Modern Therapies for Discoid Lupus Erythematosus: A Narrative Review.

Abstract

Background: Discoid lupus erythematosus (DLE) is the most common chronic form of cutaneous lupus erythematosus and can lead to scarring, dyspigmentation, and permanent alopecia. The disease often causes visible disfigurement and has a substantial psychosocial impact. Although many patients respond to standard treatment, a subset continues to experience persistent or relapsing disease that remains difficult to control.

Methods: A focused literature search was performed using PubMed, Google Scholar, Web of Science, and Scopus to identify English-language studies published from January 1990 through October 2025. Search terms included "discoid lupus erythematosus," "cutaneous lupus erythematosus," "chronic cutaneous lupus," "pathogenesis," "therapy," "antimalarial," "immunosuppressant," "biologic therapy," "JAK inhibitor," "small molecule therapy," and "targeted therapy." Recent clinical trials, consensus guidelines, and review articles were prioritized. Reference lists of key publications were manually screened to capture additional relevant studies.

Results: Current first-line topical pharmacotherapeutic treatment options of DLE include photoprotection, topical corticosteroids, and calcineurin inhibitors for localized disease, and antimalarial therapy as a first-line systemic treatment. For refractory disease, systemic immunosuppressants remain common second-line options. Emerging therapies targeting interferon and cytokine signaling pathways, including anifrolumab, belimumab, and tyrosine kinase (TYK2) inhibitors such as deucravacitinib and the plasmacytoid dendritic cell modulators litifilimab and daxdilimab have shown early promise in improving cutaneous disease activity in patients with refractory DLE. Procedural modalities such as laser therapy are being studied as adjuncts for scarring and dyspigmentation.

Conclusions: Ongoing advances in understanding the immune mechanisms underlying DLE are shaping a transition from broad immunosuppression toward more targeted treatment strategies. Integrating newer biologic and small-molecule therapies with conventional management may offer improved control and better long-term outcomes for patients with chronic disease.