Lupus erythematosus

Abstract

Several agents are approved for the treatment of systemic lupus erythematosus (SLE), including the novel monoclonal antibody belimumab, a B lymphocyte stimulator-specific inhibitor. However, no drugs have been licensed specifically for the treatment of skin manifestations of the disease. Therefore, therapeutic agents are applied off-label for patients with cutaneous lupus erythematosus (CLE), mainly based on the experience of experts. Topical corticosteroids are the mainstay of treatment for all different subtypes of the disease, but they are of limited value because of their well-known side effects, such as skin atrophy and telangiectasia. A safe and effective alternative topical treatment for CLE are the calcineurin inhibitors tacrolimus and pimecrolimus. Irrespective of the subtype of the disease, antimalarials, such as hydroxychloroquine or chloroquine, are the first-line systemic treatment for disfiguring and widespread skin manifestations. Systemic steroids can be used additionally in patients with highly acute and severe skin lesions but should be time limited due to the common side effects, such as osteoporosis. In contrast to immunosuppressive agents, such as azathioprine, cyclophosphamide, and cyclosporine, methotrexate has received more attention in the therapeutic management of skin manifestations of the disease. Further second-line treatment includes retinoids, dapsone, and mycophenolate mofetil. Other agents, such as rituximab and ustekinumab, have been used in single cases of therapy-refractory CLE and need to be evaluated in randomized controlled trials.