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For: O'Brien JC, Chong BF. Not Just Skin Deep: Systemic Disease Involvement in Patients With Cutaneous Lupus. J Investig Dermatol Symp Proc 2018;18:S69-S74. [PMID: 28941498 DOI: 10.1016/j.jisp.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/02/2016] [Indexed: 11/28/2022]

For:	O'Brien JC, Chong BF. Not Just Skin Deep: Systemic Disease Involvement in Patients With Cutaneous Lupus. J Investig Dermatol Symp Proc 2018;18:S69-S74. [PMID: 28941498 DOI: 10.1016/j.jisp.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/02/2016] [Indexed: 11/28/2022]

Number

Cited by Other Article(s)

Lee V, Sokumbi O, Onajin O. Collagen Vascular Diseases: A Review of Cutaneous and Systemic Lupus Erythematosus, Dermatomyositis, and Distinguishing Features in Skin of Color. Dermatol Clin 2023;41:435-454. [PMID: 37236713 DOI: 10.1016/j.det.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]

Stull C, Sprow G, Werth VP. Cutaneous Involvement in Systemic Lupus Erythematosus: A Review for the Rheumatologist. J Rheumatol 2023;50:27-35. [PMID: 36109075 PMCID: PMC10152495 DOI: 10.3899/jrheum.220089] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 02/08/2023]

Werth VP, Furie RA, Romero-Diaz J, Navarra S, Kalunian K, van Vollenhoven RF, Nyberg F, Kaffenberger BH, Sheikh SZ, Radunovic G, Huang X, Clark G, Carroll H, Naik H, Gaudreault F, Meyers A, Barbey C, Musselli C, Franchimont N. Trial of Anti-BDCA2 Antibody Litifilimab for Cutaneous Lupus Erythematosus. N Engl J Med 2022;387:321-331. [PMID: 35939578 DOI: 10.1056/nejmoa2118024] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]

Abstract

BACKGROUND

Blood dendritic cell antigen 2 (BDCA2) is a receptor that is exclusively expressed on plasmacytoid dendritic cells, which are implicated in the pathogenesis of lupus erythematosus. Whether treatment with litifilimab, a humanized monoclonal antibody against BDCA2, would be efficacious in reducing disease activity in patients with cutaneous lupus erythematosus has not been extensively studied.

METHODS

In this phase 2 trial, we randomly assigned adults with histologically confirmed cutaneous lupus erythematosus with or without systemic manifestations in a 1:1:1:1 ratio to receive subcutaneous litifilimab (at a dose of 50, 150, or 450 mg) or placebo at weeks 0, 2, 4, 8, and 12. We used a dose-response model to assess whether there was a response across the four groups on the basis of the primary end point, which was the percent change from baseline to 16 weeks in the Cutaneous Lupus Erythematosus Disease Area and Severity Index-Activity score (CLASI-A; scores range from 0 to 70, with higher scores indicating more widespread or severe skin involvement). Safety was also assessed.

RESULTS

A total of 132 participants were enrolled; 26 were assigned to the 50-mg litifilimab group, 25 to the 150-mg litifilimab group, 48 to the 450-mg litifilimab group, and 33 to the placebo group. Mean CLASI-A scores for the groups at baseline were 15.2, 18.4, 16.5, and 16.5, respectively. The difference from placebo in the change from baseline in CLASI-A score at week 16 was -24.3 percentage points (95% confidence interval [CI] -43.7 to -4.9) in the 50-mg litifilimab group, -33.4 percentage points (95% CI, -52.7 to -14.1) in the 150-mg group, and -28.0 percentage points (95% CI, -44.6 to -11.4) in the 450-mg group. The least squares mean changes were used in the primary analysis of a best-fitting dose-response model across the three drug-dose levels and placebo, which showed a significant effect. Most of the secondary end points did not support the results of the primary analysis. Litifilimab was associated with three cases each of hypersensitivity and oral herpes infection and one case of herpes zoster infection. One case of herpes zoster meningitis occurred 4 months after the participant received the last dose of litifilimab.

CONCLUSIONS

In a phase 2 trial involving participants with cutaneous lupus erythematosus, treatment with litifilimab was superior to placebo with regard to a measure of skin disease activity over a period of 16 weeks. Larger and longer trials are needed to determine the effect and safety of litifilimab for the treatment of cutaneous lupus erythematosus. (Funded by Biogen; LILAC ClinicalTrials.gov number, NCT02847598.).

