be the first-line drugs in SCLE. However, a minority of patients with resistant disease fail to improve on antimalarials and/or immunosuppressive agents. We here report a patient with highly recalcitrant SCLE who significantly responded to treatment with high dose intravenous immunoglobulin (IVIg).