Update on the use of topical calcineurin inhibitors in cutaneous lupus erythematosus

Abstract

Cutaneous manifestations of lupus erythematosus (CLE) are manifold, presenting with unspecific skin manifestations or well-defined clinical dermatological entities. Their relation to each other as well as to systemic lupus erythematosus is variable, yet diagnostically and therapeutically challenging. Therapeutic decisions have to be based on the activity and distribution as well as the type of skin lesions and the extent of systemic disease. Limited skin manifestations may be amply tackled by topical therapy, so far, mainly relying on corticosteroids. In many cases, however, internal treatment has to be combined by using antimalarials, in addition to strict UV-protection. The advent of topical calcineurin inhibitors has contributed substantially to the armamentarium of external treatment options. By specifically interfering with intracytoplasmic signal transduction to activate the nuclear factor of activated T-cells (NF-AT), they are able to modulate various inflammatory mechanisms. The two available compounds, pimecrolimus and tacrolimus, do not induce the skin atrophy characteristic of corticosteroids. They have been studied in a number of case reports, but only in a few randomized, comparative studies. Both are well-tolerated, but differentially effective in the various subsets of CLE. Further studies are needed to directly compare the two compounds to each other, as well as to topical corticosteroids, before final recommendations can be made.

Treatment of Scarring Alopecia in Discoid Variant of Chronic Cutaneous Lupus Erythematosus With Tacrolimus Lotion, 0.3%

“…11 In contrast to corticosteroids-which nonselectively affect epidermal and dermal cells-topical tacrolimus spares keratinocytes, fibroblasts, and endothelial cells, precluding the more robust adverse effects seen with corticosteroids. 12 Topical tacrolimus ointment has demonstrated mixed success in treating DLE lesions of the face and scalp as outlined in 2 in which a higherpotency tacrolimus ointment, 0.3%, was compounded with clobetasol propionate with a good clinical response. However, the inclusion of a corticosteroid obscures the precise role of tacrolimus and potentially begets a similar adverse effect profile to that of corticosteroids used alone.…”

Lupus erythematosus: considerations about clinical, cutaneous and therapeutic aspects

“…13,29 Histological findings show perivascular and periadnexal lymphocytic infiltrate and the distinctive presence of mucin. Association with SLE is unusual.…”

Therapeutic options for cutaneous lupus erythematosus: recent advances and future prospects

“…With their greatly reduced side-effect profile, the calcineurin inhibitors tacrolimus and pimecrolimus have emerged as effective alternatives to corticosteroids in the topical treatment of CLE [36]. A study of 38 patients showed both tacrolimus and pimecrolimus to be effective in improving symptoms of erythema, desquamation, and edema, independent of disease type [37].…”