Sticherling Michael
Hautklinik, Universitätsklinikum, Erlangen (Clinic of Dermatology, University Hospitals of Erlangen), Erlangen, Germany.
Biologics. 2011;5:21-31. doi: 10.2147/BTT.S9806. Epub 2011 Feb 14.
Cutaneous manifestations of lupus erythematosus (CLE) are manifold, presenting with unspecific skin manifestations or well-defined clinical dermatological entities. Their relation to each other as well as to systemic lupus erythematosus is variable, yet diagnostically and therapeutically challenging. Therapeutic decisions have to be based on the activity and distribution as well as the type of skin lesions and the extent of systemic disease. Limited skin manifestations may be amply tackled by topical therapy, so far, mainly relying on corticosteroids. In many cases, however, internal treatment has to be combined by using antimalarials, in addition to strict UV-protection. The advent of topical calcineurin inhibitors has contributed substantially to the armamentarium of external treatment options. By specifically interfering with intracytoplasmic signal transduction to activate the nuclear factor of activated T-cells (NF-AT), they are able to modulate various inflammatory mechanisms. The two available compounds, pimecrolimus and tacrolimus, do not induce the skin atrophy characteristic of corticosteroids. They have been studied in a number of case reports, but only in a few randomized, comparative studies. Both are well-tolerated, but differentially effective in the various subsets of CLE. Further studies are needed to directly compare the two compounds to each other, as well as to topical corticosteroids, before final recommendations can be made.
红斑狼疮（CLE）的皮肤表现多种多样，可呈现非特异性皮肤表现或明确的临床皮肤病实体。它们之间以及与系统性红斑狼疮的关系各不相同，但在诊断和治疗上都具有挑战性。治疗决策必须基于皮肤病变的活动度、分布情况、类型以及全身疾病的程度。局限性皮肤表现可通过局部治疗充分应对，目前主要依靠皮质类固醇。然而，在许多情况下，除了严格的紫外线防护外，还必须联合使用抗疟药进行内治疗法。局部钙调神经磷酸酶抑制剂的出现极大地丰富了外部治疗选择。通过特异性干扰细胞质内信号转导以激活活化T细胞核因子（NF-AT），它们能够调节各种炎症机制。两种可用的化合物——吡美莫司和他克莫司，不会引起皮质类固醇特有的皮肤萎缩。它们已在一些病例报告中进行了研究，但仅在少数随机对照研究中进行过研究。两者耐受性良好，但在CLE的不同亚组中疗效不同。在做出最终建议之前，需要进一步研究以直接比较这两种化合物以及它们与局部皮质类固醇的疗效差异。
