Discoid Lupus Erythematosus Patients Research Articles

Screening of Genes Associated with Immune Infiltration of Discoid Lupus Erythematosus Based on Weighted Gene Co-expression Network Analysis.

Discoid lupus erythematosus (DLE) is a disorder of the immune system commonly seen in women of childbearing age. The pathophysiology and aetiology are still poorly understood, and no cure is presently available. Therefore, there is an urgent need to explore the underlying molecular mechanisms, as well as search for new therapeutic targets. Gene expression data from skin biopsies samples of DLE patients and healthy controls were downloaded from the Gene Expression Omnibus database. The differentially expressed genes (DEGs) between DLE and healthy control samples were identified by differential expression analysis. Samples were analysed using CIBERSORT to examine the proportion of immune infiltration. Weighted gene co-expression network analysis was used to screen for the module most relevant to immune infiltration. Candidate genes were uploaded to the TRRUST database to obtain the potential transcription factors regulating these genes. Protein-protein interaction (PPI) analysis was performed to obtain the hub genes most associated with immune infiltration among the candidate genes. A total of 273 DEGs were identified between the DLE and healthy control samples. The results of immunoinfiltration analysis showed that the abundances of resting memory CD4 T cells, activated memory CD4 T cells and M1 macrophages were significantly higher, while those of resting infiltration of plasma cells, regulatory T cells and dendritic cells were lower in DLE samples than in healthy control samples. Correlation analysis showed that ISG15, TRIM22, XAF1, IFIT2, OAS2, OAS3, OAS1, IFI44, IFI6, BST2, IFIT1 and MX2 were negatively correlated with the abundances of plasma cells, T-cell regulatory cells and resting dendritic cells and positively correlated with activated memory CD4 T cells and M1 macrophages. Our study shows that these hub genes may regulate DLE via immune-related pathways mediated by the infiltration of these immune cells.

Evaluation of the Involvement of Heme Oxygenase-1 Expression in Discoid Lupus Erythematosus Lesions.

Discoid lupus erythematosus (DLE) is a chronic autoimmune disease that primarily affects the skin, causing red, scaly patches that may be disfiguring and can cause permanent scarring. This study aimed to investigate the potential clinical and therapeutic applications of heme oxygenase-1 (HMOX1) in the context of DLE. Immunohistochemical staining and bioinformatics analysis were performed on skin biopsy samples from DLE patients to examine the levels of HMOX1 and to correlate with markers of inflammation. Our study revealed a negative correlation between HMOX1 levels and the inflammatory status of DLE lesions, as well as an inverse correlation between HMOX1 levels and the infiltration of M1 macrophages and activated mastocytes. These findings suggest that HMOX1 plays a crucial role in the regulation of inflammation in DLE and could be a potential therapeutic target and biomarker for DLE.

A Case Series of Cutaneous Lupus Erythematosus Progressing to Systemic Lupus Erythematosus in a Lightning Phase

Discoid Lupus Erythematosus (DLE) is a chronic, disfiguring, inflammatory skin disease characterised by erythematous, indurated, well-defined scaly plaques of varying sizes that resolve with atrophy, scarring, and pigmentary changes. Although discoid cutaneous lesions are typical of DLE, they are also seen in as many as 14% of patients with Systemic Lupus Erythematosus (SLE). The aetiopathogenesis of Cutaneous Lupus Erythematosus (CLE) is thought to be related to the same autoimmune abnormality responsible for the systemic components of LE. The key feature in the pathogenesis being upregulation of Interferon-α (IFN-α) signaling. Hence, the morphology and associated clinical features of DLE can be considered as a forerunner in assessing the development of SLE. This case series highlights some potential risk factors to watch out for in the progression to SLE in patients with DLE. Some parameters that are likely to predict early progression towards SLE from DLE are: early age at diagnosis (<25 years), female gender (2:1), Fitzpatrick skin type V and VI, presence of disseminated DLE lesions, arthralgia, anaemia (Hb-<10 g/dL), lymphopenia (lymphocyte count-<20%), isolated lesions at photoprotected sites, average disease duration ranging from 5.7 to 8 years, elevated ESR, high baseline ANA titres ≥1:320, anti-ds-DNA, anti-SS-A, and anti-Sm antibody positivity. Hence, assessment of the above-mentioned parameters in initial and follow-up visits might aid in the early diagnosis of SLE. This case series consists of four patients (33 years old female, 54 years old female,34 years old female and 49 years old male patients, all married), all of whom had multiple potential risk factors indicating rapid progression towards the development of systemic symptoms. Hence, this shifts the prior paradigm that DLE patients do not typically develop severe SLE. Risk score analysis may be a helpful tool in assessing ongoing subclinical inflammation and aiding in the early diagnosis of SLE. Appropriate therapeutic intervention could be key in stemming disease progression, reducing morbidity and mortality, and improving the patient’s quality of life.

