CUTANEOUS LUPUS ERYTHEMATOSUS: A SYSTEMIC REVIEW TO ITS EPIDEMIOLOGY, PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT

Amit Kumar, Kapil Kumar Verma and Inder Kumar*

ABSTRACT

Information on the etiology of lupus erythematosus has advanced fast in the last decade, bringing with it promising new medicines for the treatment of cutaneous lupus erythematosus (CLE). It is divided into acute, subacute, and chronic subtypes, which are often recognized based on clinical criteria as well as histopathological and laboratory results. Although sunlight has been suspected for decades to play a role in the development of cutaneous lupus erythematosus (CLE), only recent research on the effects of ultraviolet irradiation on the skin of CLE patients has resulted in a more comprehensive model for the disease's pathogenesis. Significant progress has recently been achieved in elucidating the mechanisms involved in their development, allowing for the prediction of future targets for more successful therapies. Individual variables may contribute to the heterogeneity of CLE, and we speculate that the predominant inflammatory signature defined by T cells, B cells, PDCs, a strong lesional type interferon (IFN) response, or combinations of the above may be suitable to predict therapeutic response to targeted treatment. Pretherapeutic histological evaluation of the infiltrate could thus stratify patients with refractory CLE for T-cell-directed therapies (e.g., dapirolizumab pegol), B-cell-directed therapies (e.g., belimumab), PDC-directed therapies (e.g., litiflimab), or IFN-directed therapies (e.g., anifrolumab). This review provides an overview of CLE, including its epidemiology, clinical manifestations, pathophysiology, diagnosis, and available treatments, and concludes with the importance of early intervention.

Keywords: Cutaneous lupus erythematosus (CLE), Pretherapeutic histological evaluation, T-cell-directed therapies, B-cell-directed therapies, PDC-directed therapies, IFN-directed therapies, Refractory CLE.