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Affiliation(s)

Victoria P Werth From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Richard A Furie From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Juanita Romero-Diaz From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Sandra Navarra From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Kenneth Kalunian From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Ronald F van Vollenhoven From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Filippa Nyberg From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Benjamin H Kaffenberger From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Saira Z Sheikh From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Goran Radunovic From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Xiaobi Huang From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
George Clark From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Hua Carroll From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Himanshu Naik From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Francois Gaudreault From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Adam Meyers From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Catherine Barbey From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Cristina Musselli From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
Nathalie Franchimont From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Northwell Health, Great Neck, NY (R.A.F.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubrián, Mexico City (J.R.-D.); the University of Santo Tomas, Manila, Philippines (S.N.); the University of California, San Diego, La Jolla (K.K.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); Karolinska University Hospital, Stockholm (F.N.); Ohio State University, Columbus (B.H.K.); University of North Carolina at Chapel Hill, Chapel Hill (S.Z.S.); Institute of Rheumatology, University of Belgrade, Belgrade, Serbia (G.R.); Biogen, Cambridge, MA (X.H., G.C., H.C., H.N., F.G., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)

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Kelly BG, Forbes BR, Thiede RM. Late Onset Systemic Lupus Erythematosus Associated with Inverse Discoid Lupus Erythematosus on the Buttock. JAAD Case Rep 2022;24:115-117. [PMID: 35662853 PMCID: PMC9160379 DOI: 10.1016/j.jdcr.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open

Curtiss P, Walker AM, Chong BF. A Systematic Review of the Progression of Cutaneous Lupus to Systemic Lupus Erythematosus. Front Immunol 2022;13:866319. [PMID: 35359921 PMCID: PMC8963103 DOI: 10.3389/fimmu.2022.866319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/21/2022] [Indexed: 01/25/2023] Open

O'Kane D, McCourt C, Meggitt S, D'Cruz DP, Orteu CH, Benton E, Wahie S, Utton S, Hashme M, Mohd Mustapa MF, Exton LS. British Association of Dermatologists guidelines for the management of people with cutaneous lupus erythematosus (CLE) 2021. Br J Dermatol 2021;185:1112-1123. [PMID: 34170012 DOI: 10.1111/bjd.20597] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/28/2022]

Chanprapaph K, Tankunakorn J, Suchonwanit P, Rutnin S. Dermatologic Manifestations, Histologic Features and Disease Progression among Cutaneous Lupus Erythematosus Subtypes: A Prospective Observational Study in Asians. Dermatol Ther (Heidelb) 2020;11:131-147. [PMID: 33280074 PMCID: PMC7859020 DOI: 10.1007/s13555-020-00471-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/21/2020] [Indexed: 01/19/2023] Open

Abstract

Introduction

Cutaneous manifestations are central to the primary diagnosis of systemic lupus erythematosus (SLE). However, information on the clinical, histopathologic, and direct immunofluorescence (DIF) features among subtypes of cutaneous lupus erythematosus (CLE), as well as longitudinal prospective observational study to evaluate the natural history and the progression to SLE, is lacking among Asians. Our objectives are to summarize the differences in the clinical, histopathologic, and DIF characteristics and serological profiles between various subtypes of CLE, and to provide its natural history and the association with disease activity in our Asian population.

Methods

A prospective observational study on CLE patients was performed between May 2016 and May 2020. Patients underwent full physical/dermatologic examination, skin biopsy for histology, and DIF. Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores and laboratory data were evaluated. Time schedule and characteristics for resolution and/or the disease progression to SLE were recorded in subsequent follow-ups.

Results

Of 101 biopsy-proven CLE patients, 25 had acute CLE (ACLE), 8 had subacute CLE (SCLE), 39 had chronic CLE (CCLE) only, 22 had CCLE with SLE, and 7 had LE-nonspecific cutaneous lesions only. Patients with exclusive CLE showed lower female preponderance, serological abnormalities, and correlation to systemic disease. However, when CLE was accompanied with any LE-nonspecific cutaneous manifestations, they were associated with high antinuclear antibody (ANA) titer, renal, hematologic, joint involvement, and greater SLEDAI score. Of 207 biopsy sections, SCLE/CCLE regardless of systemic involvement showed significantly higher percentage of superficial/deep perivascular and perieccrine infiltration than ACLE. On DIF, deposition of multiple immunoreactants was associated with higher systemic disease. Approximately 10% of CLE-only patients later developed SLE but had mild systemic involvement.

Conclusion

Our findings support that each CLE subtype has a diverse and unique character. Comprehensive understanding of the differences among CLE subtypes is important for achieving the correct diagnosis and providing appropriate disease monitoring and management.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13555-020-00471-y.

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Zhou W, Wu H, Zhao M, Lu Q. New insights into the progression from cutaneous lupus to systemic lupus erythematosus. Expert Rev Clin Immunol 2020;16:829-837. [PMID: 32746644 DOI: 10.1080/1744666x.2020.1805316] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]

Hair and Scalp Changes in Cutaneous and Systemic Lupus Erythematosus. Am J Clin Dermatol 2018;19:679-694. [PMID: 29948959 DOI: 10.1007/s40257-018-0363-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]