Active cutaneous lupus erythematosus (CLE) is a distinct and clinically significant manifestation seen in patients with systemic lupus erythematosus. Selecting the appropriate treatment strategy for active skin disease in this context requires a structured, evidence-based approach.
This protocol is specifically designed for patients with a confirmed diagnosis of systemic lupus erythematosus who present with active cutaneous lupus erythematosus — a sub-population for which management decisions extend beyond general SLE care to include targeted skin-directed and systemic interventions.
Management of active skin disease begins with topical therapies and antimalarials as foundational options. For patients with persistent or inadequately controlled cutaneous disease activity, certain systemic agents — drawn from immunosuppressive and biologic drug classes — may be considered as second-line therapy. The complete sequencing, selection criteria, and full regimen are available in the structured protocol below.
DOI: 10.1136/ard-2023-224762
Treatment of active skin disease should include topical agents (glucocorticoids, calcineurin inhibitors) (2b/B), antimalarials (hydroxychloroquine, chloroquine) (1a/A), and/or systemic glucocorticoids (4/C) as needed, with methotrexate (1b/B), mycophenolate (4/C), anifrolumab (1a/A), or belimumab (1a/B) considered as second-line therapy.
A small retrospective study in 73 patients with refractory CLE to first-line therapy found similar response rates (~65%) between MTX and mycophenolate.
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