Significant improvement was observed for oedema and erythema of CLE lesions using 0.1% tacrolimus ointment compared to the vehicle, while no effect was seen on desquamation and hypertrophy as well as on subjective symptoms, such as dysesthesia. How do dermatologists treat lupus on the skin? atrophy, telangiec- Due to the well-known side-effects (e.g. Beyond generalized autoimmunity, more cases are now also being seen secondary to drug-induced CLE, especially as a side effect of novel cancer therapies [ 1 , 2 ]. There is currently no cure for cutaneous lupus. Cutaneous lupus erythematosus (CLE) manifests in about 70% of all patients with systemic lupus erythematosus (SLE) and also can occur without associated SLE. The best clinical improvement was observed in patients with DLE and SCLE; however, seven patients discontinued treatment due to side‐effects. Open trial in 5 cases, High‐dose intravenous immunoglobulin in cutaneous lupus erythematosus, Intravenous immunoglobulin in the treatment of resistant subacute cutaneous lupus erythematosus: a possible alternative, Intravenous immunoglobulin (IVIg) for therapy‐resistant cutaneous lupus erythematosus (LE), Intravenous immunoglobulin for recalcitrant subacute cutaneous lupus erythematosus, Intravenous immunoglobulin in lupus panniculitis, Efficacy of Intravenous Immunoglobulin Monotherapy in Patients with Cutaneous Lupus Erythematosus: Results of Proof‐of‐Concept Study, Intravenous immunoglobulin therapy is not able to efficiently control cutaneous manifestations in patients with lupus erythematosus, SER consensus statement on the use of biologic therapy for systemic lupus erythematosus, New biologic therapy for systemic lupus erythematosus, Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo‐controlled, phase 3 trial, A phase III, randomized, placebo‐controlled study of belimumab, a monoclonal antibody that inhibits B lymphocyte stimulator, in patients with systemic lupus erythematosus, Rituximab in systemic lupus erythematosus and lupus nephritis, Safety and efficacy of rituximab in systemic lupus erythematosus: results from 136 patients from the French AutoImmunity and Rituximab registry, Efficacy and safety of rituximab in moderately‐to‐severely active systemic lupus erythematosus: the randomized, double‐blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial, Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study, A case of subacute cutaneous lupus erythematosus in a patient with mixed connective tissue disease: successful treatment with plasmapheresis and rituximab, Effects of rituximab‐based B‐cell depletion therapy on skin manifestations of lupus erythematosus–report of 17 cases and review of the literature, Refractory subacute cutaneous lupus erythematosus treated with rituximab, Treatment of severe cutaneous lupus erythematosus with a chimeric CD4 monoclonal antibody, cM‐T412, Recombinant interferon alpha 2a is effective in the treatment of discoid and subacute cutaneous lupus erythematosus, Response of discoid and subacute cutaneous lupus erythematosus to recombinant interferon alpha 2a, Possible induction of systemic lupus erythematosus by interferon‐alpha treatment in a patient with a malignant carcinoid tumour, Therapy of cutaneous lupus erythematosus with recombinant interferon alpha‐2a: a case report, Double‐blind, randomized, placebo‐controlled pilot study of leflunomide in systemic lupus erythematosus, Benefits of leflunomide in systemic lupus erythematosus: a pilot observational study, Leflunomide in subacute cutaneous lupus erythematosus ‐ two sides of a coin, Subacute cutaneous lupus erythematosus associated with leflunomide, Subacute cutaneous lupus erythematosus precipitated by leflunomide, Leflunomide‐induced subacute cutaneous lupus erythematosus, Leflunomide‐induced subacute cutaneous lupus erythematosus with erythema multiforme‐like lesions, Severe cutaneous adverse drug reaction to leflunomide: a report of two cases, Phase I, randomized, double‐blind, placebo‐controlled, multiple intravenous, dose‐ascending study of sirukumab in cutaneous or systemic lupus erythematosus, Successful