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American Journal of Clinical Dermatology

Published in:

01-04-2016 | Review Article

Cutaneous Lupus Erythematosus: An Update on Pathogenesis, Diagnosis and Treatment

Authors: Emily Z. Hejazi, Victoria P. Werth

Published in: American Journal of Clinical Dermatology | Issue 2/2016

Abstract

Cutaneous lupus erythematosus (CLE) includes a broad range of dermatologic manifestations, which may or may not be associated with systemic disease. Recent studies in this area continue to shape our understanding of this disease and treatment options. Epidemiologic studies have found an incidence of CLE of 4.30 per 100,000, which approaches similar analysis for systemic lupus erythematosus (SLE). Although there have been extensive efforts to define SLE, the classification of CLE and its subgroups remains a challenge. Currently, diagnosis relies on clinical and laboratory findings as well as skin histology. The Cutaneous Lupus Area and Severity Index™ (CLASI™) is a validated measure of disease activity and damage. CLE pathogenesis is multifactorial and includes genetic contributions as well as effects of ultraviolet (UV) light. Immune dysregulation and aberrant cell signaling pathways through cytokine cascades are also implicated. Patient education and avoidance of triggers are key to disease prevention. Antimalarials and topical steroids continue to be the standard of care; however, immunosuppressants, thalidomide analogs and monoclonal antibodies are possible systemic therapies for the treatment of recalcitrant disease.

Gilliam JN, Sontheimer RD. Distinctive cutaneous subsets in the spectrum of lupus erythematosus. J Am Acad Dermatol. 1981;4(4):471–5.CrossRefPubMed

Pons-Estel GJ, Alarcon GS, Scofield L, Reinlib L, Cooper GS. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum. 2010;39(4):257–68. doi:10.1016/j.semarthrit.2008.10.007.CrossRefPubMedPubMedCentral

Petri M. Epidemiology of systemic lupus erythematosus. Best Pract Res Clin Rheumatol. 2002;16(5):847–58.CrossRefPubMed

Durosaro O, Davis MD, Reed KB, Rohlinger AL. Incidence of cutaneous lupus erythematosus, 1965–2005: a population-based study. Arch Dermatol. 2009;145(3):249–53. doi:10.1001/archdermatol.2009.21.CrossRefPubMedPubMedCentral

Gronhagen CM, Fored CM, Granath F, Nyberg F. Cutaneous lupus erythematosus and the association with systemic lupus erythematosus: a population-based cohort of 1088 patients in Sweden. Br J Dermatol. 2011;164(6):1335–41. doi:10.1111/j.1365-2133.2011.10272.x.CrossRefPubMed

Jarukitsopa S, Hoganson DD, Crowson CS, Sokumbi O, Davis MD, Michet CJ Jr, et al. Epidemiology of systemic lupus erythematosus and cutaneous lupus erythematosus in a predominantly white population in the United States. Arthritis Care Res (Hoboken). 2015;67(6):817–28. doi:10.1002/acr.22502.CrossRefPubMed

McCarty DJ, Manzi S, Medsger TA Jr, Ramsey-Goldman R, LaPorte RE, Kwoh CK. Incidence of systemic lupus erythematosus. Race and gender differences. Arthritis Rheum. 1995;38(9):1260–70.CrossRefPubMed

Chiu YM, Lai CH. Nationwide population-based epidemiologic study of systemic lupus erythematosus in Taiwan. Lupus. 2010;19(10):1250–5. doi:10.1177/0961203310373780.CrossRefPubMed

Mok CC, To CH, Ho LY, Yu KL. Incidence and mortality of systemic lupus erythematosus in a southern Chinese population, 2000–2006. J Rheumatol. 2008;35(10):1978–82.PubMed

10.

Albrecht J, Berlin JA, Braverman IM, Callen JP, Connolly MK, Costner MI, et al. Dermatology position paper on the revision of the 1982 ACR criteria for systemic lupus erythematosus. Lupus. 2004;13(11):839–49.CrossRefPubMed

11.

Petri M, Orbai AM, Alarcon GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64(8):2677–86. doi:10.1002/art.34473.CrossRefPubMedPubMedCentral

12.

Schultz HY, Dutz JP, Furukawa F, Goodfield MJ, Kuhn A, Lee LA, et al. From pathogenesis, epidemiology, and genetics to definitions, diagnosis, and treatments of cutaneous lupus erythematosus and dermatomyositis: a report from the 3rd International Conference on Cutaneous Lupus Erythematosus (ICCLE) 2013. J Investig Dermatol. 2015;135(1):7–12. doi:10.1038/jid.2014.316.

