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Cutaneous Lupus Erythematosus: Progress and Challenges

  • Autoimmunity (TK Tarrant, Section Editor)
  • Published:
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Abstract

Purpose of Review

The review provides an update on the diagnosis, pathogenesis, and treatment of cutaneous lupus erythematosus (CLE).

Recent Findings

Diagnostic challenges exist in better defining CLE as an independent disease distinct from systemic lupus erythematosus with cutaneous features and further classifying CLE based on clinical, histological, and laboratory features. Recent mechanistic studies revealed more genetic variations, environmental triggers, and immunologic dysfunctions that are associated with CLE. Drug induction specifically has emerged as one of the most important triggers for CLE. Treatment options include topical agents and systemic therapies, including newer biologics such as belimumab, rituximab, ustekinumab, anifrolumab, and BIIB059 that have shown good clinical efficacy in trials.

Summary

CLE is a group of complex and heterogenous diseases. Future studies are warranted to better define CLE within the spectrum of lupus erythematosus. Better insight into the pathogenesis of CLE could facilitate the design of more targeted therapies.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hejazi EZ, Werth VP. Cutaneous lupus erythematosus: an update on pathogenesis, diagnosis and treatment. Am J Clin Dermatol. 2016;17:135–46.

    Article  PubMed  Google Scholar 

  2. Okon LG, Werth VP. Cutaneous lupus erythematosus: diagnosis and treatment. Best Pract Res Clin Rheumatol. 2013;27:391–404.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Stannard JN, Kahlenberg JM. Cutaneous lupus erythematosus: updates on pathogenesis and associations with systemic lupus. Curr Opin Rheumatol. 2016;28:453–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Biazar C, Sigges J, Patsinakidis N, Ruland V, Amler S, Bonsmann G, et al. Cutaneous lupus erythematosus: first multicenter database analysis of 1002 patients from the European Society of Cutaneous Lupus Erythematosus (EUSCLE). Autoimmun Rev. 2013;12:444–54.

    Article  PubMed  Google Scholar 

  5. •• Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. European League against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019;78:1151–9. Comment: These are the latest guidelines for classification criteria.

    Article  PubMed  Google Scholar 

  6. Petri M, Orbai AM, Alarcon GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64:2677–86.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Elman SA, Joyce C, Nyberg F, Furukawa F, Goodfield M, Hasegawa M, et al. Development of classification criteria for discoid lupus erythematosus: results of a Delphi exercise. J Am Acad Dermatol. 2017;77:261–7.

    Article  PubMed  Google Scholar 

  8. Samotij D, Szczech J, Kushner CJ, Mowla MR, Danczak-Pazdrowska A, Antiga E, et al. Prevalence of pruritus in cutaneous lupus erythematosus: brief report of a multicenter, multinational cross-sectional study. Biomed Res Int. 2018;2018:3491798.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Albrecht J, Taylor L, Berlin JA, Dulay S, Ang G, Fakharzadeh S, et al. The CLASI (Cutaneous Lupus Erythematosus Disease Area and Severity Index): an outcome instrument for cutaneous lupus erythematosus. J Invest Dermatol. 2005;125:889–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Jolly M, Kazmi N, Mikolaitis RA, Sequeira W, Block JA. Validation of the Cutaneous Lupus Disease Area and Severity Index (CLASI) using physician- and patient-assessed health outcome measures. J Am Acad Dermatol. 2013;68:618–23.

    Article  PubMed  Google Scholar 

  11. Tebbe B, Orfanos C. Epidemiology and socioeconomic impact of skin disease in lupus erythematosus. Lupus. 1997;6:96–104.

    Article  CAS  PubMed  Google Scholar 

  12. Durosaro O, Davis MD, Reed KB, Rohlinger AL. Incidence of cutaneous lupus erythematosus, 1965-2005: a population-based study. Arch Dermatol. 2009;145:249–53.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Drenkard C, Parker S, Aspey LD, Gordon C, Helmick CG, Bao G, et al. Racial disparities in the incidence of primary chronic cutaneous lupus erythematosus in the Southeastern US: the Georgia Lupus Registry. Arthritis Care Res (Hoboken). 2019;71:95–103.

