CUTANEOUS LUPUS ERYTHEMATOSUS: THERAPEUTIC STRATEGIES

Abstract

Cutaneous lupus erythematosus (CLE) is an autoimmune disease with a spectrum of manifestations ranging from exclusively cutaneous lesions to components of systemic lupus erythematosus (SLE). Therapeutic management aims to control disease activity and prevent damage, significantly impacting quality of life. This narrative review analyzes current and emerging therapeutic strategies for CLE. First-line treatment is based on general measures, such as rigorous photoprotection and smoking cessation, combined with topical therapies, including corticosteroids and calcineurin inhibitors. Systemically, antimalarials, such as hydroxychloroquine (HCQ), remain the cornerstone of treatment, being the only ones, along with glucocorticoids, approved by the FDA for this condition. In refractory cases or to facilitate corticosteroid withdrawal, second- and third-line agents such as methotrexate, retinoids, dapsone, and mycophenolate mofetil (MMF) are frequently used. Recent advances in understanding the pathogenesis of SLE, highlighting the central role of the type I interferon (IFN) pathway, plasmacytoid dendritic cells (pDCs), and B cells, have driven the development of targeted therapies. Biologics such as anifrolumab (anti-IFNAR) and belimumab (anti-BAFF), approved for SLE, have demonstrated significant efficacy in cutaneous outcomes (CLASI). Furthermore, new molecules such as litifilimab (anti-BDCA2, targeting pDCs) and small molecule inhibitors such as deucravacitinib (TYK2 inhibitor) have shown robust results in recent clinical trials, representing a promising new frontier for the treatment of SLE.