13.

Merola JF, Nyberg F, Furukawa F, Goodfield MJ, Hasegawa M, Marinovic B, et al. Redefining cutaneous lupus erythematosus: a proposed international consensus approach and results of a preliminary questionnaire. Lupus Sci Med. 2015;2(1):e000085. doi:10.1136/lupus-2015-000085.CrossRefPubMedPubMedCentral

14.

Walling HW, Sontheimer RD. Cutaneous lupus erythematosus: issues in diagnosis and treatment. Am J Clin Dermatol. 2009;10(6):365–81. doi:10.2165/11310780-000000000-00000.CrossRefPubMed

15.

Tebbe B, Mansmann U, Wollina U, Auer-Grumbach P, Licht-Mbalyohere A, Arensmeier M, et al. Markers in cutaneous lupus erythematosus indicating systemic involvement. A multicenter study on 296 patients. Acta Derm Venereol. 1997;77(4):305–8.PubMed

16.

Rothfield N, Sontheimer RD, Bernstein M. Lupus erythematosus: systemic and cutaneous manifestations. Clin Dermatol. 2006;24(5):348–62. doi:10.1016/j.clindermatol.2006.07.014.CrossRefPubMed

17.

Fonseca E, Alvarez R, Gonzalez MR, Pascual D. Prevalence of anticardiolipin antibodies in subacute cutaneous lupus erythematosus. Lupus. 1992;1(4):265–8.CrossRefPubMed

18.

Garcia-Martin P, Garcia-Garcia C, Fraga J, Garcia-Diez A. Prevalence of antiphospholipid antibodies in patients with subacute and chronic cutaneous lupus erythematosus. Actas Dermosifiliogr. 2013;104(3):232–8. doi:10.1016/j.ad.2012.10.017.CrossRefPubMed

19.

Albrecht J, Taylor L, Berlin JA, Dulay S, Ang G, Fakharzadeh S, et al. The CLASI (Cutaneous Lupus Erythematosus Disease Area and Severity Index): an outcome instrument for cutaneous lupus erythematosus. J Investig Dermatol. 2005;125(5):889–94. doi:10.1111/j.0022-202X.2005.23889.x.CrossRefPubMedPubMedCentral

20.

Krathen MS, Dunham J, Gaines E, Junkins-Hopkins J, Kim E, Kolasinski SL, et al. The Cutaneous Lupus Erythematosus Disease Activity and Severity Index: expansion for rheumatology and dermatology. Arthritis Rheum. 2008;59(3):338–44. doi:10.1002/art.23319.CrossRefPubMed

21.

Klein R, Moghadam-Kia S, LoMonico J, Okawa J, Coley C, Taylor L, et al. Development of the CLASI as a tool to measure disease severity and responsiveness to therapy in cutaneous lupus erythematosus. Arch Dermatol. 2011;147(2):203–8. doi:10.1001/archdermatol.2010.435.CrossRefPubMedPubMedCentral

22.

Braunstein I, Klein R, Okawa J, Werth VP. The interferon-regulated gene signature is elevated in subacute cutaneous lupus erythematosus and discoid lupus erythematosus and correlates with the Cutaneous Lupus Area And Severity Index score. Br J Dermatol. 2012;166(5):971–5. doi:10.1111/j.1365-2133.2012.10825.x.CrossRefPubMedPubMedCentral

23.

Nabatian AS, Bashir MM, Wysocka M, Sharma M, Werth VP. Tumor necrosis factor alpha release in peripheral blood mononuclear cells of cutaneous lupus and dermatomyositis patients. Arthritis Res Ther. 2012;14(1):R1. doi:10.1186/ar3549.CrossRefPubMedPubMedCentral

24.

Vasquez R, Wang D, Tran QP, Adams-Huet B, Chren MM, Costner MI, et al. A multicentre, cross-sectional study on quality of life in patients with cutaneous lupus erythematosus. Br J Dermatol. 2013;168(1):145–53. doi:10.1111/j.1365-2133.2012.11106.x.CrossRefPubMedPubMedCentral

25.

