Indian Journal of Dermatology
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Table of Contents 
CORRESPONDENCE
Year : 2016  |  Volume : 61  |  Issue : 3  |  Page : 333-334
Author's Reply


Department of Dermatology, Venereology and Leprosy, JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan, India

Date of Web Publication13-May-2016

Correspondence Address:
Swati Gondane
Department of Dermatology, Venereology and Leprosy, JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.182421

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How to cite this article:
Gondane S, Kothiwala R, Dangi S, Meherda A. Author's Reply. Indian J Dermatol 2016;61:333-4

How to cite this URL:
Gondane S, Kothiwala R, Dangi S, Meherda A. Author's Reply. Indian J Dermatol [serial online] 2016 [cited 2021 Nov 28];61:333-4. Available from: https://www.e-ijd.org/text.asp?2016/61/3/333/182421


Sir,

I appreciate the interest shown by the esteemed reader in the article titled “lupus erythematosus panniculitis (LEP) in pregnancy” published in the esteemed journal, Indian Journal of Dermatology, and we are happy to respond to queries raised by him.

  • As per the company package insert of hydroxychloroquine, it crosses the placenta. Data are limited regarding the use of hydroxychloroquine during pregnancy. Hydroxychloroquine should be avoided in pregnancy. It should be noted that the 4-aminoquinolines in therapeutic doses have been associated with central nervous system damage, including ototoxicity (auditory and vestibular toxicity, congenital deafness), retinal hemorrhages, and abnormal retinal pigmentation to the fetus.[1] However, considering the risk-benefit ratio for the prescription of antimalarial drugs, it is recommended that antimalarial drug can be safely administered in pregnant patients of LE. We agree with the reader that hydroxychloroquine sulfate should be continued as there is an increased risk of flares on its discontinuation [2],[3]
  • LEP is now usually accepted as a variant of LE, related more to discoid LE (DLE) than systemic LE (SLE).[4] In our case, the diagnosis of lupus panniculitis was considered on clinical and histopathological grounds. Her antinuclear antibody, anti-double-stranded DNA, anti-Ro/SSA, and anti-La/SSB antibodies were within normal limits and also any lesions of DLE or SLE were not being reported. Serological abnormalities occur when panniculitis is associated with SLE.[4] As antiphospholipid antibody syndrome is commonly associated with SLE, all women with SLE who have recurrent abortions and thrombotic episodes, or who are biological false-positive reactors, should be screened for the lupus anticoagulant.[4] There was no history of recurrent abortions in our case. The patient had LEP in pregnancy without SLE. Considering all above points, we did not screen the patient for antiphospholipid antibody syndrome.


Financial support and sponsorship

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Conflicts of interest

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   References Top

1.
Available from: http://www.products.sanofi.ca/en/plaquenil.pdf. [Last accessed on 2016 Jan 15].  Back to cited text no. 1
    
2.
Nadkar MY, Sonawale A, Desai NK. Lupus and pregnancy. Med Update 2012;22:635-8. Available from: http://www.apiindia.org/pdf/medicine_update_2012/rheumatology_01.pdf. [Last accessed on 2016 Jan 15].  Back to cited text no. 2
    
3.
Clowse ME, Magder L, Witter F, Petri M. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum 2006;54:3640-7.  Back to cited text no. 3
    
4.
Goodfield MJ, Jones SK, Veals DJ. The connective tissue diseases. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 8th ed. Oxford: Wiley-Blackwell; 2010.  Back to cited text no. 4
    




 

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