Tratamiento del lupus eritematoso cutáneo resistente

Abstract

Lupus erythematosus (LE) is an autoimmune inflammatory disease that includes a broad spectrum of manifestations, ranging from systemic disease (systemic lupus erythematosus [SLE]) to purely cutaneous forms (cutaneous lupus erythematosus [CLE]). Cutaneous involvement occurs in 90% of patients with SLE. Based on morphological and histopathological features, CLE can be divided into three categories: chronic CLE, subacute CLE and acute CLE. The precise etiology of LE is not fully understood, but the disease occurs when environmental factors, drugs and infectious agents trigger an abnormal immune response in an individual with predisposing genetic factors. To assess cutaneous involvement, several scores have been developed over the years. A recent study, called CLASI (Cutaneous Lupus Erythematosus Disease Area and Severity Index), staged mucocutaneous damage and disease activity separately, allowing assessment of therapeutic response to be standardized. The management of CLE is challenging. Although treatment traditionally consists of photoprotection, topical steroids and antimalarial agents, these measures are sometimes ineffective in subgroup of patients, giving rise to what is called resistant CLE. This article reviews the topical and systemic treatment options, both the classical and new treatment alternatives currently available.