Jolly M, Kazmi N, Mikolaitis RA, Sequeira W, Block JA. Validation of the Cutaneous Lupus Disease Area and Severity Index (CLASI) using physician- and patient-assessed health outcome measures. J Am Acad Dermatol. 2013;68(4):618–23. doi:10.1016/j.jaad.2012.08.035.CrossRefPubMed

26.

Salphale P, Danda D, Chandrashekar L, Peter D, Jayaseeli N, George R. The study of Cutaneous Lupus Erythematosus Disease Area and Severity Index in Indian patients with systemic lupus erythematosus. Lupus. 2011;20(14):1510–7. doi:10.1177/0961203311418789.CrossRefPubMed

27.

Ishiguro M, Hashizume H, Ikeda T, Yamamoto Y, Furukawa F. Evaluation of the quality of life of lupus erythematosus patients with cutaneous lesions in Japan. Lupus. 2014;23(1):93–101. doi:10.1177/0961203313509293.CrossRefPubMed

28.

Kuhn A, Meuth AM, Bein D, Amler S, Beissert S, Bohm M, et al. Revised Cutaneous Lupus Erythematosus Disease Area and Severity Index (RCLASI): a modified outcome instrument for cutaneous lupus erythematosus. Br J Dermatol. 2010;163(1):83–92. doi:10.1111/j.1365-2133.2010.09799.x.PubMed

29.

Wahie S, McColl E, Reynolds NJ, Meggitt SJ. Measuring disease activity and damage in cutaneous lupus erythematosus. Br J Dermatol. 2011;164(1):221–2. doi:10.1111/j.1365-2133.2010.10072.x (author reply 2–4).CrossRefPubMed

30.

Yu C, Chang C, Zhang J. Immunologic and genetic considerations of cutaneous lupus erythematosus: a comprehensive review. J Autoimmun. 2013;41:34–45. doi:10.1016/j.jaut.2013.01.007.CrossRefPubMed

31.

Osmola A, Namysl J, Jagodzinski PP, Prokop J. Genetic background of cutaneous forms of lupus erythematosus: update on current evidence. J Appl Genet. 2004;45(1):77–86.PubMed

32.

Fischer GF, Pickl WF, Fae I, Anegg B, Milota S, Volc-Platzer B. Association between chronic cutaneous lupus erythematosus and HLA class II alleles. Hum Immunol. 1994;41(4):280–4.CrossRefPubMed

33.

Jarvinen TM, Hellquist A, Koskenmies S, Einarsdottir E, Koskinen LL, Jeskanen L, et al. Tyrosine kinase 2 and interferon regulatory factor 5 polymorphisms are associated with discoid and subacute cutaneous lupus erythematosus. Exp Dermatol. 2010;19(2):123–31. doi:10.1111/j.1600-0625.2009.00982.x.CrossRefPubMed

34.

Lee-Kirsch MA, Gong M, Schulz H, Ruschendorf F, Stein A, Pfeiffer C, et al. Familial chilblain lupus, a monogenic form of cutaneous lupus erythematosus, maps to chromosome 3p. Am J Hum Genet. 2006;79(4):731–7. doi:10.1086/507848.CrossRefPubMedPubMedCentral

35.

Lee-Kirsch MA, Chowdhury D, Harvey S, Gong M, Senenko L, Engel K, et al. A mutation in TREX1 that impairs susceptibility to granzyme A-mediated cell death underlies familial chilblain lupus. J Mol Med. 2007;85(5):531–7. doi:10.1007/s00109-007-0199-9.CrossRefPubMed

36.

Jarvinen TM, Hellquist A, Koskenmies S, Einarsdottir E, Panelius J, Hasan T et al. Polymorphisms of the ITGAM gene confer higher risk of discoid cutaneous than of systemic lupus erythematosus. PLoS One. 2010;5(12):e14212. doi:10.1371/journal.pone.0014212.CrossRef

37.

Lin JH, Dutz JP, Sontheimer RD, Werth VP. Pathophysiology of cutaneous lupus erythematosus. Clin Rev Allergy Immunol. 2007;33(1–2):85–106. doi:10.1007/s12016-007-0031-x.CrossRefPubMed

38.

Kuhn A, Herrmann M, Kleber S, Beckmann-Welle M, Fehsel K, Martin-Villalba A, et al. Accumulation of apoptotic cells in the epidermis of patients with cutaneous lupus erythematosus after ultraviolet irradiation. Arthritis Rheum. 2006;54(3):939–50. doi:10.1002/art.21658.CrossRefPubMed

39.

