Effective for cutaneous, musculoskeletal, and mild systemic symptoms. Mechanism of action is unknown. Begin 400 mg PO daily for 4 weeks and then taper to maintenance dose. Relapse is frequent with discontinuation of drug, but control can be maintained at a low dose. Having patient view an Ansler grid every day may give an early indication of eye disease.
Topical preparations are effective for cutaneous manifestations.
Low-dose oral prednisone can be used for minor disease activity. Dose should be once daily in a.m. to reduce effect on pituitary-adrenal axis and high dose limited to 4 to 6 weeks if possible. Maintenance should be the lowest possible dose, using alternate-day therapy if possible. IV therapy with methylprednisolone may be needed in particularly severe disease. For severe flare and renal or CNS involvement.