Advancements in the Treatment of Cutaneous Lupus Erythematosus and Dermatomyositis: A Review of the Literature

Elhage, Kareem; Zhao, Raymond; Nakamura, Mio

doi:10.2147/ccid.s382628

Cited by 5 publications

(7 citation statements)

References 76 publications

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“…A pesquisa sugere que a fisiopatologia das lesões de LEC está ligada à produção aberrante de interferon tipo I (IFN). Portanto, terapias biológicas que visam seu receptor, como o anifrolumabe, mostram-se promissoras para o tratamento do LEC 12 .…”

Section: Discussionunclassified

O acometimento cutâneo do Lúpus Eritematoso e as principais estratégias utilizadas para seu tratamento

Gonçalves,

Bastos,

Frattari

et al. 2024

Braz. J. Hea. Rev.

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O lúpus eritematoso é uma doença autoimune com manifestações clínicas diversas, sendo que o acometimento cutâneo pode se manifestar como uma condição exclusivamente de pele, lúpus eritematoso cutâneo (LEC), ou como parte das várias apresentações do lúpus eritematoso sistêmico (LES). As lesões cutâneas causadas pela doença podem ter um impacto significativo na qualidade de vida dos pacientes, principalmente devido à sua persistência crônica e às sequelas desfigurantes que podem resultar delas. Nesse contexto, as abordagens terapêuticas atuais podem beneficiar os pacientes, porém persistem várias necessidades não atendidas, incluindo o desenvolvimento de medicamentos mais eficazes e menos tóxicos. O objetivo do presente artigo é revisar a literatura acerca do acometimento cutâneo do lúpus eritematoso e as principais estratégias utilizadas para seu tratamento. Realizou-se uma revisão integrativa a partir das bases de dados PubMed, MEDLINE e SciELO, mediante a utilização dos descritores: “Cutaneous lupus erythematosus” e “Cutaneous lupus erythematosus AND treatments”. Foram selecionados 18 artigos nos idiomas português, inglês e espanhol, publicados no período de 2018 a 2023. O desenvolvimento de lúpus eritematoso envolve condições complexas, influenciadas por múltiplos fatores genéticos e ambientais. Em relação aos fatores genéticos, destaca-se o acometimento de genes relacionados à apoptose celular, migração de leucócitos, via do interferon tipo I, cascata de complemento, apresentação de antígenos e produção de anticorpos. Já em relação às influências ambientais, evidencia-se a exposição à radiação ultravioleta (UVA e UVB), o consumo de medicamentos indutores e o tabagismo como possíveis gatilhos. No tratamento, é essencial adotar medidas gerais, como a fotoproteção e a suplementação de vitamina D, além da abstinência ao tabagismo, caso esteja presente. A terapêutica medicamentosa envolve medicamentos tópicos, como corticosteroides tópicos e inibidores da calcineurina, e sistêmicos, como corticosteroides e retinoides sistêmicos, antimaláricos, imunomoduladores, anti-inflamatórios e imunossupressores. Ademais, existem terapias biológicas emergentes, que visam células do sistema imunológico ou moléculas pró-inflamatórias, sendo possível citar a Rituximabe, Belimumabe, BIIB059, Anifrolumabe, AMG 811, Baricitinibe e Ustekinumabe como integrantes de estudos promissores. A percepção do acometimento cutâneo do lúpus eritematoso como uma condição digna de estudo independente é fundamental para pacientes que sofrem de LEC sem LES associado, além daqueles com LES que têm um bom controle da doença, mas enfrentam lesões cutâneas resistentes ao tratamento. Dessa forma, a compreensão aprofundada das melhores abordagens terapêuticas é fundamental para a melhoria da qualidade de vida dos pacientes e o desenvolvimento de diretrizes de tratamento eficazes para essa condição dermatológica.

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Section: Discussionunclassified

O acometimento cutâneo do Lúpus Eritematoso e as principais estratégias utilizadas para seu tratamento

Gonçalves,

Bastos,

Frattari

et al. 2024

Braz. J. Hea. Rev.