    Article  CAS  Google Scholar 

  14. Petersen MP, Moller S, Bygum A, Voss A, Bliddal M. Epidemiology of cutaneous lupus erythematosus and the associated risk of systemic lupus erythematosus: a nationwide cohort study in Denmark. Lupus. 2018;27:1424–30.

    Article  PubMed  Google Scholar 

  15. Achtman JC, Werth VP. Pathophysiology of cutaneous lupus erythematosus. Arthritis Res Ther. 2015;17:182.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Wenzel J. Cutaneous lupus erythematosus: new insights into pathogenesis and therapeutic strategies. Nat Rev Rheumatol. 2019;15:519–32.

    Article  PubMed  Google Scholar 

  17. Osmola A, Namysl J, Jagodzinski PP, Prokop J. Genetic background of cutaneous forms of lupus erythematosus: update on current evidence. J Appl Genet. 2004;45:77–86.

    PubMed  Google Scholar 

  18. Fischer GF, Pickl WF, Fae I, Anegg B, Milota S, Volc-Platzer B. Association between chronic cutaneous lupus erythematosus and HLA class II alleles. Hum Immunol. 1994;41:280–4.

    Article  CAS  PubMed  Google Scholar 

  19. Pickering MC, Fischer S, Lewis MR, Walport MJ, Botto M, Cook HT. Ultraviolet-radiation-induced keratinocyte apoptosis in C1q-deficient mice. J Invest Dermatol. 2001;117:52–8.

    Article  CAS  PubMed  Google Scholar 

  20. Werth VP, Zhang W, Dortzbach K, Sullivan K. Association of a promoter polymorphism of tumor necrosis factor-alpha with subacute cutaneous lupus erythematosus and distinct photoregulation of transcription. J Invest Dermatol. 2000;115:726–30.

    Article  CAS  PubMed  Google Scholar 

  21. Jarvinen TM, Hellquist A, Koskenmies S, Einarsdottir E, Koskinen LL, Jeskanen L, et al. Tyrosine kinase 2 and interferon regulatory factor 5 polymorphisms are associated with discoid and subacute cutaneous lupus erythematosus. Exp Dermatol. 2010;19:123–31.

    Article  CAS  PubMed  Google Scholar 

  22. Kunz M, Konig IR, Schillert A, Kruppa J, Ziegler A, Grallert H, et al. Genome-wide association study identifies new susceptibility loci for cutaneous lupus erythematosus. Exp Dermatol. 2015;24:510–5.

    Article  CAS  PubMed  Google Scholar 

  23. Renauer P, Coit P, Jeffries MA, Merrill JT, McCune WJ, Maksimowicz-McKinnon K, et al. DNA methylation patterns in naive CD4+ T cells identify epigenetic susceptibility loci for malar rash and discoid rash in systemic lupus erythematosus. Lupus Sci Med. 2015;2:e000101.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Furukawa F, Itoh T, Wakita H, Yagi H, Tokura Y, Norris DA, et al. Keratinocytes from patients with lupus erythematosus show enhanced cytotoxicity to ultraviolet radiation and to antibody-mediated cytotoxicity. Clin Exp Immunol. 1999;118:164–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Toberer F, Sykora J, Gottel D, Hartschuh W, Werchau S, Enk A, et al. Apoptotic signal molecules in skin biopsies of cutaneous lupus erythematosus: analysis using tissue microarray. Exp Dermatol. 2013;22:656–9.

    Article  PubMed  Google Scholar 

  26. Bashir MM, Sharma MR, Werth VP. UVB and proinflammatory cytokines synergistically activate TNF-alpha production in keratinocytes through enhanced gene transcription. J Invest Dermatol. 2009;129:994–1001.