Reefman E, de Jong MC, Kuiper H, Jonkman MF, Limburg PC, Kallenberg CG, et al. Is disturbed clearance of apoptotic keratinocytes responsible for UVB-induced inflammatory skin lesions in systemic lupus erythematosus? Arthritis Res Ther. 2006;8(6):R156. doi:10.1186/ar2051.CrossRefPubMedPubMedCentral

40.

Bashir MM, Sharma MR, Werth VP. UVB and proinflammatory cytokines synergistically activate TNF-alpha production in keratinocytes through enhanced gene transcription. J Invest Dermatol. 2009;129(4):994–1001. doi:10.1038/jid.2008.332.CrossRefPubMedPubMedCentral

41.

Kuhn A, Wenzel J, Weyd H. Photosensitivity, apoptosis, and cytokines in the pathogenesis of lupus erythematosus: a critical review. Clin Rev Allergy Immunol. 2014;47(2):148–62. doi:10.1007/s12016-013-8403-x.CrossRefPubMed

42.

Kuhn A, Wozniacka A, Szepietowski JC, Glaser R, Lehmann P, Haust M, et al. Photoprovocation in cutaneous lupus erythematosus: a multicenter study evaluating a standardized protocol. J Investig Dermatol. 2011;131(8):1622–30. doi:10.1038/jid.2011.101.CrossRefPubMed

43.

Ruland V, Haust M, Stilling RM, Metze D, Amler S, Ruzicka T, et al. Updated analysis of standardized photoprovocation in patients with cutaneous lupus erythematosus. Arthritis Care Res (Hoboken). 2013;65(5):767–76. doi:10.1002/acr.21867.CrossRefPubMed

44.

Calderon C, Zucht HD, Kuhn A, Wozniacka A, Szepietowski JC, Nyberg F, et al. A multicenter photoprovocation study to identify potential biomarkers by global peptide profiling in cutaneous lupus erythematosus. Lupus. 2015;. doi:10.1177/0961203315596077.

45.

Biazar C, Sigges J, Patsinakidis N, Ruland V, Amler S, Bonsmann G, et al. Cutaneous lupus erythematosus: first multicenter database analysis of 1002 patients from the European Society of Cutaneous Lupus Erythematosus (EUSCLE). Autoimmun Rev. 2013;12(3):444–54. doi:10.1016/j.autrev.2012.08.019.CrossRefPubMed

46.

Li PH, Wong WH, Lee TL, Lau CS, Chan TM, Leung AM, et al. Relationship between autoantibody clustering and clinical subsets in SLE: cluster and association analyses in Hong Kong Chinese. Rheumatology (Oxford). 2013;52(2):337–45. doi:10.1093/rheumatology/kes261.CrossRefPubMed

47.

Fredi M, Cavazzana I, Quinzanini M, Taraborelli M, Cartella S, Tincani A, et al. Rare autoantibodies to cellular antigens in systemic lupus erythematosus. Lupus. 2014;23(7):672–7. doi:10.1177/0961203314524850.CrossRefPubMed

48.

Zahn S, Rehkamper C, Ferring-Schmitt S, Bieber T, Tuting T, Wenzel J. Interferon-alpha stimulates TRAIL expression in human keratinocytes and peripheral blood mononuclear cells: implications for the pathogenesis of cutaneous lupus erythematosus. Br J Dermatol. 2011;165(5):1118–23. doi:10.1111/j.1365-2133.2011.10479.x.CrossRefPubMed

49.

Toberer F, Sykora J, Gottel D, Hartschuh W, Werchau S, Enk A, et al. Apoptotic signal molecules in skin biopsies of cutaneous lupus erythematosus: analysis using tissue microarray. Exp Dermatol. 2013;22(10):656–9. doi:10.1111/exd.12216.CrossRefPubMed

50.

Kanda N, Shimizu T, Tada Y, Watanabe S. IL-18 enhances IFN-gamma-induced production of CXCL9, CXCL10, and CXCL11 in human keratinocytes. Eur J Immunol. 2007;37(2):338–50. doi:10.1002/eji.200636420.CrossRefPubMed

51.

Wang D, Drenker M, Eiz-Vesper B, Werfel T, Wittmann M. Evidence for a pathogenetic role of interleukin-18 in cutaneous lupus erythematosus. Arthritis Rheum. 2008;58(10):3205–15. doi:10.1002/art.23868.CrossRefPubMed

52.

