C Günther1, S Beissert. 1. Klinik und Poliklinik für Dermatologie, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland, claudia.guenther@uniklinikum-dresden.de.
Abstract
BACKGROUND: Lupus erythematosus is an autoimmune disease with a broad spectrum of cutaneous manifestations. The pathogenesis of lupus is based on a loss of tolerance against self antigens and can be mediated by defects in apoptosis, defects in eliminating cellular remnants and increased activation of the innate as well as the adaptive immune system. The increased activation of the innate immune system can be mediated by sensing of endogenous or exogenous nucleic acids, genetic variants in the components of the receptor cascade or disturbances in restriction of self nucleic acids. The inflammatory milieu is characterized by type I interferon expression and autoantibody production. The main trigger factors of the disease are sun exposure and viral infections. TREATMENT: Lupus erythematosus is effectively treated by glucocorticosteroids. Approved alternatives for long-term treatment are antimalarial agents and the B-cell inhibitor belimumab for patients with systemic lupus erythematosus. CONCLUSION: Future studies should more intensely analyse the effect of novel therapies on cutaneous manifestations to allow early detection of cutaneous lupus. Furthermore novel therapeutic strategies which specifically target the responsible pathogenetic mechanisms of the individual subtypes of lupus erythematosus are needed to improve the therapeutic success for this heterogeneous patient population.
BACKGROUND:Lupus erythematosus is an autoimmune disease with a broad spectrum of cutaneous manifestations. The pathogenesis of lupus is based on a loss of tolerance against self antigens and can be mediated by defects in apoptosis, defects in eliminating cellular remnants and increased activation of the innate as well as the adaptive immune system. The increased activation of the innate immune system can be mediated by sensing of endogenous or exogenous nucleic acids, genetic variants in the components of the receptor cascade or disturbances in restriction of self nucleic acids. The inflammatory milieu is characterized by type I interferon expression and autoantibody production. The main trigger factors of the disease are sun exposure and viral infections. TREATMENT: Lupus erythematosus is effectively treated by glucocorticosteroids. Approved alternatives for long-term treatment are antimalarial agents and the B-cell inhibitor belimumab for patients with systemic lupus erythematosus. CONCLUSION: Future studies should more intensely analyse the effect of novel therapies on cutaneous manifestations to allow early detection of cutaneous lupus. Furthermore novel therapeutic strategies which specifically target the responsible pathogenetic mechanisms of the individual subtypes of lupus erythematosus are needed to improve the therapeutic success for this heterogeneous patient population.
Authors: Claudia Günther; Martin Aringer; Marlene Lochno; Eva Kämmerer; Andrea Bauer; Gottfried Wozel; Michael Meurer Journal: Acta Derm Venereol Date: 2012-07 Impact factor: 4.437
Authors: Jamie J Bernard; Christopher Cowing-Zitron; Teruaki Nakatsuji; Beda Muehleisen; Jun Muto; Andrew W Borkowski; Laisel Martinez; Eric L Greidinger; Benjamin D Yu; Richard L Gallo Journal: Nat Med Date: 2012-07-08 Impact factor: 53.440
Authors: Stephan Meller; Franziska Winterberg; Michel Gilliet; Anja Müller; Ingrida Lauceviciute; Juliane Rieker; Norbert J Neumann; Robert Kubitza; Michael Gombert; Erich Bünemann; Ulrike Wiesner; Petra Franken-Kunkel; Holger Kanzler; Marie-Caroline Dieu-Nosjean; Ali Amara; Thomas Ruzicka; Percy Lehmann; Albert Zlotnik; Bernhard Homey Journal: Arthritis Rheum Date: 2005-05