Guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus

Lu, Qianjin; Long, Hai; Chow, Sam; Hidayat, Syarief; Danarti, Retno; Listiawan, Yulianto; Deng, Di; Guo, Qing; Fang, Hong; Tao, Juan; Zhao, Ming; Xiang, Leihong; Che, Nan; Li, Fen; Zhao, Hongjun; Lau, Chak Sing; Ip, Fong Cheng; Ho, King Man; Paliza, Arnelfa C.; Chan, Vicheth; Godse, Kiran; Cho, Soyun; Seow, Chew Swee; Miyachi, Yoshiki; Khang, Tran Hau; Ungpakorn, Rataporn; Galadari, Hassan; Shah, Rachit D.; Yang, Kehu; Zhou, Youwen; Selmi, Carlo; Sawalha, Amr H.; Zhang, Xuan; Chen, Yaolong; Lin, Chrang-Shi

doi:10.1016/j.jaut.2021.102707

Cited by 51 publications

(45 citation statements)

References 136 publications

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“…26 CCLE is notable for demonstrating a chronic, recurrent disease course which typically requires longterm treatment with potential for progression to involve internal organs. 27,28 DLE is the most common subtype of CCLE representing 50% of cases. 28 DLE is considered localized if it involves exclusively the head and neck area while generalized DLE extends below the neck with a predilection for the upper extremity extensor surfaces.…”

Section: Le Specific Skin Diseasementioning

confidence: 99%

“…1 Up to 50% of patients with SCLE meet diagnostic criteria for SLE but systemic symptoms are typically arthritis/arthralgias, malaise and myalgias, with internal organ involvement such as renal or nervous system disease occurring in <10%. 4,27 70% of patients with SCLE are anti-Ro (SSA) positive and 70-80% are ANA positive. 34 Children of women who have SSA or SSB antibodies during pregnancy should be carefully monitored as they are at increased risk of neonatal lupus erythematosus.…”

Section: Subacute Cutaneous Lupus Erythematosusmentioning

confidence: 99%

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Cutaneous Involvement in Systemic Lupus Erythematosus: A Review for the Rheumatologist

2022

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The majority of patients with systemic lupus erythematosus (SLE) have cutaneous manifestations at some point in their disease. The skin findings in lupus erythematosus are classified as lupus-specific or lupus-nonspecific based on histopathologic findings. Lupus-specific skin diseases include chronic cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and acute cutaneous lupus erythematosus. There are subsets of skin lesions within each group and the likelihood of associated SLE varies amongst them. Lupus nonspecific lesions are more common in patients with SLE and tend to coincide with active systemic disease. Lupus nonspecific lesions may be seen as a feature of another disease process, including other connective tissue diseases. It is important for the rheumatologist to be familiar with the spectrum of cutaneous disease in lupus erythematosus to help prognosticate the likelihood of systemic disease and ensure patients receive timely dermatologic care with the goal of controlling disease activity to prevent damage.

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Section: Le Specific Skin Diseasementioning

confidence: 99%

Section: Subacute Cutaneous Lupus Erythematosusmentioning

confidence: 99%

Cutaneous Involvement in Systemic Lupus Erythematosus: A Review for the Rheumatologist

2022

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“…Current screening recommendations suggest monitoring patients for various lab abnormalities and clinical symptoms included in the lupus classification criteria sets, including the development of hematological abnormalities, autoantibodies including anti-nuclear antibodies (ANA) and double-stranded DNA (dsDNA) antibodies, and signs of joint, kidney or neurologic involvement ( 6 ). Current standard of care involves checking CLE patients for systemic disease on presentation as well as interval assessments for the development of SLE ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of the Progression of Cutaneous Lupus to Systemic Lupus Erythematosus

2022

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Lupus erythematosus is an autoimmune disease that may manifest in a variety of organs and tissues including the skin, kidney, brain, heart and lung. Many patients present with cutaneous lupus, where disease is often limited to the skin, but are at risk for developing systemic lupus. The objective of our present study is to perform a systematic review of studies that investigated patient cohorts and populations for the occurrence of cutaneous lupus progressing to systemic lupus. Inclusion criteria required that studies present longitudinal data of patients with limited cutaneous lupus erythematosus who were followed for development of systemic lupus erythematosus. Studies were excluded if patients had concurrent diagnosis of SLE, or if they failed to present longitudinal data. Medline and Embase were searched for English language studies using the Ovid platform. A total of 25 adult studies were identified, as well as 8 pediatric studies. The rate of cutaneous to systemic lupus progression ranged between 0% to 42% in the adult studies and 0% to 31% in the pediatric groups. The variability in these rates were due to differences in patient populations, study design, criteria used to diagnose systemic lupus, and follow-up time. Common risk factors associated with systemic lupus erythematosus development including having positive anti-nuclear antibodies, hematologic abnormalities, and higher number of lupus classification criteria at baseline. This study emphasizes the importance for providers to routinely monitor for systemic lupus in patients with cutaneous lupus.

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“…According to current guidelines (7)(8)(9), management of CLE involves a combination of topical and systemic drugs, fairly similar for the different subtypes. Although consensus over the treatment and guidelines have been succeeded over the years, to date, no specific drugs have been approved by the Food and Drug Administration (FDA).…”

Section: Introductionmentioning

confidence: 99%

“…Topical corticosteroids remain the first-line treatment of all CLE subtypes, both in localized and widespread form (7)(8)(9). They should be applied for a short time or intermittently to reduce side effects, such as atrophy, telangiectasia and steroid-induced dermatitis.…”

Section: Introductionmentioning

confidence: 99%

An update on the management of refractory cutaneous lupus erythematosus

et al. 2022

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Management of cutaneous lupus erythematosus (CLE) involves a combination of preventive measures, topical and systemic drugs, fairly similar for the different subtypes. Although guidelines exist, to date, no specific drugs have been specifically licensed for CLE. Antimalarials remain the first-line systemic treatment, but many patients do not respond, making refractory lupus a challenge for clinicians. The choice of alternative medication should be based on effectiveness, safety and cost. Most of the available drugs for CLE have been adapted from systemic lupus erythematosus (SLE) treatment but the existing literature is limited to small studies and evidence often lacks. As knowledge of pathogenesis of both CLE and SLE is improving, promising new therapies are emerging. In this review, we discuss the available medications, focusing on the novelties under development for CLE.

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Guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus

Cited by 51 publications

References 136 publications

Cutaneous Involvement in Systemic Lupus Erythematosus: A Review for the Rheumatologist

Cutaneous Involvement in Systemic Lupus Erythematosus: A Review for the Rheumatologist

A Systematic Review of the Progression of Cutaneous Lupus to Systemic Lupus Erythematosus

An update on the management of refractory cutaneous lupus erythematosus

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