    Article  CAS  PubMed  Google Scholar 

  27. Kahlenberg JM, Thacker SG, Berthier CC, Cohen CD, Kretzler M, Kaplan MJ. Inflammasome activation of IL-18 results in endothelial progenitor cell dysfunction in systemic lupus erythematosus. J Immunol. 2011;187:6143–56.

    Article  CAS  PubMed  Google Scholar 

  28. Wang D, Drenker M, Eiz-Vesper B, Werfel T, Wittmann M. Evidence for a pathogenetic role of interleukin-18 in cutaneous lupus erythematosus. Arthritis Rheum. 2008;58:3205–15.

    Article  CAS  PubMed  Google Scholar 

  29. Nakamura K, Jinnin M, Kudo H, Inoue K, Nakayama W, Honda N, et al. The role of PSMB9 upregulated by interferon signature in the pathophysiology of cutaneous lesions of dermatomyositis and systemic lupus erythematosus. Br J Dermatol. 2016;174:1030–41.

    Article  CAS  PubMed  Google Scholar 

  30. Wenzel J, Worenkamper E, Freutel S, Henze S, Haller O, Bieber T, et al. Enhanced type I interferon signalling promotes Th1-biased inflammation in cutaneous lupus erythematosus. J Pathol. 2005;205:435–42.

    Article  CAS  PubMed  Google Scholar 

  31. Fredi M, Cavazzana I, Quinzanini M, Taraborelli M, Cartella S, Tincani A, et al. Rare autoantibodies to cellular antigens in systemic lupus erythematosus. Lupus. 2014;23:672–7.

    Article  CAS  PubMed  Google Scholar 

  32. Ioannides D, Golden BD, Buyon JP, Bystryn J-C. Expression of SS-A/Ro and SS-B/La antigens in skin biopsy specimens of patients with photosensitive forms of lupus erythematosus. Arch Dermatol. 2000;136:340–6.

    CAS  PubMed  Google Scholar 

  33. • He Y, Sawalha AH. Drug-induced lupus erythematosus: an update on drugs and mechanisms. Curr Opin Rheumatol. 2018;30:490–7. Comment: Drug induced lupus is a common, and commonly overlooked, entity and should be recognized. Many common medications are implicated.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Gronhagen CM, Fored CM, Linder M, Granath F, Nyberg F. Subacute cutaneous lupus erythematosus and its association with drugs: a population-based matched case-control study of 234 patients in Sweden. Br J Dermatol. 2012;167:296–305.

    Article  CAS  PubMed  Google Scholar 

  35. Marano AL, Clarke JM, Morse MA, Shah A, Barrow W, Selim MA, et al. Subacute cutaneous lupus erythematosus and dermatomyositis associated with anti-programmed cell death 1 therapy. Br J Dermatol. 2019;181:580–3.

    Article  CAS  PubMed  Google Scholar 

  36. Liu RC, Sebaratnam DF, Jackett L, Kao S, Lowe PM. Subacute cutaneous lupus erythematosus induced by nivolumab. Australas J Dermatol. 2018;59:e152–4.

    Article  PubMed  Google Scholar 

  37. Michot JM, Fusellier M, Champiat S, Velter C, Baldini C, Voisin AL, et al. Drug-induced lupus erythematosus following immunotherapy with anti-programmed death-(ligand) 1. Ann Rheum Dis. 2019;78:e67.

    Article  PubMed  Google Scholar 

  38. Tarazi M, Aiempanakit K, Werth VP. Subacute cutaneous lupus erythematosus and systemic lupus erythematosus associated with abatacept. JAAD Case Rep. 2018;4:698–700.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Tierney E, Kirthi S, Ramsay B, Ahmad K. Ustekinumab-induced subacute cutaneous lupus. JAAD Case Rep. 2019;5:271–3.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Wehrmann C, Sondermann W, Korber A. Secukinumab-induced subacute-cutaneous lupus erythematosus. Hautarzt. 2018;69:64–6.