Lin YJ, Wan L, Lee CC, Huang CM, Tsai Y, Tsai CH, et al. Disease association of the interleukin-18 promoter polymorphisms in Taiwan Chinese systemic lupus erythematosus patients. Genes Immun. 2007;8(4):302–7. doi:10.1038/sj.gene.6364387.CrossRefPubMed

53.

Wenzel J, Uerlich M, Worrenkamper E, Freutel S, Bieber T, Tuting T. Scarring skin lesions of discoid lupus erythematosus are characterized by high numbers of skin-homing cytotoxic lymphocytes associated with strong expression of the type I interferon-induced protein MxA. Br J Dermatol. 2005;153(5):1011–5. doi:10.1111/j.1365-2133.2005.06784.x.CrossRefPubMed

54.

Wenzel J, Worenkamper E, Freutel S, Henze S, Haller O, Bieber T, et al. Enhanced type I interferon signalling promotes Th1-biased inflammation in cutaneous lupus erythematosus. J Pathol. 2005;205(4):435–42. doi:10.1002/path.1721.CrossRefPubMed

55.

Fett N, Werth VP. Systemic lupus erythematosus treatment: a guide to photoprotection. CML Rheumatol. 2010;29(2):33–41.

56.

Kuhn A, Gensch K, Haust M, Meuth AM, Boyer F, Dupuy P, et al. Photoprotective effects of a broad-spectrum sunscreen in ultraviolet-induced cutaneous lupus erythematosus: a randomized, vehicle-controlled, double-blind study. J Am Acad Dermatol. 2011;64(1):37–48. doi:10.1016/j.jaad.2009.12.053.CrossRefPubMed

57.

Klein RS, Werth VP, Dowdy JC, Sayre RM. Analysis of compact fluorescent lights for use by patients with photosensitive conditions. Photochem Photobiol. 2009;85(4):1004–10. doi:10.1111/j.1751-1097.2009.00540.x.CrossRefPubMedPubMedCentral

58.

Klein RS, Sayre RM, Dowdy JC, Werth VP. The risk of ultraviolet radiation exposure from indoor lamps in lupus erythematosus. Autoimmun Rev. 2009;8(4):320–4. doi:10.1016/j.autrev.2008.10.003.CrossRefPubMedPubMedCentral

59.

Fenton L, Dawe R, Ibbotson S, Ferguson J, Silburn S, Moseley H. Impact assessment of energy-efficient lighting in patients with lupus erythematosus: a pilot study. Br J Dermatol. 2014;170(3):694–8. doi:10.1111/bjd.12719.CrossRefPubMed

60.

Heine G, Lahl A, Muller C, Worm M. Vitamin D deficiency in patients with cutaneous lupus erythematosus is prevalent throughout the year. Br J Dermatol. 2010;163(4):863–5. doi:10.1111/j.1365-2133.2010.09948.x.CrossRefPubMed

61.

Cutillas-Marco E, Marquina-Vila A, Grant WB, Vilata-Corell JJ, Morales-Suarez-Varela MM. Vitamin D and cutaneous lupus erythematosus: effect of vitamin D replacement on disease severity. Lupus. 2014;23(7):615–23. doi:10.1177/0961203314522338.CrossRefPubMed

62.

Schoindre Y, Jallouli M, Tanguy ML, Ghillani P, Galicier L, Aumaitre O, et al. Lower vitamin D levels are associated with higher systemic lupus erythematosus activity, but not predictive of disease flare-up. Lupus Sci Med. 2014;1(1):e000027. doi:10.1136/lupus-2014-000027.CrossRefPubMedPubMedCentral

63.

Terrier B, Derian N, Schoindre Y, Chaara W, Geri G, Zahr N, et al. Restoration of regulatory and effector T cell balance and B cell homeostasis in systemic lupus erythematosus patients through vitamin D supplementation. Arthritis Res Ther. 2012;14(5):R221. doi:10.1186/ar4060.CrossRefPubMedPubMedCentral

64.

Kuhn A, Ruland V, Bonsmann G. Cutaneous lupus erythematosus: update of therapeutic options part I. J Am Acad Dermatol. 2011;65(6):e179–93. doi:10.1016/j.jaad.2010.06.018.CrossRefPubMed

65.