Squamous Cell Carcinoma Arising in Lesions of Discoid Lupus Erythematosus in a Patient with Overlap Syndrome: A Chronic Rare Complication.

Squamous Cell Carcinoma Arising in Lesions of Discoid Lupus Erythematosus in a Patient with Overlap Syndrome: A Chronic Rare Complication.

Single-cell sequencing shows cellular heterogeneity of cutaneous lesions in lupus erythematosus

Discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE) are both types of lupus, yet the characteristics, and differences between them are not fully understood. Here we show single-cell RNA sequencing data of cutaneous lesions from DLE and SLE patients and skin tissues from healthy controls (HCs). We find significantly higher proportions of T cells, B cells and NK cells in DLE than in SLE. Expanded CCL20+ keratinocyte, CXCL1+ fibroblast, ISGhiCD4/CD8 T cell, ISGhi plasma cell, pDC, and NK subclusters are identified in DLE and SLE compared to HC. In addition, we observe higher cell communication scores between cell types such as fibroblasts and macrophage/dendritic cells in cutaneous lesions of DLE and SLE compared to HC. In summary, we clarify the heterogeneous characteristics in cutaneous lesions between DLE and SLE, and discover some specific cell subtypes and ligand-receptor pairs that indicate possible therapeutic targets of lupus erythematosus.

Merkel cell number and distribution, and CD200 expression in patients with lichen planopilaris and discoid lupus erythematosus.

Immune mechanisms are considered to be responsible for the pathogenesis of cicatricial alopecia in lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) diseases. CD200 has an immunomodulatory function in hair follicles. The functions of Merkel cells (MCs) in hair follicles remain to be fully understood. This study aimed to determine the number and distribution of MCs as well as CD200 expression in patients with DLE and LPP. Using immunohistochemistry, the number and distribution of MCs (staining with CK20) and CD200 expression in biopsy specimens of LPP and DLE patients were compared with control group patients. The number of follicular MCs, total MCs, mean follicular MCs, and CD200 expression were significantly lower in the case groups compared to the control group. In CD200- cases, the number of follicular MCs and mean follicular MCs were significantly lower than in CD200+ cases. Retrospective design, lack of data regarding the history of alopecia in the control group, and unknown stage of disease in patients were the limitations. MC loss might play a role in immune privilege collapse in hair follicles. This study is novel in terms of investigating MCs in DLE and LPP patients.

Efficacy of antimalarial agents to prevent the progression of discoid lupus erythematosus to systemic lupus erythematosus: A retrospective cross-sectional study.

Discoid Lupus Erythematosus (DLE) patients have the potential to developing Systemic Lupus Erythematosus (SLE) at a later time. The prescription of antimalarial agents might be beneficial to prevent this progression but the validated data is still lacking. Our study aimed to explore whether antimalarial agent could slow progression to SLE in DLE patients, adjusting for other potential confounders. We retrospectively studied 65 patients who were diagnosed as DLE and attended the outpatient clinic at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between January 1, 2017 and December 31, 2020. We reviewed medical records including history of DLE, SLE signs and symptoms, laboratory findings and treatment options. Over a total of 458.73 person years (PY), 19 patients (29.23%) eventually progressed to SLE within approximately 1 year. Of these, 15 patients had widespread lesions whereas only 4 patients presented with localized form. The prescription of antimalarial drug was associated with delayed SLE progression in our cohort. Other parameters such as generalized form (IRR 6.243 (95% CI 1.450-26.872); P = 0.014), joint involvement (IRR 5.005 (95% CI 1.931-12.969); P = 0.001) and LE specific skin lesions (IRR 3.799 (95% CI 1.220-11.825); P = 0.021) were considered as strong risk factors in SLE development. Our study suggested that an antimalarial drug could postpone the SLE development in DLE patients.

Dendritic cells may help differentiate discoid lupus erythematosus alopecia from lichen planopilaris.