    Article  CAS  PubMed  Google Scholar 

  41. Borucki R, Werth VP. Cutaneous lupus erythematosus induced by drugs - novel insights. Expert Rev Clin Pharmacol. 2019:1–8.

  42. Irizarry-Caro JA, Carmona-Rivera C, Schwartz DM, Khaznadar SS, Kaplan MJ, Grayson PC. Brief report: drugs implicated in systemic autoimmunity modulate neutrophil extracellular trap formation. Arthritis Rheumatol. 2018;70:468–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. • Fairley JL, Oon S, Saracino AM, Nikpour M. Management of cutaneous manifestations of lupus erythematosus: a systematic review. Semin Arthritis Rheum. 2019; Comment: Recent extensive review of treatment options.

  44. Company-Quiroga J, Alique-Garcia S, Romero-Mate A. Current insights into the management of discoid lupus erythematosus. Clin Cosmet Investig Dermatol. 2019;12:721–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Wang X, Zhang L, Luo J, Wu Z, Mei Y, Wang Y, et al. Tacrolimus 0.03% ointment in labial discoid lupus erythematosus: a randomized, controlled clinical trial. J Clin Pharmacol. 2015;55:1221–8.

    Article  CAS  PubMed  Google Scholar 

  46. Pothinamthong P, Janjumratsang P. A comparative study in efficacy and safety of 0.1% tacrolimus and 0.05% clobetasol propionate ointment in discoid lupus erythematosus by modified cutaneous lupus erythematosus disease area and severity index. J Med Assoc Thail. 2012;95:933–40.

    Google Scholar 

  47. Barikbin B, Givrad S, Yousefi M, Eskandari F. Pimecrolimus 1% cream versus betamethasone 17-valerate 0.1% cream in the treatment of facial discoid lupus erythematosus: a double-blind, randomized pilot study. Clin Exp Dermatol. 2009;34:776–80.

    Article  CAS  PubMed  Google Scholar 

  48. Kuhn A, Gensch K, Haust M, Schneider SW, Bonsmann G, Gaebelein-Wissing N, et al. Efficacy of tacrolimus 0.1% ointment in cutaneous lupus erythematosus: a multicenter, randomized, double-blind, vehicle-controlled trial. J Am Acad Dermatol. 2011;65:54–64 64.e51–52.

    Article  CAS  PubMed  Google Scholar 

  49. Tzung TY, Liu YS, Chang HW. Tacrolimus vs. clobetasol propionate in the treatment of facial cutaneous lupus erythematosus: a randomized, double-blind, bilateral comparison study. Br J Dermatol. 2007;156:191–2.

    Article  CAS  PubMed  Google Scholar 

  50. Kuhn A, Ruland V, Bonsmann G. Cutaneous lupus erythematosus: update of therapeutic options part I. J Am Acad Dermatol. 2011;65:e179–93.

    Article  PubMed  Google Scholar 

  51. Kuhn A, Aberer E, Bata-Csorgo Z, Caproni M, Dreher A, Frances C, et al. S2k guideline for treatment of cutaneous lupus erythematosus - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol. 2017;31:389–404.

    Article  CAS  PubMed  Google Scholar 

  52. Wozniacka A, Carter A, McCauliffe DP. Antimalarials in cutaneous lupus erythematosus: mechanisms of therapeutic benefit. Lupus. 2002;11:71–81.

    Article  CAS  PubMed  Google Scholar 

  53. Torigoe M, Sakata K, Ishii A, Iwata S, Nakayamada S, Tanaka Y. Hydroxychloroquine efficiently suppresses inflammatory responses of human class-switched memory B cells via Toll-like receptor 9 inhibition. Clin Immunol. 2018;195:1–7.

    Article  CAS  PubMed  Google Scholar 

  54. Yokogawa N, Eto H, Tanikawa A, Ikeda T, Yamamoto K, Takahashi T, et al. Effects of Hydroxychloroquine in patients with cutaneous lupus erythematosus: a multicenter, double-blind, randomized, parallel-group trial. Arthritis Rheum. 2017;69:791–9.