Kuhn A, Sigges J, Biazar C, Ruland V, Patsinakidis N, Landmann A, et al. Influence of smoking on disease severity and antimalarial therapy in cutaneous lupus erythematosus: analysis of 1002 patients from the EUSCLE database. Br J Dermatol. 2014;171(3):571–9. doi:10.1111/bjd.13006.CrossRefPubMed

66.

Gallego H, Crutchfield CE 3rd, Lewis EJ, Gallego HJ. Report of an association between discoid lupus erythematosus and smoking. Cutis. 1999;63(4):231–4.PubMed

67.

Miot HA, Bartoli Miot LD, Haddad GR. Association between discoid lupus erythematosus and cigarette smoking. Dermatology. 2005;211(2):118–22. doi:10.1159/000086440.CrossRefPubMed

68.

Wahie S, Daly AK, Cordell HJ, Goodfield MJ, Jones SK, Lovell CR, et al. Clinical and pharmacogenetic influences on response to hydroxychloroquine in discoid lupus erythematosus: a retrospective cohort study. J Investig Dermatol. 2011;131(10):1981–6. doi:10.1038/jid.2011.167.CrossRefPubMed

69.

Piette EW, Foering KP, Chang AY, Okawa J, Ten Have TR, Feng R, et al. Impact of smoking in cutaneous lupus erythematosus. Arch Dermatol. 2012;148(3):317–22. doi:10.1001/archdermatol.2011.342.CrossRefPubMedPubMedCentral

70.

Chasset F, Frances C, Barete S, Amoura Z, Arnaud L. Influence of smoking on the efficacy of antimalarials in cutaneous lupus: a meta-analysis of the literature. J Am Acad Dermatol. 2015;72(4):634–9. doi:10.1016/j.jaad.2014.12.025.CrossRefPubMed

71.

Tzung TY, Liu YS, Chang HW. Tacrolimus vs. clobetasol propionate in the treatment of facial cutaneous lupus erythematosus: a randomized, double-blind, bilateral comparison study. Br J Dermatol. 2007;156(1):191–2. doi:10.1111/j.1365-2133.2006.07595.x.CrossRefPubMed

72.

Kuhn A, Gensch K, Haust M, Schneider SW, Bonsmann G, Gaebelein-Wissing N, et al. Efficacy of tacrolimus 0.1 % ointment in cutaneous lupus erythematosus: a multicenter, randomized, double-blind, vehicle-controlled trial. J Am Acad Dermatol. 2011;65(1):54–64, e1–2. doi:10.1016/j.jaad.2010.03.037.

73.

Avgerinou G, Papafragkaki DK, Nasiopoulou A, Arapaki A, Katsambas A, Stavropoulos PG. Effectiveness of topical calcineurin inhibitors as monotherapy or in combination with hydroxychloroquine in cutaneous lupus erythematosus. J Eur Acad Dermatol Venereol. 2012;26(6):762–7. doi:10.1111/j.1468-3083.2011.04161.x.CrossRefPubMed

74.

James JA, Kim-Howard XR, Bruner BF, Jonsson MK, McClain MT, Arbuckle MR, et al. Hydroxychloroquine sulfate treatment is associated with later onset of systemic lupus erythematosus. Lupus. 2007;16(6):401–9. doi:10.1177/0961203307078579.CrossRefPubMed

75.

Frances C, Cosnes A, Duhaut P, Zahr N, Soutou B, Ingen-Housz-Oro S, et al. Low blood concentration of hydroxychloroquine in patients with refractory cutaneous lupus erythematosus: a French multicenter prospective study. Arch Dermatol. 2012;148(4):479–84. doi:10.1001/archdermatol.2011.2558.CrossRefPubMed

76.

Chang AY, Piette EW, Foering KP, Tenhave TR, Okawa J, Werth VP. Response to antimalarial agents in cutaneous lupus erythematosus: a prospective analysis. Arch Dermatol. 2011;147(11):1261–7. doi:10.1001/archdermatol.2011.191.CrossRefPubMedPubMedCentral

77.

Cavazzana I, Sala R, Bazzani C, Ceribelli A, Zane C, Cattaneo R, et al. Treatment of lupus skin involvement with quinacrine and hydroxychloroquine. Lupus. 2009;18(8):735–9. doi:10.1177/0961203308101714.CrossRefPubMed

78.

Wenzel J, Brahler S, Bauer R, Bieber T, Tuting T. Efficacy and safety of methotrexate in recalcitrant cutaneous lupus erythematosus: results of a retrospective study in 43 patients. Br J Dermatol. 2005;153(1):157–62. doi:10.1111/j.1365-2133.2005.06552.x.CrossRefPubMed

79.

