# Adjunctive molecular hydrogen therapy for refractory malar rash in systemic lupus erythematosus: A case report with immunological insights.
> 全身性エリテマトーデスにおける難治性蝶形紅斑に対する分子状水素の補助的使用：免疫学的知見を含む症例報告


## Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune condition frequently accompanied by cutaneous manifestations including malar rash. A 27-year-old woman with SLE whose malar rash persisted despite hydroxychloroquine use was reported. Following the addition of oral molecular hydrogen, sustained improvement was observed over several months, encompassing reduced rash severity, diminished fatigue, and better overall well-being. Concurrent immunological assessments revealed an elevation in KLRG1-positive effector T cells, reduced plasmablast activity, stabilization of B-cell exhaustion markers, and declining titers of antinuclear antibody and anti-double-stranded DNA antibody. These findings indicate that molecular hydrogen may modulate systemic immune responses and alleviate cutaneous features in SLE cases resistant to standard pharmacotherapy.

### Mechanism

Molecular hydrogen is proposed to exert anti-inflammatory and immunomodulatory effects by increasing KLRG1-positive effector T cells, suppressing plasmablast activity, stabilizing B-cell exhaustion markers, and reducing autoantibody (ANA and anti-dsDNA) levels, thereby attenuating aberrant immune activation in SLE.

## Bibliographic

- **Authors**: Hsu NS, Lu J, Liu H, Ho YJ, Wang K, Liu FT
- **Journal**: SAGE Open Med Case Rep
- **Year**: 2025
- **PMID**: [40964664](https://pubmed.ncbi.nlm.nih.gov/40964664/)
- **DOI**: [10.1177/2050313X251372755](https://doi.org/10.1177/2050313X251372755)
- **PMC**: [PMC12437174](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437174/)
- **Study type**: human case report
- **Delivery route**: hydrogen-rich water
- **Effect reported**: positive

## Delivery context

Hydrogen-rich water is a low-risk delivery route, but the achievable systemic hydrogen dose is bounded. For clinical applications, inhalation is the most efficient route; inhalation, however, carries explosion risk, and concentration matters (empirical LFL of 10% applies to inhalation environments; high-concentration devices are documented in the Consumer Affairs Agency accident database and are not recommended).

## Safety notes

Hydrogen-rich water is a low-risk delivery route, but the achievable systemic hydrogen dose is bounded. For clinical applications, inhalation is the most efficient route; inhalation, however, carries explosion risk, and concentration matters (empirical LFL of 10% applies to inhalation environments; high-concentration devices are documented in the Consumer Affairs Agency accident database and are not recommended).

See also:
- [Inhalation concentration and LFL / UFL](https://h2-papers.org/en/safety-notes/inhalation-concentration)
- [Consumer Affairs Agency accident cases](https://h2-papers.org/en/safety-notes/accident-cases)
- [Inhalation safety threshold lineage](https://h2-papers.org/en/safety-notes/lineage)

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> **Cite as**: H2 Papers — PMID 40964664. https://h2-papers.org/en/papers/40964664
> **Source**: PubMed PMID [40964664](https://pubmed.ncbi.nlm.nih.gov/40964664/)