New approaches to the management of cutaneous lupus.

Abstract

Purpose of review: Cutaneous lupus erythematosus (CLE) is a heterogeneous inflammatory skin disease that can be disfiguring and profoundly affect patient quality of life. CLE is frequently challenging to manage and may remain refractory even when systemic disease is well controlled. Currently, no therapies are FDA-approved specifically for isolated CLE. This review summarizes established treatment approaches and highlights emerging targeted therapies informed by recent advances in disease pathogenesis.

Recent findings: Recent studies expand the role of biologics and highlight the promise of additional interferon (IFN)-targeted therapies for the treatment of refractory CLE. Therapies targeting B cells, plasmacytoid dendritic cells, the type I IFN receptor, and downstream pathways - including JAK, TYK2, TLR7/8, and IRAK4 inhibitors - continue to broaden therapeutic options. Importantly, the incorporation of skin-specific outcome measures into systemic lupus erythematosus (SLE) clinical trials has supported the evaluation of cutaneous responses within broader SLE programs, which in turn has expanded the use of newer SLE therapies for CLE. This evolution in trial design may also facilitate future FDA approval pathways for treatments aimed at isolated CLE, an area currently lacking approved therapies.

Summary: A deepening understanding of CLE pathogenesis has yielded multiple promising new treatments for CLE, with targeting of type I IFN and downstream signaling proving especially fruitful.