    Article  CAS  Google Scholar 

  55. Chasset F, Arnaud L, Jachiet M, Monfort JB, Bouaziz JD, Cordoliani F, et al. Changing antimalarial agents after inefficacy or intolerance in patients with cutaneous lupus erythematosus: a multicenter observational study. J Am Acad Dermatol. 2018;78:107–114.e101.

    Google Scholar 

  56. Kishi C, Motegi S-i, Yasuda M, Ishikawa O. Therapeutic efficacy and adverse events of hydroxychloroquine administration in Japanese systemic/cutaneous lupus erythematosus patients. J Dermatol. 2018;45:1020–2.

    Article  PubMed  Google Scholar 

  57. Mok CC, Penn HJ, Chan KL, Tse SM, Langman LJ, Jannetto PJ. Hydroxychloroquine serum concentrations and flares of systemic lupus erythematosus: a longitudinal cohort analysis. Arthritis Care Res (Hoboken). 2016;68:1295–302.

    Article  CAS  Google Scholar 

  58. Ugarte A, Porta S, Ríos R, Martinez-Zapico A, Ortego-Centeno N, Agesta N, et al. Combined mepacrine–hydroxychloroquine treatment in patients with systemic lupus erythematosus and refractory cutaneous and articular activity. Lupus. 2018;27:1718–22.

    Article  CAS  PubMed  Google Scholar 

  59. Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 Revision). Ophthalmology. 2016;123:1386–94.

    Article  PubMed  Google Scholar 

  60. Wenzel J, Brahler S, Bauer R, Bieber T, Tuting T. Efficacy and safety of methotrexate in recalcitrant cutaneous lupus erythematosus: results of a retrospective study in 43 patients. Br J Dermatol. 2005;153:157–62.

    Article  CAS  PubMed  Google Scholar 

  61. Islam MN, Hossain M, Haq SA, Alam MN, Ten Klooster PM, Rasker JJ. Efficacy and safety of methotrexate in articular and cutaneous manifestations of systemic lupus erythematosus. Int J Rheum Dis. 2012;15:62–8.

    Article  CAS  PubMed  Google Scholar 

  62. Sadlier M, Kirby B, Lally A. Mycophenolate mofetil and hydroxychloroquine: an effective treatment for recalcitrant cutaneous lupus erythematosus. J Am Acad Dermatol. 2012;66:160–1 author reply 161-162.

    Article  PubMed  Google Scholar 

  63. Gammon B, Hansen C, Costner MI. Efficacy of mycophenolate mofetil in antimalarial-resistant cutaneous lupus erythematosus. J Am Acad Dermatol. 2011;65:717–721.e712.

    Article  CAS  Google Scholar 

  64. Kreuter A, Tomi NS, Weiner SM, Huger M, Altmeyer P, Gambichler T. Mycophenolate sodium for subacute cutaneous lupus erythematosus resistant to standard therapy. Br J Dermatol. 2007;156:1321–7.

    Article  CAS  PubMed  Google Scholar 

  65. Cipriani P, Ruscitti P, Carubbi F, Liakouli V, Giacomelli R. Methotrexate: an old new drug in autoimmune disease. Expert Rev Clin Immunol. 2014;10:1519–30.

    Article  CAS  PubMed  Google Scholar 

  66. Velo-Garcia A, Ntatsaki E, Isenberg D. The safety of pharmacological treatment options for lupus nephritis. Expert Opin Drug Saf. 2016;15:1041–54.

    Article  CAS  PubMed  Google Scholar 

  67. Cortés-Hernández J, Torres-Salido M, Castro-Marrero J, Vilardell-Tarres M, Ordi-Ros J. Thalidomide in the treatment of refractory cutaneous lupus erythematosus: prognostic factors of clinical outcome. Br J Dermatol. 2012;166:616–23.

