Approach to systemic lupus erythematosus and skin lesions

Abstract

Abstract

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease that involves a broad spectrum of symptoms. The underlying cause of LE is unknown but the etiology is thought to be multifactorial and polygenic. Although it can occur in both genders, it has a higher incidence in women, commonly around 30 years of age. The cutaneous manifestations of lupus are pleomorphic. Various cutaneous manifestations of LE are divided into LE-specific and LE-nonspecific skin diseases based on histological criteria. Treatment is based on preventive measures, reversal of inflammation, prevention of damage to target organs and relief of adverse events due to pharmacological therapy. In this review, clinical signs, especially skin manifestations of SLE, diagnostic criteria and treatment options have been discussed.

Keywords: cutaneous lupus erythematosus, systemic lupus erythematosus, skin manifestations, therapy

Özet

Sistemik lupus eritematozus (SLE), geniş spektrumda semptomları barındıran, kronik otoimmün bir hastalıktır. Lupus eritematozusun (LE) nedeni tam olarak bilinmemektedir fakat etiyoloji multifaktöryel ve poligenik olabilir. Her iki cinsiyeti etkileyebilse de özellikle 30 yaş civarı kadınlarda insidansı daha yüksektir. Lupusun kutanöz bulguları polimorfiktir. Lupusun kutanöz bulguları histolojik kriterlere göre lupusa spesifik ve lupusa spesifik olmayan lezyonlar olarak ayrılmaktadır. Tedavi, koruyucu önlemler, inflamasyonun baskılanması, hedef organlardaki hasarın önlenmesi ve farmokolojik tedaviye bağlı yan etkilerin azaltılmasına dayalıdır. Bu derlemede, klinik bulgular, özellikle LE’un kutanöz bulguları, tanı kriterleri ve tedavi seçenekleri tartışılmıştır.

Anahtar sözcükler: kutanöz lupus eritematozus; sistemik lupus eritematozus; deri bulguları; tedavi

Kaynakça

1. Sayarlıoğlu M. Sistemik Lupus Eritematozus. Onat MA (Eds). Romatoloji vaka derlemeleri II [Rheumatology case review]. Romatoloji Vaka Eğitim Grubu (ROVAG). İstanbul MSD, Mart 2012; 158-9.
2. Moura Filho JP, Peixoto RL, Martins LG, Melo SD, Carvalho LL, Pereira AK et al. Lupus erythematosus: considerations about clinical, cutaneous and therapeutic aspects. An Bras Dermatol. 2014;89(1):118-25.
3. Pamuk ÖN. Sistemik Lupus Eritematozus. Kısacık B (Eds). Romatoloji vaka derlemeleri III [Rheumatology case review]. Romatoloji Vaka Eğitim grubu (ROVAG). İstanbul MSD, Mart 2013; 62-6.
4. Wenzel J, Zahn S, Tuting T. Pathogenesis of cutaneous lupus erythematosus: Common and different features in distinct subsets. Lupus. 2010; 19: 1020-8.
5. Callen JP. Management of "refractory" skin disease in patients with lupus erythematosus. Best Pract Res Clin Rheumatol. 2005; 19(5): 767-84.16. Kuhn A, Ruland V, Bonsmann G. Cutaneous lupus erythematosus: update of therapeutic options part I. J Am Acad Dermatol. 2011; 65(6): e179-93. doi: 10.1016/j.jaad.2010.06.018. Epub 2010 Aug 23.
6. Boeckler P, Cosnes A, Francès C, Hedelin G, Lipsker D. Association of cigarette smoking but not alcohol consumption with cutaneous lupus erythematosus. Arch Dermatol. 2009; 145(9): 1012-6.
7. Radic M, Herrmann M, van der Vlag J, et al. Regulatory and pathogenic mechanisms of autoantibodies in SLE. Autoimmunity 2011; 44:349-56.
8. Grönhagen CM, Nyberg F. Cutaneous lupus erythematosus: An update. Indian Dermatol Online J. 2014; 5(1): 7-13.

9. Kuhn A, Sticherling M, Bonsmann G. Clinical manifestations of cutaneous lupus erythematosus. J DtschDermatolGes. 2007; 5(12): 1124-37.
10. Gilliam JN, Sontheimer RD. Distinctive cutaneous subsets in the spectrum of lupus erythematosus. J Am Acad Dermatol. 1981; 4(4): 471-5.
11. Walling HW, Sontheimer RD. Cutaneous lupus erythematosus: issues in diagnosis and treatment.Am J Clin Dermatol. 2009; 10(6): 365-81.
12. Sontheimer RD, Henderson CL, Grau RH. Drug-induced subacute cutaneous lupus erythematosus: a paradigm for bedside-to-bench patient-oriented translational clinical investigation. Arch Dermatol Res. 2009; 301(1): 65-70.
13. Bielsa I, Herrero C, Ercilla G, Collado A, Font J, Ingelmo M et al. Immunogenetic findings in cutaneous lupus erythematosus.J Am Acad Dermatol. 1991; 25(2 Pt 1): 251- 7.
14. D’Cruz DP. Systemic Lupus Erythematosus. Lancet 2007; 369: 587-96.
15. Cervera R, Espinosa G, D’Cruz D. Systemic Lupus Erythematosus: pathogenesis, clinical manifestations and diagnosis. EULAR Compendium on Rheumatic Disease. BMJ Publishing Group, 2009; p.257-279.
16. Kuhn A, Ruland V, Bonsmann G. Cutaneous lupus erythematosus: update of therapeutic options part I. J Am Acad Dermatol. 2011 Dec;65(6):e179-93. doi: 10.1016/j.jaad.2010.06.018. Epub 2010 Aug 23. Review.
17. Kuhn A, Ruland V, Bonsmann G. J Am Acad Dermatol. Cutaneous lupus erythematosus: update of therapeutic options part II. 2011 Dec;65(6):e195-213. doi: 10.1016/j.jaad.2010.06.017. Epub 2010 Aug 30.
18. Oksel F. Sistemik Lupus Eritematozus [Systemic lupus erythematosus]. Doğanavşargil E, Gümüşdiş G (Eds). Klinik Romatoloji El Kitabı. İzmir Güven Kitabevi, 2003; 260-4.
19. Klippel JH. Guidelines for the management of rheumaticdiseases. Stone JH, Crofford LJ (Eds). Primer on the Rheumatic Diseases. Thirteenth Edition. Springer, 2008; 684-5.
20. Rovin BH, Furie R, Latinis K, Looney RJ, Fervenza FC, Sanchez-Guerrero J et al. LUNAR Investigator Group. Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: The lupus nephritis assessment with rituximab
21. (LUNAR) study. Arthritis Rheum, 2012 Apr;64(4):1215-26. doi: 10.1002/art.34359. Epub 2012 Jan 9.