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American Journal of Clinical Dermatology

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Open Access 04-05-2023 | Lupus Erythematosus | Review Article

Cutaneous Lupus Erythematosus: An Update on Pathogenesis and Future Therapeutic Directions

Authors: Dennis Niebel, Luka de Vos, Tanja Fetter, Christine Brägelmann, Jörg Wenzel

Published in: American Journal of Clinical Dermatology | Issue 4/2023

Abstract

Lupus erythematosus comprises a spectrum of autoimmune diseases that may affect various organs (systemic lupus erythematosus [SLE]) or the skin only (cutaneous lupus erythematosus [CLE]). Typical combinations of clinical, histological and serological findings define clinical subtypes of CLE, yet there is high interindividual variation. Skin lesions arise in the course of triggers such as ultraviolet (UV) light exposure, smoking or drugs; keratinocytes, cytotoxic T cells and plasmacytoid dendritic cells (pDCs) establish a self-perpetuating interplay between the innate and adaptive immune system that is pivotal for the pathogenesis of CLE. Therefore, treatment relies on avoidance of triggers and UV protection, topical therapies (glucocorticosteroids, calcineurin inhibitors) and rather unspecific immunosuppressive or immunomodulatory drugs. Yet, the advent of licensed targeted therapies for SLE might also open new perspectives in the management of CLE. The heterogeneity of CLE might be attributable to individual variables and we speculate that the prevailing inflammatory signature defined by either T cells, B cells, pDCs, a strong lesional type I interferon (IFN) response, or combinations of the above might be suitable to predict therapeutic response to targeted treatment. Therefore, pretherapeutic histological assessment of the inflammatory infiltrate could stratify patients with refractory CLE for T-cell-directed therapies (e.g. dapirolizumab pegol), B-cell-directed therapies (e.g. belimumab), pDC-directed therapies (e.g. litifilimab) or IFN-directed therapies (e.g. anifrolumab). Moreover, Janus kinase (JAK) and spleen tyrosine kinase (SYK) inhibitors might broaden the therapeutic armamentarium in the near future. A close interdisciplinary exchange with rheumatologists and nephrologists is mandatory for optimal treatment of lupus patients to define the best therapeutic strategy.

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Title: Cutaneous Lupus Erythematosus: An Update on Pathogenesis and Future Therapeutic Directions
Authors: Dennis Niebel
Luka de Vos
Tanja Fetter
Christine Brägelmann
Jörg Wenzel
Publication date: 04-05-2023
Publisher: Springer International Publishing
Keywords: Lupus Erythematosus
Interferon
Published in: American Journal of Clinical Dermatology / Issue 4/2023
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI: https://doi.org/10.1007/s40257-023-00774-8

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Cutaneous Lupus Erythematosus: An Update on Pathogenesis and Future Therapeutic Directions

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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