Abstract Number: 2

Update on cutaneous lupus erythematosus

A.M. Saracino

Meeting: 2017 Dermcoll

Session Information

Date: -

Session Title: Registrars and Fellows Update Session 1

Session Time: -

Latest developments in cutaneous-lupus-erythematosus (CLE) have something for everyone. Perhaps you fancy the intellectual stimulation of immunogenetics? If so, you will be interested in latest evidence which suggests variable immunopathological mechanisms underlie CLE-subtypes and will likely guide development of future targeted-treatments. Or do you prefer to keep it ‘natural’ and address the latest dietary factors and Vitamin-D effects in CLE? For those of us who like to categorise our patients, the Systemic Lupus International Collaborative Clinics (SLICC) SLE classification-criteria have positive points, but also some pitfalls. Then there are the pharmacologists amongst us, who are comforted by drug-levels to direct prescribing. Evidence indicates many patients (including non-smokers) have sub-therapeutic hydroxychloroquine blood-levels with ‘ophthalmologically-safe’ dosing, and derive benefit from short-bursts of higher-doses. And we must properly address hydroxychloroquine; heart-block prevention in neonatal-lupus, thrombotic-risk lowering in selected lupus patients – what a drug! Then there is the untapped potential of hydroxychloroquine’s ‘sister-act’, mepacrine. Safe, cheap and effective; why don’t we use it in Australia? And on the note of underutilised older therapies, the emergence of fumaric-acid-esters is exciting isn’t it? There’s also topical R-salbutamol cream, oral tacrolimus and alitretinoin in CLE. But of course, in the era of targeted personalised-medicine, B-cell-depletion-therapy, JAK-inhibitors and phosphodiesterase-4-inhibitors hold much promise, with further new therapies on the horizon. Finally, robust outcome-measures for disease monitoring and drug trials are vital. The Cutaneous Lupus Area and Severity Index enables Dermatologists to ‘treat-to-target’ in CLE, as our Rheumatology colleagues do so well with the BILAG and SLEDIA in SLE.