Roadmap to Cutaneous and Systemic Lupus Erythematosus

At the Masterclasses in Dermatology APP Institute, Joseph Merola, MD, MMSc, FAAD, FACR, a dual-trained dermatologist and rheumatologist, tackled the evolving landscape of lupus care. His presentation, “Cutaneous Lupus: Systemic Considerations and Treatment Update,” highlighted the overlap between cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE), the risk of progression, and the therapies poised to change the game.

Dr Merola began by framing CLE as more than skin deep. “The median time to progression from discoid lupus erythematosus to SLE was 453 days,” he said, citing Brigham Lupus Registry data, emphasizing that dermatology often serves as the frontline in catching systemic disease early.

He reminded attendees that fatigue, while absent from American College of Rheumatology classification criteria, remains the most common presenting symptom. Notably, “up to 30% of patients with CLE have co-prevalent SLE,” he shared, urging APPs to monitor closely for systemic signs even in what may appear to be isolated cutaneous disease.

The talk also explored the nuances of drug-induced subacute cutaneous lupus erythematosus (SCLE), a phenomenon with growing clinical relevance. “Drug-induced SCLE tends to be more widespread and anti-Ro/SSA antibodies will disappear after resolution in 73% of patients,” Dr Merola noted, citing culprits like hydrochlorothiazide, beta blockers, tumor necrosis factor inhibitors, and proton pump inhibitors.

Where the session truly shined was in its focus on emerging therapies. Highlights included:

• Anifrolumab, a type I interferon receptor antagonist, approved for moderate-to-severe SLE.
• Deucravacitinib, a TYK2 inhibitor, which demonstrated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI)-50 and CLASI-70 responses in CLE and SLE trials.
• Enpatoran, a dual TLR7/8 inhibitor, which led to a ≥70% reduction in CLASI-A scores in up to 69% of patients by week 24.

“These are game-changing molecules,” said Dr Merola. “They’re helping us treat the right domain in the right patient at the right time.”

“The future is very bright for cutaneous lupus.” The session closed with a strong call for integrated care: “Co-management and facilitated communication between dermatology and rheumatology is critical,” he emphasized.

Reference

Merola J. Cutaneous lupus: systemic considerations and treatment update​. Presented at: Masterclasses in Dermatology APP Institute; October 11–12, 2025; Dallas, TX.