treatment of subacute lupus erythematosus with ustekinumab, Response to ustekinumab in a patient with both severe psoriasis and hypertrophic cutaneous lupus, Apremilast for discoid lupus erythematosus: results of a phase 2, open‐label, single‐arm, pilot study, Fumaric acid ester treatment in cutaneous lupus erythematosus (CLE): a prospective, open‐label, phase II pilot study, Pharmacokinetics, tolerability, and preliminary efficacy of paquinimod (ABR‐215757), a new quinoline‐3‐carboxamide derivative: studies in lupus‐prone mice and a multicenter, randomized, double‐blind, placebo‐controlled, repeat‐dose, dose‐ranging study in patients with systemic lupus erythematosus, To evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics, and clinical efficacy of AMG 811 (anti‐IFN‐gamma) in subjects with discoid lupus erythematosus, Monoclonal antibody against macrophage colony‐stimulating factor suppresses circulating monocytes and tissue macrophage function but does not alter cell infiltration/activation in cutaneous lesions or clinical outcomes in patients with cutaneous lupus erythematosus, Advances in the treatment of cutaneous lupus erythematosus, Journal of the European Academy of Dermatology and Venereology, Angiotensin‐converting enzyme inhibitors: cilazapril, captopril, Calcium channel blockers: diltiazem, verapamil, nifedipine, nitrendipine, Betablockers: oxprenolol, acebutolol; Diuretics: hydrochlorothiazide, spironolactone, Etanercept, infliximab, efalizumab, IFN‐α, leflunomide, Ex vivo expanded human autologous polyclonal regulatory T cells, Phase I, open‐label, dose escalation study, Phase IIa, randomized, placebo‐controlled, double‐blind study, Phase II, randomized, placebo‐controlled, double‐blind study, Phase III, randomized, placebo‐controlled, double‐blind study, Phase I, randomized, placebo‐controlled, double‐blind study, ‘Recommended’→ strong (positive) recommendation, ‘Suggested’ → moderate (positive) recommendation, ‘Not recommended’ → strong (negative) recommendation. A randomized controlled trial demonstrated that the application of a broad‐spectrum sunscreen with a high protection factor prevents UV‐induced skin lesions under standardized conditions.9 The clinical results have recently been confirmed by an open‐label study with a liposomal sunscreen, supported by histology and immunohistochemistry.10, 11, Smoking as a relevant risk factor for widespread CLE has been described in a cohort of 1346 patients with SLE from Canada.12 A multicentre analysis of 1002 patients with CLE in Europe confirmed that smoking influences disease severity and the efficacy of antimalarials.13 However, other studies investigating the relationship between smoking and the efficacy of antimalarials in patients with CLE indicate that cigarette smoking might not have any significant influence on the response to hydroxychloroquine (HCQ) and/or chloroquine (CQ).14-16, Drug‐induced lupus erythematosus (DILE/DIL) in its classical form shows all features of idiopathic SLE with arthralgia, myalgia, serositis and fever. Due to high incidence of polyneuropathy, electrophysiological examination of the peripheral nerves must be performed prior to use and during treatment according to clinical symptoms. Why choose a board-certified dermatologist? Genetic variations together with immunological and environmental factors can result in an increased risk of developing autoimmune diseases such as CLE.3 In rare cases, CLE (mainly SCLE) is reported as paraneoplastic disease.4 Moreover, a Swedish study presented an increased risk for buccal cancer, lymphomas, respiratory cancer and non‐melanoma skin cancer among patients with CLE.5, Ultraviolet (UV) A and B light is one of the most important risk factors for CLE, clearly documented by photoprovocation studies in large patient cohorts.2, 6-8 In the past years, several trials have been performed to investigate the preventive effect of sunscreens in patients with UV‐induced CLE. In particular, HCQ is associated with a higher rate of remission, fewer relapses and reduced damage in the course of the disease, even in lupus nephritis.58, 