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“…Thus, PDE-4 inhibitors may play an important role in the negative and positive regulation of gene expression [8]. In T lymphocytes, both PDE-4 and c-AMP have been reported to be involved in the regulation of their proliferation, expression of TNF-α and other interleukins (IL-2, IL-4 and IL-5) [12]. By cross-linking with T cell membranes (e.g.…”

Section: Inflammation and Pde-4mentioning

confidence: 99%

Advances in the Study of PDE4 Inhibitors in Dermatological Disorders

Jiang,

Wang,

et al. 2024

AJST

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Since the 1980s, phosphodiesterase 4 (PDE-4) has been one of the most prominent targets for the treatment of inflammatory diseases. More recently, a number of synthetic ligands targeting PDE-4 have received more attention in the academic and pharmaceutical communities and are expected to have applications in these diseases. Due to various potential side effects of PDE-4 inhibitors, there are several obstacles to the clinical translation of specific PDE-4 inhibitors from the preclinical to the clinical phase. Therefore, similar to roflumilast in chronic obstructive pulmonary disease, many PDE-4 inhibitors can take up to 30 years or even longer from development to clinical application. This article is a review of the development of PDE-4 inhibitors, such as crisaborole and apremilast, for use in skin disorders.

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“…Moreover, specific treatment protocols are not routinely established, which impacts adapted individualized care that is the optimal aim of treatment. 49,50 Topical corticosteroids are used for limited cutaneous disease, and systemic disease is generally treated with the antimalarial hydroxychloroquine. Cigarette smoking should be discouraged as it interferes with antimalarial efficacy.…”

Section: Lettermentioning

confidence: 99%

“…7,13,48 Photo-protective wear (long sleeves and pants, hats, and gloves) can reduce UVR access to the skin and should be promoted. 49,50 Avoiding the use of photosensitizing drugs in this population is also important. Supplemental vitamin D may be indicated in SLE patients, as vitamin D deficiency is common in those avoiding direct sunlight.…”

Section: Lettermentioning

confidence: 99%

New concepts on abnormal UV reactions in systemic lupus erythematosus and a screening tool for assessment of photosensitivity

Corbin

Christian

Rapp

et al. 2023

Skin Research and Technology

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Systemic lupus erythematosus (SLE) is a multisystem autoimmune recurrent inflammatory condition that most often manifests as a mixture of mucocutaneous, musculoskeletal, and hematologic involvements. SLE is subdivided into acute, subacute, and chronic forms. 1,2 As many as 90% of SLE patients develop mucocutaneous symptoms at some point during the course of their disease, and up to 25% have cutaneous involvement at the time of diagnosis. 1,3 The presentation of mucocutaneous symptoms range in severity and frequency and are often triggered and intensified by ultraviolet radiation (UVR). 3 The resulting cutaneous lesions can occur with or without SLE. 3 SLE can run many courses clinically and as such has a classification that separates the 47 forms that have cutaneous involvement from the overall systemic involvement of the disease. SLE Diagnostic Criteria, as described by the American College of Rheumatology (ACR) and European League Against Rheumatism in 2019, pose the new criteria that appear to have an increased specificity and sensitivity compared to previous diagnostic criteria models. 4 SLE affects 62.2-84.8 per 100 000 in the United States with an estimated prevalence of 4.6-5.6 per 100 000 per year. 2 SLE is 3-4× more prevalent in Black women, 1.5-2× more likely in Asian and Hispanic women than in White women, with evidence that there are disparities due socioeconomic factors that play a role in the diagnosis and treatment of SLE. 5,6 Black women tend to develop SLE earlier in life and have a higher mortality rate. 6 The risk for skin damage is higher in Black people with lupus than in Whites and Hispanics. 6,7 The incidence of cutaneous lupus erythematosus (CLE) is 4 cases per 100 000, and the prevalence is 73 cases per 100 000 persons. 8 SLE is not a reportable diagnosis, and thus, it is likely that number of people with this condition is greater than estimated.Broadly, photosensitivity (PSN) is an abnormal reaction to sunlight/UVR exposure that leads to a rash or lesion formation as determined by a practitioner. Photosensitivity is one of the 11 classification criteria for SLE, and the ACR defines it as "a skin rash as a result of unusual reaction to sunlight." Between 23% and 83% of patients with SLE are reported to be sensitive to UVR. 3 True photosensitive reactions to UVR can occur up to 3 weeks after exposure and may present with fatigue and arthralgias. 2,3 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Advancements in the Treatment of Cutaneous Lupus Erythematosus and Dermatomyositis: A Review of the Literature

Cited by 5 publications

References 76 publications

O acometimento cutâneo do Lúpus Eritematoso e as principais estratégias utilizadas para seu tratamento

O acometimento cutâneo do Lúpus Eritematoso e as principais estratégias utilizadas para seu tratamento

Advances in the Study of PDE4 Inhibitors in Dermatological Disorders

New concepts on abnormal UV reactions in systemic lupus erythematosus and a screening tool for assessment of photosensitivity

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