IntroductionPrimary cicatricial alopecia (PCA) encompasses a heterogeneous group of inflammatory diseases characterized by the replacement of hair follicle structures by fibrous tissue. Discoid lupus erythematosus (DLE) and lichen planopilaris (LPP) are the most common causes of scarring alopecia. The distinction between both entities is often challenging because of significant clinical and histopathological overlap.AimWe hypothesized that dendritic cells which are implicated in PCA pathogenesis can provide a reliable histopathological clue to distinguish between these two entities.Material and methodsIn a retrospective cohort study including 51 patients diagnosed with LPP and DLE we mapped and quantified the distribution of dendritic cells. Cell count in lesional skin was performed on immunohistochemistry by using characteristic monoclonal antibodies to specific subpopulations of dendritic cells.ResultsWe demonstrated that almost all subpopulations of dendritic cells were highly expressed in lesional skin of discoid lupus erythematosus patients in comparison with lichen planopilaris ones.ConclusionsIn the light of this observation, dendritic cells might be used as an additional clue in differential diagnosis of PCA.

The role of interleukin-17 (IL-17) in the pathogenesis of discoid lupus erythematosus and lichen planopilaris: is immunohistochemistry for IL-17 a promising way to differentiate these entities?

Interleukin-17 (IL-17) is a pro-inflammatory mediator which its excess secretion by immune cells is found in many chronic autoimmune diseases. This survey is aimed to compare the amount and pattern of distribution of IL-17 positive cells in lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) which are of the most frequent causes of primary cicatricial alopecia (CA). Biopsies of lesional scalp skin from adult LPP (n = 30), DLE patients (n = 19), and control scalp skin (n = 18) were analyzed by immunohistochemistry (IHC) method using rabbit polyclonal antibody against IL-17. Cells stained positive for IL-17 and their pattern of distribution were assessed and compared between these groups. The mean of IL-17 positive cell counts per high power field (HPF) in both LPP and DLE groups was significantly higher in comparison with the control group (both p < .0001). The LPP group had higher values of IL-17 positive cell counts per HPF (47.56 ± 13.37) compared to the DLE group (22.21 ± 11.06) (p < .0001). More than 30 IL-17 positive cell counts in IHC have a sensitivity of 90% and a specificity of 78% for differentiating LPP from DLE. Our findings suggest that IL-17 is effective in the pathogenesis of DLE and LPP and its role is more prominent in LPP. IL-17 positive cells in IHC can distinguish DLE from LPP with satisfactory sensitivity and specificity.

S2k guideline: Diagnosis and management of cutaneous lupus erythematosus - Part1: Classification, diagnosis, prevention, activity scores.

S2k guideline: Diagnosis and management of cutaneous lupus erythematosus - Part1: Classification, diagnosis, prevention, activity scores.

Clinical-therapeutic study on the efficacy and safety of thalidomide in the management of discoid lupus erythematosus. A single-centre, retrospective study.

Thalidomide is a second-line treatment for discoid lupus erythematosus (DLE). The efficacy of this treatment, the minimum effective doses, and safety is poorly documented in the literature. The aim of the study was to determine the efficacy and tolerance of thalidomide as first or second line of therapy for discoid lupus erythematosus. We present a retrospective single-centre study of 68 patients with DLE treated with thalidomide from 2003 to 2019. The inclusion criteria were the presence of clinical lesions suggestive of DLE, confirmed by histological examination and direct immunofluorescence. The mean age at diagnosis was 37.45years (range 18-65years). Thalidomide was started an average of 2.25years after the diagnosis of DLE, as second-line therapy in 85% of the cases (58 patients), and as first-line therapy in 10 patients (15%). Fifty-six patients improved with thalidomide (82%), 39 cases achieved complete remission and 17 partial remissions. The mean duration of follow-up with thalidomide was 8.4months (range 3-25months). Five patients discontinued thalidomide due to adverse events. The most frequent side effect was headache (23.5%). Thalidomide is effective and safe in DLE patients as first or second-line treatment with a good safety profile.

Variability of the rs333 in Polish patients with lupus erythematosus.

