Practical therapeutics for skin lesions of Japanese patients with discoid lupus erythematosus

Abstract

Introduction: Discoid lupus erythematosus (DLE) is an inflammatory skin disease seen in patients with or without systemic LE. There are several clinical features, such as localized DLE, generalized/widespread DLE, hypertrophic/verrucous DLE and mucosal DLE. There are topical and systemic therapy options. Topical therapies include corticosteroids and calcineurin inhibitors. As systemic therapies, antimalarials are acknowledged as the first-line option throughout the world. Dapsone and/or retinoids are also useful with careful evaluation of their positive and adverse effects. In order to develop better treatments, it is important to know and investigate the mechanisms of skin eruption development using several methods such as mouse models.Areas covered: This manuscript summarizes the disease features, pathogenesis, diagnosis and current and new targeted treatments for DLE. A literature search on PubMed and the Cochrane Database of Systematic Reviews has been undertaken and the most relevant references have been considered.Expert opinion: Treatment for DLE includes topical and systemic options. The professional use of topical corticosteroids and topical calcineurin inhibitors is considered to be first-line. Next, antimalarials are accepted as a first-line systemic therapy when topical therapies are ineffective. If the antimalarial treatment programme is insufficient, an immunosuppressive or immunomodulator may be added. Some new, promising agents are considered in patients who are refractory to various combinations of antimalarials and immunosuppressives/immunomodulators.