Gammon B, Hansen C, Costner MI. Efficacy of mycophenolate mofetil in antimalarial-resistant cutaneous lupus erythematosus. J Am Acad Dermatol. 2011;65(4):717–21. doi:10.1016/j.jaad.2010.08.011.CrossRefPubMed

80.

Kreuter A, Tomi NS, Weiner SM, Huger M, Altmeyer P, Gambichler T. Mycophenolate sodium for subacute cutaneous lupus erythematosus resistant to standard therapy. Br J Dermatol. 2007;156(6):1321–7. doi:10.1111/j.1365-2133.2007.07826.x.CrossRefPubMed

81.

Pisoni CN, Obermoser G, Cuadrado MJ, Sanchez FJ, Karim Y, Sepp NT, et al. Skin manifestations of systemic lupus erythematosus refractory to multiple treatment modalities: poor results with mycophenolate mofetil. Clin Exp Rheumatol. 2005;23(3):393–6.PubMed

82.

Ruzicka T, Sommerburg C, Goerz G, Kind P, Mensing H. Treatment of cutaneous lupus erythematosus with acitretin and hydroxychloroquine. Br J Dermatol. 1992;127(5):513–8.CrossRefPubMed

83.

Al-Mutairi N, Rijhwani M, Nour-Eldin O. Hypertrophic lupus erythematosus treated successfully with acitretin as monotherapy. J Dermatol. 2005;32(6):482–6.CrossRefPubMed

84.

D’Erme AM, Milanesi N, Difonzo EM, Lotti T, Gola M. Treatment of refractory subacute cutaneous lupus erythematosus with oral isotretinoin: a valid therapeutic option. Dermatol Ther. 2012;25(3):281–2. doi:10.1111/j.1529-8019.2012.01461.x.CrossRefPubMed

85.

Kuhn A, Patsinakidis N, Luger T. Alitretinoin for cutaneous lupus erythematosus. J Am Acad Dermatol. 2012;67(3):e123–6. doi:10.1016/j.jaad.2011.10.030.CrossRefPubMed

86.

Klebes M, Wutte N, Aberer E. Dapsone as second-line treatment for cutaneous lupus erythematosus? A retrospective analysis of 34 patients and a review of the literature. Dermatology. 2015. doi:10.1159/000441054.

87.

De Pita O, Bellucci AM, Ruffelli M, Girardelli CR, Puddu P. Intravenous immunoglobulin therapy is not able to efficiently control cutaneous manifestations in patients with lupus erythematosus. Lupus. 1997;6(4):415–7.CrossRefPubMed

88.

Lampropoulos CE, Hughes GR. DP DC. Intravenous immunoglobulin in the treatment of resistant subacute cutaneous lupus erythematosus: a possible alternative. Clin Rheumatol. 2007;26(6):981–3. doi:10.1007/s10067-006-0222-5.CrossRefPubMed

89.

Espirito Santo J, Gomes MF, Gomes MJ, Peixoto L, Pereira SC, Acabado A, et al. Intravenous immunoglobulin in lupus panniculitis. Clin Rev Allergy Immunol. 2010;38(2–3):307–18. doi:10.1007/s12016-009-8162-x.CrossRefPubMed

90.

Ky C, Swasdibutra B, Khademi S, Desai S, Laquer V, Grando SA. Efficacy of intravenous immunoglobulin monotherapy in patients with cutaneous lupus erythematosus: results of proof-of-concept study. Dermatol Rep. 2015;7(1):5804. doi:10.4081/dr.2015.5804.CrossRef

91.

Cortes-Hernandez J, Torres-Salido M, Castro-Marrero J, Vilardell-Tarres M, Ordi-Ros J. Thalidomide in the treatment of refractory cutaneous lupus erythematosus: prognostic factors of clinical outcome. Br J Dermatol. 2012;166(3):616–23. doi:10.1111/j.1365-2133.2011.10693.x.CrossRefPubMed

92.

Frankel HC, Sharon VR, Vleugels RA, Merola JF, Qureshi AA. Lower-dose thalidomide therapy effectively treats cutaneous lupus erythematosus but is limited by neuropathic toxicity. Int J Dermatol. 2013;52(11):1407–9. doi:10.1111/j.1365-4632.2011.05200.x.CrossRefPubMed

93.