IntroductionLupus erythematosus (LE) is an autoimmune disease with a strong influence of genetic and environmental factors. C-C motif chemokine receptor 5 (CCR5) gene expression may affect the development and intensity of LE.AimTo evaluate the possible association between the 32bp deletion in rs333 locus located within the CCR5 gene and the development of LE or the occurrence of various clinical symptoms in the course of the disease.Material and methodsOne hundred and twenty patients with LE (77 with systemic lupus erythematosus (SLE) and 43 with discoid lupus erythematosus (DLE)) and 100 healthy controls from the Polish population were genotyped for deletion in rs333.Results32 bp deletion in the rs333 was significantly more frequent among healthy individuals than DLE patients. Moreover, heterozygotes and homozygotes with deletion in rs333 were significantly more frequent within the control group than the group of patients with discoid lupus erythematosus. In contrast, any statistically significant differences in allele or genotype frequencies between healthy persons and SLE patients were observed. Furthermore, nucleotide sequence variability of rs333 was not associated with certain clinical symptoms of LE patients.ConclusionsDeletion in the rs333 might be a protective factor for DLE, but not SLE in the Polish population. Nevertheless further studies performed on larger populations are needed to confirm these observations.

Focal alopecia in parietal area in adult women — assessment of usefulness of trichoscopy in making a proper diagnosis

Introduction. Focal alopecia in the parietal area is one of the types of hair loss that can be found in dermatological practice. Trichoscopy is a non-invasive and easily accessible diagnostic method widely used in scalp disorders.Aim. The aim of this study was to assess the usefulness of trichoscopy in the non-invasive diagnosis of focal hair loss in adult women.Material and Methods. The study included 40 adult women. The study group consisted of 30 patients including 10 patients with alopecia areata (AA), 10 patients with discoid lupus erythematosus (DLE) and 10 with classical form of lichen planopilaris (LPP). The control group consisted of 10 healthy volunteers. Four groups of structures observed in trichoscopic examination were evaluated: hair follicle openings, hair shafts, vessels, perifollicular and interfollicular skin surface. Results. Among patients with AA the most frequently observed trichoscopic structures were: yellow dots in 100% (10/10), broken hairs in 90% (9/10), hairs resembling exclamation marks in 90% (9/10). DLE patients most often presented white / white-pink structureless areas and prominent, interfollicular scaling in 100% (10/10) and 90% (9/10) of cases, respectively. On the other hand, in the group of patients with LPP, the most frequent findings were: fine perifollicular scaling in 100% (10/10) and linear, slightly branched vessels arranged concentrically around the follicular openings - both features observed also in 100% (10/10) of cases.Conclusion. Trichoscopy as a non-invasive diagnostic method may be helpful in differentiating non-scarring and scarring alopecia in the parietal area in women. Moreover, there are some trichoscopic features typical for AA, DLE and LPP, which allow for differentiation and facilitate the diagnosis of these entities.

Demodex positive discoid lupus erythematosus: Is it a separate entity or an overlap syndrome?

Discoid lupus erythematosus (DLE) is a chronic inflammatory erythematous skin disease that can be triggered by several factors. Rosacea is another skin disease that causes facial redness and tenderness. Demodex mites have been reported in rosacea and DLE patients commonly in the literature. These two diseases can be seen concomitant, mimic each other clinically and share common possible etiologic factors. To assess demodex mite infestation in both clinical and histopathological findings in DLE patients. We retrospectively evaluated the files of 42 patients with DLE who had been diagnosed DLE based on clinical and histopathological findings between August 2018 and August 2019. Demodex positivity was detected 50% of patients (n = 21). Neutrophile percentages in the dermal and perivascular area were higher in the demodex positive patients (4.43%) than in the Demodex negative patients (2.19%). The intensity of demodex mites correlated positively with dermal neutrophile percentages. ANA was negative in 29 patients (69%) and positive in 13 patients (31%). Anti-dsDNA was negative in serology and follicular plugging was positive in histopathology in all 42 patients (100%). This was a retrospective study. DLE and rosacea share common features in etiopathogenesis and clinical presentation. Inflammation and exacerbations caused by the demodex mites may increase the clinical severity of DLE. Although the position of demodex mites in DLE etiopathogenesis is not known exactly, the presence of high demodex in DLE patients has been determined. Standard skin surface biopsy can be a routine procedure for the evaluation of DLE patients in daily clinical practice.

Do lncRNAs and circRNAs expression profiles influence discoid lupus erythematosus progression?-a comprehensive analysis.

