Cutaneous lupus erythematosus (CLE) represents a diverse group of autoimmune diseases with differing clinical, histological and immunological findings.
Consequently, CLE has become an ill-defined disease according to a recent review of the condition by a group from Duke University, Durham, USA.
The article considers the difficulty in making a diagnosis as there are at least four subtypes with an additional barrier being that the precise pathophysiology remains unclear which therefore hinders the develop a specific and effective treatment. Despite this, the authors describe how over the years, a wide range of therapies have been used including topical agents for example, corticosteroids and calcineurin inhibitors and systemic agents such as antimalarials, immunosuppressants, retinoids and thalidomide. In recent years, attention has focused on the use treatment with biologics, in particular belimumab and rituximab although ustekinumab has also been tried. Other biologics include anifrolumab, which targets the type 1 interferon receptor.
The results to date indicate that the biologics show some promise for patients suffering from moderate-to-severe CLE or even systemic lupus erythematosus (SLE) which cutaneous involvement. However, currently none of these treatments are specially licensed for CLE. The authors finish by describing how current studies are underway to target the immune cells and inflammatory pathways involved in the pathogenesis in an effort to develop more targeted treatments in the future.
Petty AJ et al. Cutaneous lupus erythematosus: progress and challenges. Curr Allergy Asthma R. 2020;20:12-22