Treatments for disease damage in cutaneous lupus erythematosus: A narrative review

Abstract

Cutaneous lupus erythematosus (CLE) is an autoimmune photosensitive disorder that affects the skin. CLE lesions can have signs of skin damage including dyspigmentation, scarring, atrophy and/or alopecia. Disease damage secondary to CLE can be cosmetically disfiguring and causes patients significant distress. While many current treatments for CLE focus primarily on reducing inflammation, there are few options for managing disease damage. Providers currently lack strong guidance on managing CLE damage due to the paucity of literature on this topic. Because of this knowledge gap, we aim to provide an overview of what is currently known about the pathogenesis and management of signs of disease damage in CLE. In this narrative review, Pubmed, Ovid Medline, and Google scholar were searched for relevant articles assessing pathogenesis and treatment of disease damage. Therapeutic options for CLE damage, including hyperpigmentation (laser and camouflage), hypopigmentation (melanocyte grafting and camouflage), scarring (laser, dermabrasion, and camouflage), atrophy (filler, fat transplantation, and flap procedures), and scarring alopecia (hair transplantation and camouflage) were identified. We found that investigations of therapeutics for CLE disease damage primarily consist of case reports and small case series. Reported adverse events due to treatment for CLE disease damage range from temporary erythema and discomfort to disease reactivation and pigmentary defects. There are various treatments for disease damage for each sign of disease damage. However, more robust investigations are needed to assess disease pathogenesis and improve treatments of disease damage due to CLE.

Improvement in Cutaneous Lupus Erythematosus After Twenty Weeks of Belimumab Use: A Systematic Review and Meta‐Analysis

“…Cutaneous lupus or CLE is the most common presentation in SLE, and up to 85% of patients with SLE develop cutaneous lupus within the first 2 years of diagnosis (1,39). CLE can have potentially disfiguring implications that lead to psychological distress and anxiety, highlighting the need for urgent diagnosis and prompt initiation of treatment (4). However, the current treatment paradigm, an antimalarial therapy with or without csDMARDs along with topical therapies and sun protection, is ineffective in up to 50% of patients with CLE manifestations of SLE (6).…”

“…CLE is the most common presentation of systemic lupus erythematosus (SLE or lupus), with up to 85% of patients with SLE presenting with CLE, and CLE is more commonly seen in young to middle-aged women (1). Delay in starting treatment or inadequate control of CLE can result in pigmentary changes, alopecia, and scarring that can lead to psychological distress and depression (2)(3)(4). Thus, effective and timely management of CLE is important to prevent irreversible physical disfigurement and to improve the quality of life of such patients.…”

“…CLE is the most common presentation of systemic lupus erythematosus (SLE or lupus), with up to 85% of patients with SLE presenting with CLE, and CLE is more commonly seen in young to middle‐aged women (1). Delay in starting treatment or inadequate control of CLE can result in pigmentary changes, alopecia, and scarring that can lead to psychological distress and depression (2–4). Thus, effective and timely management of CLE is important to prevent irreversible physical disfigurement and to improve the quality of life of such patients.

Our study is the first meta‐analysis of belimumab's efficacy in cutaneous lupus erythematosus (CLE) and highlights the fact that belimumab is an effective adjunct therapy for patients with CLE as a predominant manifestation of systemic lupus erythematosus (SLE). This study highlights the fact that belimumab can take at least 20 weeks to achieve a sustained clinical response in patients with CLE with SLE, and thus the drug should not be prematurely discontinued in such patients. Our findings show that belimumab users face approximately 50% lower odds of experiencing a severe cutaneous flare compared to nonusers. Findings support belimumab as an effective biologic therapy for patients with CLE with SLE, and lay a foundation for future studies to examine the comparative efficacy of belimumab across CLE subtypes.

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Cutaneous lupus erythematosus: a review of etiopathogenic, clinical, diagnostic and therapeutic aspects

“…The use of cosmetic camouflage and hair protheses can hide scars and alopecia, improving patients quality of life and self-esteem. 59 , 62 It is important that patients with CLE be advised to avoid interventions that traumatize the skin, due to the risk of koebnerization. 62 …”

“… 59 , 62 It is important that patients with CLE be advised to avoid interventions that traumatize the skin, due to the risk of koebnerization. 62 …”