Patients with cutaneous lupus who smoke tend to have more active skin disease and respond less well to antimalarials such as hydroxychloroquine. Asking about smoking and supporting cessation is part of treating the skin, not just general health advice. Before escalating to systemic immunosuppression for apparent antimalarial failure, check smoking status, adherence and photoprotection. Keep the hydroxychloroquine dose within weight-based limits and arrange retinal screening.
- Ask every patient with cutaneous lupus about smoking and offer cessation support.
- Check adherence and sun protection before calling hydroxychloroquine a failure.
- Keep hydroxychloroquine within weight-based dosing limits.
- Arrange baseline and periodic retinal screening for long-term hydroxychloroquine use.
Why it matters
Smoking is a modifiable reason for apparent treatment failure that is easy to miss.
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