Successful Treatment with Hydroxychloroquine for Systemic Lupus Erythematosus with Cutaneous Involvement Accompanied by a Xanthomatous Reaction

A 34-year-old woman with systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE) on the scalp, which included a rare xanthomatous reaction, was successfully treated with hydroxychloroquine (HCQ) at 200 mg/day. Despite previous treatment with prednisolone, her hair loss persisted until HCQ was introduced, leading to complete resolution of skin lesions within 5 months without increasing the prednisolone dose. The study suggested that chronic epithelial injury in DLE might trigger a secondary xanthomatous reaction, although other unknown factors could also contribute.