Lupus erythematosus: Pathogenesis of cutaneous manifestations

Abstract

Systemic lupus erythematosus (SLE) is a multi-systemic, autoimmune disease with protean clinical manifestations. Skin involvement or cutaneous lupus erythematosus (CLE) is common in patients with SLE, and there has been significant progress in understanding the pathogenesis, classification, clinical manifestations, and treatment of CLE. The initial event in the pathogenesis of CLE involves environmental stimuli such as ultraviolet light, smoking, or exposure to certain drugs. The adaptive and innate immune mechanisms amplify the interactions between keratinocytes, plasmacytoid dendritic cells, and cytotoxic T cells, which play their respective pivotal roles in the pathogenesis of CLE. Our understanding of the pathophysiology of CLE has led to the treatment strategy that involves avoidance of sunlight exposure, topical glucocorticoids, calcineurin inhibitors, and systemic immunosuppressive therapies. Recent understanding of the disease mechanisms based on underlying inflammatory signatures defined by B cells, T cells, plasmacytoid dendritic cells, type I interferon response or a combination of those potentially translate to personalized therapy for defined treatment targets for CLE.