Braunstein I, Goodman NG, Rosenbach M, Okawa J, Shah A, Krathen M, et al. Lenalidomide therapy in treatment-refractory cutaneous lupus erythematosus: histologic and circulating leukocyte profile and potential risk of a systemic lupus flare. J Am Acad Dermatol. 2012;66(4):571–82. doi:10.1016/j.jaad.2011.01.015.CrossRefPubMedPubMedCentral

94.

Cortes-Hernandez J, Avila G, Vilardell-Tarres M, Ordi-Ros J. Efficacy and safety of lenalidomide for refractory cutaneous lupus erythematosus. Arthritis Res Ther. 2012;14(6):R265. doi:10.1186/ar4111.CrossRefPubMedPubMedCentral

95.

Manzi S, Sanchez-Guerrero J, Merrill JT, Furie R, Gladman D, Navarra SV, et al. Effects of belimumab, a B lymphocyte stimulator-specific inhibitor, on disease activity across multiple organ domains in patients with systemic lupus erythematosus: combined results from two phase III trials. Ann Rheum Dis. 2012;71(11):1833–8. doi:10.1136/annrheumdis-2011-200831.CrossRefPubMedPubMedCentral

96.

Strand V, Levy RA, Cervera R, Petri MA, Birch H, Freimuth WW, et al. Improvements in health-related quality of life with belimumab, a B-lymphocyte stimulator-specific inhibitor, in patients with autoantibody-positive systemic lupus erythematosus from the randomised controlled BLISS trials. Ann Rheum Dis. 2014;73(5):838–44. doi:10.1136/annrheumdis-2012-202865.CrossRefPubMedPubMedCentral

97.

Ginzler EM, Wallace DJ, Merrill JT, Furie RA, Stohl W, Chatham WW, et al. Disease control and safety of belimumab plus standard therapy over 7 years in patients with systemic lupus erythematosus. J Rheumatol. 2014;41(2):300–9. doi:10.3899/jrheum.121368.CrossRefPubMed

98.

Cobo-Ibanez T, Loza-Santamaria E, Pego-Reigosa JM, Marques AO, Rua-Figueroa I, Fernandez-Nebro A, et al. Efficacy and safety of rituximab in the treatment of non-renal systemic lupus erythematosus: a systematic review. Semin Arthritis Rheum. 2014;44(2):175–85. doi:10.1016/j.semarthrit.2014.04.002.CrossRefPubMed

99.

Vital EM, Wittmann M, Edward S, Md Yusof MY, MacIver H, Pease CT, et al. Brief report: responses to rituximab suggest B cell-independent inflammation in cutaneous systemic lupus erythematosus. Arthritis Rheumatol. 2015;67(6):1586–91. doi:10.1002/art.39085.CrossRefPubMed

100.

Petri M, Wallace DJ, Spindler A, Chindalore V, Kalunian K, Mysler E, et al. Sifalimumab, a human anti-interferon-alpha monoclonal antibody, in systemic lupus erythematosus: a phase I randomized, controlled, dose-escalation study. Arthritis Rheum. 2013;65(4):1011–21. doi:10.1002/art.37824.CrossRefPubMedPubMedCentral

101.

Furie R MJ, Werth V, Khamashta M, Kalunian K, Brohawn P, Illei G, Drappa J, Wang L, Yoo S. Anifrolumab, an anti-interferon alpha receptor monoclonal antibody, in moderate to severe systemic lupus erythematosus (SLE) [abstract]. Arthritis Rheumatol. 2015;67:(suppl 10).

102.

Khamashta MMJ, Werth VP, Furie R, Kalunian K, Illeis GG, Drappas J, Wang L, Greth W. Safety and efficacy of sifilmumab, an anti IFN-alpha monoclonal antibody, in a phase 2b study of moderate to severe systemic lupus erythematosus (SLE) [abstract]. Arthritis Rheum. 2014;66:3530–1 (L4).

Title: Cutaneous Lupus Erythematosus: An Update on Pathogenesis, Diagnosis and Treatment
Authors: Emily Z. Hejazi
Victoria P. Werth
Publication date: 01-04-2016
Publisher: Springer International Publishing
Published in: American Journal of Clinical Dermatology / Issue 2/2016
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI: https://doi.org/10.1007/s40257-016-0173-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cutaneous Lupus Erythematosus: An Update on Pathogenesis, Diagnosis and Treatment

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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