Long noncoding RNAs (lncRNAs) and circular RNAs (circRNAs)are involved in the progression of discoid lupus erythematosus (DLE), but an understanding of their underlying mechanisms remains elusive. To explore the expression profiles of lncRNAs and circRNAs in DLE, we surveyed the lncRNA/circRNA and mRNA expression profiles in the epithelia of oral DLE and adjacent normal tissues. The lesional and non-lesional lower lips of three DLE patients were analysed by RNA-sequencing (RNA-seq). The principal functions of the significantly deregulated genes were identified using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. And the correlated expression networks (coding-noncoding co-expression and lncRNAs-transcription factor-mRNA) were evaluated as well. Hundreds of significantly changed lncRNAs and mRNAs and dozens of significantly changed circRNAs were identified. lncRNA lnc-MIPOL1-6 and IncRNA IncDDX47-3 expressions were correlated with immune response-related genes, including IL19, CXCL1, CXCL11, and TNFSF15. Up-regulated IncRNA-TF network consists of 8 TFs and 74 related lncRNAs. The lncRNA-TF-gene trans-regulation consisting of 204 lncRNAs,39 TFs, and correlated 3 genes. These results demonstrate that lncRNAs and circRNAs can influence the progression of DLE. Certain mRNAs/lncRNAs/circRNAs may have substantial value in DLE diagnosis and therapy.

Mean platelet volume and platelet distribution width levels in discoid lupus erythematosus patients: A case-control study

Aim: Platelets (PLT) play an important role in inflammatory reactions and immune responses. This study aims to evaluate PLT and PLT parameters in patients with discoid lupus erythematosus (DLE), which is characterized by inflammation. Methods: In this case-control study, a total of 125 participants, consisting of 60 DLE patients and 65 healthy controls, were selected to participate. PLT, platelet distribution width (PDW), mean platelet volume (MPV), plateletcrit (PCT), the ratio of neutrophils to lymphocytes (NLR) and the ratio of platelets to lymphocytes (PLR) were studied retrospectively in both groups. Results: The mean age of the patient group was 47.30 (15.14) years, and the mean age of the control group was 38.08 (13.33) years. There were no statistically significant differences between the PLT, PDW, MPV, PCT, NLR and PLR levels in DLE patients and healthy controls (P=0.365, P=0.988, P=0.160, P=0.851, P=0.898 and P=0.887, respectively). Conclusion: To the best of our knowledge, there are no reports on both PLT, PDW, PCT, NLR, PLR and MPV in patients with DLE. We did not find a significant difference in the DLE group. PLT parameters are low-cost tests that can be used to define inflammation levels in inflammatory diseases. Further prospective studies on this subject will contribute to this work.

A study of the histopathological features of alopecias on transverse sections of scalp biopsies

Background:Transverse sections of scalp biopsies are performed for the assessment of alopecias and are considered advantageous over vertical sections.Aim:The aim was to study the histopathological features of alopecias on transverse sections of scalp biopsies.Methods:It was a descriptive study. Clinically confirmed cases of noncicatricial and cicatricial alopecias were subjected to 4 mm scalp biopsies, which were sectioned transversely and analyzed. Biopsies obtained from occipital region of androgenetic alopecia (AGA) cases were taken as controls.Results:Biopsies from 41 cases were assessed, including male and female AGA, alopecia areata (AA), trichotillomania, lichen planopilaris (LPP), discoid lupus erythematosus (DLE), and folliculitis decalvans (FD). Normal scalp (control) biopsies showed the median total number of hair follicles of 35 (32–37), anagen:telogen/catagen ratio of 17.5 (16.5–31), and terminal:vellus ratio of 15 (10.7–17.5). In AGA and AA, miniaturization and shift toward telogen and catagen hair were consistently observed. Peribulbar inflammation was seen in two-third of AA. Trichotillomania showed increased catagen hair and numerous pigment casts. In DLE, besides perifollicular inflammation, prominent peri-arrector pili and peri-eccrine inflammation were observed. Type of inflammatory infiltrate was similar in DLE and LPP (lymphocytic), whereas FD showed neutrophilic and plasma cell infiltrate, both around follicles and interstitially. Basal cell damage in the follicles and pigment incontinence were seen in majority of DLE and LPP patients. DLE also showed basement membrane thickening, mucin deposition, and telangiectasia. Reduction/absence of sebaceous glands and perifollicular fibrosis were observed in almost all cicatricial alopecias.Conclusion:Transverse sectioning may be a useful tool in the diagnosis of alopecias.

