LAUSR

can be recalcitrant. The first line of therapy usually includes topical or intralesional steroids, which tend to provide only partial or temporary resolution and fail to prevent recurrence. Many patients, especially those with disfiguring lesions, will have to undergo systemic treatment, including methotrexate, hydroxychloroquine, and cyclosporine. There are reports of therapeutic benefit with the tumor necrosis factor-a inhibitors infliximab and adalimumab. Bachelez et al. observed improvement in 10 out of 12 patients with minocycline and doxycycline after a median treatment duration of 12 months. Surgical resection and the CO2 laser may be tried when other treatments have failed, particularly for disfiguring lesions, but the resulting scar may be objectionable if located on the central face. Long-term follow-up by an internist, a pulmonologist, and an ophthalmologist is recommended, as well as a dermatologist, who will not only treat the skin lesions but will also monitor patients for possible emerging neoplasms.