    Article  PubMed  CAS  Google Scholar 

  68. Wang D, Chen H, Wang S, Zou Y, Li J, Pan J, et al. Thalidomide treatment in cutaneous lesions of systemic lupus erythematosus: a multicenter study in China. Clin Rheumatol. 2016;35:1521–7.

    Article  PubMed  Google Scholar 

  69. Kyriakis KP, Kontochristopoulos GJ, Panteleos DN. Experience with low-dose thalidomide therapy in chronic discoid lupus erythematosus. Int J Dermatol. 2000;39:218–22.

    Article  CAS  PubMed  Google Scholar 

  70. Ordi-Ros J, Cortes F, Cucurull E, Mauri M, Bujan S, Vilardell M. Thalidomide in the treatment of cutaneous lupus refractory to conventional therapy. J Rheumatol. 2000;27:1429–33.

    CAS  PubMed  Google Scholar 

  71. Cesbron E, Bessis D, Jachiet M, Lipsker D, Cordel N, Bouaziz J-D, et al. Risk of thromboembolic events in patients treated with thalidomide for cutaneous lupus erythematosus: a multicenter retrospective study. J Am Acad Dermatol. 2018;79:162–5.

    Article  PubMed  Google Scholar 

  72. Frankel HC, Sharon VR, Vleugels RA, Merola JF, Qureshi AA. Lower-dose thalidomide therapy effectively treats cutaneous lupus erythematosus but is limited by neuropathic toxicity. Inter J Dermatol. 2013;52:1407–9.

    Article  CAS  Google Scholar 

  73. Baret I, De Haes P. Thalidomide: still an important second-line treatment in refractory cutaneous lupus erythematosus? J Dermatol Treat. 2015;26:173–7.

    Article  CAS  Google Scholar 

  74. Tseng S, Pak G, Washenik K, Pomeranz MK, Shupack JL. Rediscovering thalidomide: a review of its mechanism of action, side effects, and potential uses. J Am Acad Dermatol. 1996;35:969–79.

    Article  CAS  PubMed  Google Scholar 

  75. Braunstein I, Goodman NG, Rosenbach M, Okawa J, Shah A, Krathen M, et al. Lenalidomide therapy in treatment-refractory cutaneous lupus erythematosus: histologic and circulating leukocyte profile and potential risk of a systemic lupus flare. J Am Acad Dermatol. 2012;66:571–82.

    Article  CAS  PubMed  Google Scholar 

  76. Cortés-Hernández J, Ávila G, Vilardell-Tarrés M, Ordi-Ros J. Efficacy and safety of lenalidomide for refractory cutaneous lupus erythematosus. Arthritis Res Ther. 2012;14:R265.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  77. Okon L, Rosenbach M, Krathen M, Rose M, Propert K, Okawa J, et al. Lenalidomide in treatment-refractory cutaneous lupus erythematosus: efficacy and safety in a 52-week trial. J Am Acad Dermatol. 2014;70:583–4.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Fennira F, Chasset F, Soubrier M, Cordel N, Petit A, Francès C. Lenalidomide for refractory chronic and subacute cutaneous lupus erythematosus: 16 patients. J Am Acad Dermatol. 2016;74:1248–51.

    Article  PubMed  Google Scholar 

  79. Kindle SA, Wetter DA, Davis MDP, Pittelkow MR, Sciallis GF. Lenalidomide treatment of cutaneous lupus erythematosus: the Mayo Clinic experience. Inter J Dermatol. 2016;55:e431–9.

    Article  CAS  Google Scholar 

  80. van Vollenhoven RF, Hahn BH, Tsokos GC, Wagner CL, Lipsky P, Touma Z, et al. Efficacy and safety of ustekinumab, an IL-12 and IL-23 inhibitor, in patients with active systemic lupus erythematosus: results of a multicentre, double-blind, phase 2, randomised, controlled study. Lancet. 2018;392:1330–9.