MicroRNA Expression Profiling Identifies miR-31 and miR-485-3p as Regulators in the Pathogenesis of Discoid Cutaneous Lupus

Cutaneous lupus erythematosus is a common and disfiguring manifestation in systemic lupus erythematosus. Subacute cutaneous lupus erythematosus and discoid lupus erythematosus (DLE) are the most prevalent forms. Despite sharing histological similarities, clinically they differ in their course and prognosis, suggesting different pathogenesis. Here, we show that DLE-affected skin has a specific microRNA expression profile when compared with subacute cutaneous lupus erythematosus. Among the DLE-specific microRNAs, we identified one keratinocyte-derived microRNA, miR-31, and one leukocyte-derived microRNA, miR-485-3p. We show that UV and transforming growth factor-β1 stimulation up-regulates miR31 expression in DLE. Specific miR-31 overexpression induces keratinocyte apoptosis and NF-κB pathway activation with the production of related inflammatory cytokines and contributes to the recruitment of neutrophils and intermediate monocytes at the inflammation site. IL-1α and TGF-β1 stimulation increased the expression of miR-485-3p in peripheral mononuclear blood cells from DLE patients and induced T-cell activation, mainly of CD8 lymphocytes. In addition, miR-485-3p overexpression in dermal fibroblasts contributes to fibrosis by targeting peroxisome PGC-1α. Collectively, our findings suggest that overexpression of miR-31 and miR-485-p contribute to skin inflammation in DLE lesions by regulating the production of inflammatory mediators and attracting neutrophils and intermediate monocytes to the skin.

Chronic Inflammation Promotes Skin Carcinogenesis in Cancer-Prone Discoid Lupus Erythematosus

High-risk skin cancer is a rare, but severe, complication associated with discoid lupus erythematosus (DLE). Chronic scar, inflammation, UVR, and immunosuppressive medications are proposed explanations for this heightened skin cancer risk; however, the exact mechanism driving skin carcinogenesis in DLE is unknown. The distinct co-localization of multiple independent skin cancers with areas of active inflammation in two DLE patients followed over 8 years strongly suggested that lupus inflammation promotes skin carcinogenesis in DLE. To investigate this clinical observation, we subjected lupus-prone MRL/lpr and control (MRL/n) mice to a skin carcinogenesis protocol. Skin tumors developed preferentially within the cutaneous lupus inflammation without scarring in MRL/lpr mice (P < 0.01). The inflammation in MRL/lpr skin was characterized by the accumulation of regulatory T cells, mast cells, M2 macrophages, and markedly elevated transforming growth factor-β1 and IL-6 levels, which have been linked to tumor promotion. Tacrolimus treatment reduced skin inflammation and blocked cancer development in MRL/lpr mice (P= 0.0195). A similar tumor-promoting immune environment was detected in SCCs and the perilesional skin of cancer-prone DLE patients. Therefore, discoid lupus inflammation promotes skin cancer in high-risk DLE patients, and blocking the inflammation may be critical for preventing this life-threatening complication of DLE.

Treating lupus patients with antimalarials: analysis of safety profile in a single-center cohort.

This longitudinal retrospective study aims at describing the safety profile and the reasons for discontinuation of antimalarials in patients with systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE), focusing on ocular toxicity. We analyzed the clinical data of 845 SLE and DLE patients; 59% of them were taking antimalarials: 1.4% chloroquine (CQ), 88.5% hydroxychloroquine (HCQ) and 10.1% both. The mean therapy duration was 82.5 ± 77.4 months. At least one side effect was reported by 19.4% of patients, leading to temporary or permanent withdrawal in 9.1% and 10.3% of cases, respectively; 19.3% of patients experienced side effects with HCQ and 8.6% with CQ. In 55.1% of cases, the adverse event was mild or moderate. Ophthalmological alterations were reported by 8.5% but were confirmed by the ophthalmological examination in 5.5% of cases. Retinal alterations were associated with age, disease duration and duration of the antimalarial therapy, but not to drug dose and comorbidities or lupus nephritis. This is the largest monocentric longitudinal study confirming the good safety profile of antimalarials in DLE and SLE patients. The main adverse events during the therapy were mild or moderate, but maculopathy-reported in a low percentage of patients-remains the main cause of treatment withdrawal.