What is your approach to patients with SLE who develop a rash after hydroxychloroquine initiation?  

First, I diagnose the type of rash. If it is a severe cutaneous reaction, e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), or if it is a more persistent type of reaction like a lichenoid reaction, I stop hydroxychlor...

From a dermatologist's perspective, I strongly consider that the diagnosis might be dermatomyositis, rather than lupus. Up to 30% of dermatomyositis patients develop a morbilliform drug rash in response to hydroxychloroquine (and DM sine myositis or clinically minimal myositis is frequently misdiagn...

Also, let’s not forget that HCQ can cause skin toxicity: I've seen many follow-up patients on chronic HCQ with the grey discoloration has promoted a dose reduction or discontinuation discussion for some as most RA and on much better med TNF or CSDMARD MTX/Lef equivalent.