59, Antimalarials include HCQ, CQ and quinacrine (synonym: atabrine, atebrine, mepacrine); quinacrine is not available in all European countries and therefore not reimbursed by the insurance in most cases. To date, no therapeutic agents have been licensed specifically for … Removing the skin is a simple procedure, which your dermatologist can perform during an office visit. Open trial in 5 cases . Elisabeth Aberer, Zsuszanna Bata‐Csörgö, Marcia Caproni, Andreas Dreher, Camille Frances, Regine Gläser, Hans‐Wilhelm Klötgen, Annegret Kuhn, Aysche Landmann, Branka Marinovic, Filippa Nyberg, Rodica Olteanu, Annamari Ranki and Beatrix Volc‐Platzer have no conflicts of interest with regard to fees for participation in review activities, such as data monitoring boards, statistical analysis, or end point committees. Systemic steroids should only be applied intermittently, in the lowest possible dosage with the aim to discontinue the application as … atrophy, telangiectasia, steroid‐induced rosacea‐like dermatitis), topical steroids should be applied time‐limited (2–4 weeks) and preferably intermittent. In particular, we are indebted to Professor Luca Borradori, MD, Department of Dermatology, Inselspital Bern – University Hospital, Bern, Switzerland; Professor Hana Jedličková, MD, I. In an analysis by EUSCLE, HCQ and CQ were applied by 56.7% and 30.8% of the included 1002 patients, respectively, with an efficacy of 81.5% and 86.9%, respectively.62 In their review of clinical efficacy and side‐effects of antimalarials in SLE using the GRADE system, Ruiz‐Irastorza and co‐workers63 found high evidence supporting the global safety of HCQ and CQ, and moderate grade of evidence that HCQ has a safer profile than CQ. This grant was used to organize the consensus conferences and to reimburse the travel fees and the accommodation of each participant. Do you know which one? To treat discoid lupus, your dermatologist may inject a thick patch with a corticosteroid to help it clear. Lupus erythematosus with leflunomide: induction or reactivation? A complete or almost complete clearing of CLE lesions was seen in 11 patients; treatment failure was observed in eight patients. Zsuszanna Bata‐Csörgö received consulting fee or honorarium from Berlin Chemie, Ewopharma, Janssen, Novartis, MSD; Annegret Kuhn received consulting fee or honorarium from Biogen, Forward Pharma, Gruenenthal, GlaxoSmithKline, La Roche Posay and Lilly; Filippa Nyberg received consulting fee or honorarium from Biogen; Rodica Olteanu received consulting fee or honorarium from Abbvie, Alvogen, Novartis and Pfizer; Annamari Ranki received consulting fee or honorarium from Immunoqure; Jacek C. Szepietowski received consulting fee or honorarium from Celgene, Leo Pharma, Lilly, Novartis, Pierre Fabre and Sun‐Farm; Beatrix Volc‐Platzer received consulting fee or honorarium from Biotest, Galderma and Meda. First-line systemic treatments include anti-malarial drugs, with hydroxychloroquine the preferred choice. Kuhn A, Gensch K, et. Some people have dark or light spots on their skin. Retinoids were suggested as second‐line systemic therapy by the ‘American Academy of Dermatology’ guidelines in 1996.83 In a double‐blind, randomized, multicentre trial, acitretin was compared to HCQ for eight‐week duration with marked improvement or clearing in 13 (46%) of 28 patients using acitretin and in 15 (50%) of 30 patients treated with HCQ.60 Acitretin was especially useful in treating hyperkeratotic verrucous forms of DLE on hands, feet and legs.84 Single case reports describe a combination of acitretin with CQ and quinacrine with complete resolution in hypertrophic DLE85 or isotretinoin in SCLE with a remarkable improvement within 1 month.86 Treatment for DLE and SCLE with isotretinoin has been reported in approximately 50 patients in open studies and in case reports with a success rate of approximately up to 87%.51, 87-91 Etretinate 50 mg daily was used in an open prospective trial by Ruzicka and co‐workers92 including 19 patients with localized and disseminated DLE, SCLE, and one patient with cutaneous manifestations of SLE.