What is the most pertinent follow-up for a woman with discoid lupus who did not respond to her current treatment?

In the scenario presented, considering higher immunosuppressive therapy is the most pertinent follow-up for a woman with discoid lupus who has not responded to her current treatment. Discoid lupus erythematosus (DLE) is a chronic condition often managed with medications like corticosteroids, but when a patient fails to respond adequately to initial treatment, it is important to reassess and intensify the immunosuppressive approach.

Higher immunosuppressive therapies, such as antimalarials like hydroxychloroquine, or other immunosuppressive agents like azathioprine or mycophenolate mofetil, can be effective in controlling the disease, especially in cases that do not respond to topical or low-dose systemic corticosteroids. By considering these agents, the healthcare provider aims to achieve better control of the autoimmune process causing the skin lesions.

Corticosteroid dosage adjustments can be part of the management but may not be sufficient for cases of discoid lupus that show no response. Dermatological interventions could be appropriate in some contexts but would typically follow or complement systemic treatment rather than being the primary step in cases where systemic disease management is inadequate. Physical therapy is generally not indicated as a first-line follow-up for a dermatological condition