    Article  PubMed  Google Scholar 

  81. Furie R, Khamashta M, Merrill JT, Werth VP, Kalunian K, Brohawn P, et al. Investigators ftCS: Anifrolumab, an anti–interferon-α receptor monoclonal antibody, in moderate-to-severe systemic lupus erythematosus. Arthritis Rheum. 2017;69:376–86.

    Article  CAS  Google Scholar 

  82. Furie R, Werth VP, Merola JF, Stevenson L, Reynolds TL, Naik H, et al. Monoclonal antibody targeting BDCA2 ameliorates skin lesions in systemic lupus erythematosus. J Clin Invest. 2019;129:1359–71.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Werth VP, Fiorentino D, Sullivan BA, Boedigheimer MJ, Chiu K, Wang C, et al. Brief report: pharmacodynamics, safety, and clinical efficacy of AMG 811, a human anti–interferon-γ antibody, in patients with discoid lupus erythematosus. Arthritis Rheum. 2017;69:1028–34.

    Article  CAS  Google Scholar 

  84. Szepietowski JC, Nilganuwong S, Wozniacka A, Kuhn A, Nyberg F, van Vollenhoven RF, et al. Phase I, randomized, double-blind, placebo-controlled, multiple intravenous, dose-ascending study of sirukumab in cutaneous or systemic lupus erythematosus. Arthritis Rheum. 2013;65:2661–71.

    CAS  PubMed  Google Scholar 

  85. Stohl W, Schwarting A, Okada M, Scheinberg M, Doria A, Hammer AE, et al. Efficacy and safety of subcutaneous belimumab in systemic lupus erythematosus: a fifty-two–week randomized, double-blind, placebo-controlled study. Arthritis Rheum. 2017;69:1016–27.

    Article  CAS  Google Scholar 

  86. Iaccarino L, Bettio S, Reggia R, Zen M, Frassi M, Andreoli L, et al. Effects of belimumab on flare rate and expected damage progression in patients with active systemic lupus erythematosus. Arthritis Care Res. 2017;69:115–23.

    Article  CAS  Google Scholar 

  87. Parodis I, Gomez A, Frodlund M, Jonsen A, Zickert A, Sjowall C, et al. Smoking reduces the efficacy of belimumab in mucocutaneous lupus. Expert Opin Biol Ther. 2018;18:911–20.

    Article  CAS  PubMed  Google Scholar 

  88. Quelhas da Costa R, Aguirre-Alastuey ME, Isenberg DA, Saracino AM. Assessment of response to B-cell depletion using rituximab in cutaneous lupus erythematosus. JAMA Dermatol. 2018;154:1432–40.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Vital EM, Wittmann M, Edward S, Md Yusof MY, MacIver H, Pease CT, et al. Brief report: responses to rituximab suggest B cell–independent inflammation in cutaneous systemic lupus erythematosus. Arthritis Rheum. 2015;67:1586–91.

    Article  CAS  Google Scholar 

  90. Hofmann S, Leandro M, Morris S, Isenberg D. Effects of rituximab-based B-cell depletion therapy on skin manifestations of lupus erythematosus – report of 17 cases and review of the literature. Lupus. 2013;22:932–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  91. Lowe GC, Henderson CL, Grau RH, Hansen CB, Sontheimer RD. A systematic review of drug-induced subacute cutaneous lupus erythematosus. Br J Dermatol. 2011;164:465–72.

    CAS  PubMed  Google Scholar 

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  1. School of Medicine, Duke University, Durham, NC, 27710, USA

    Amy J. Petty

  2. Department of Dermatology, Duke University, Durham, NC, 27710, USA

    Lauren Floyd, Christopher Henderson & Matilda W. Nicholas

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Petty, A.J., Floyd, L., Henderson, C. et al. Cutaneous Lupus Erythematosus: Progress and Challenges. Curr Allergy Asthma Rep 20, 12 (2020). https://doi.org/10.1007/s11882-020-00906-8

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