An update on the management of refractory cutaneous lupus erythematosus

Abstract

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.

Synthetic Pharmacotherapy for Systemic Lupus Erythematosus: Potential Mechanisms of Action, Efficacy, and Safety

“…EULAR recommends the use of dapsone at a dose of 100 mg per day in patients with BSLE who do not respond to or require high doses of GC [ 309 ]. However, it is common to start with a dose of 50 mg per day, which is titrated according to response and tolerance up to a maximum of 200 mg per day [ 300 , 309 ].…”

Successful treatment of severe chronic cutaneous lupus with anifrolumab: A series of 6 cases

“…Treatment progression with potent immunosuppressants is unfortunately common as many patients are inadequately treated with monotherapy. 7 There is a paucity of clinical trials evaluating therapies specifically for CLE. Most medications used to treat CLE in our current armamentarium have been adapted from SLE treatments.…”