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Cutaneous Lupus Erythematosus in Children
Vivian Tsang1, Alexander K C Leung2, Joseph M Lam3
1Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, BC, Canada.
Insights
Pediatric cutaneous lupus erythematosus (CLE) involves various skin presentations and requires early diagnosis. Understanding its subtypes and treatment is crucial for effective management in children.
Area of Science:
- Immunodermatology
- Pediatric Autoimmune Diseases
Background:
- Cutaneous lupus erythematosus (CLE) frequently impacts the skin in autoimmune conditions.
- CLE can present with or without systemic involvement, highlighting the need for early detection.
- Preventing complications is particularly vital in pediatric cases of CLE.
Purpose of the Study:
- To provide physicians with a comprehensive overview of pediatric cutaneous lupus.
- This includes familiarizing them with clinical presentation, diagnostic approaches, evaluation methods, and management strategies.
Main Methods:
- A systematic literature search using "cutaneous lupus" was conducted on PubMed.
- The search focused on epidemiology, clinical diagnosis, investigations, comorbidities, and treatment in English literature concerning children.
- A narrative synthesis of included studies (meta-analyses, RCTs, trials, observational studies, reviews) was performed.
Main Results:
- Pathogenesis of CLE involves diverse innate and adaptive immune responses.
- Cutaneous manifestations vary widely, encompassing different subtypes like acute, subacute, and chronic CLE.
- First-line treatments include topical agents (calcineurin inhibitors, corticosteroids) and oral medications (glucocorticoids, antimalarials, hydroxychloroquine).
Conclusions:
- CLE encompasses multiple subtypes with distinct dermatological features in pediatric and adult populations.
- Evolving understanding of molecular targets will likely alter current treatment paradigms.
- Continued research into CLE mechanisms is essential for developing novel pediatric interventions.
Background:
The skin is commonly involved in autoimmune diseases, such as lupus erythematous. The cutaneous lupus erythematosus (CLE) can manifest with or without systemic symptoms. It is advantageous from a patient and healthcare system standpoint for early diagnosis and intervention. Prevention of complications is especially important in the pediatric population.
Objective:
To familiarize physicians with the clinical presentation, diagnosis, evaluation, and management of pediatric cutaneous lupus.
Methods:
The search term "cutaneous lupus" was entered into a Pubmed search. A narrow scope was applied to the categories of "epidemiology", "clinical diagnosis", "investigations", "comorbidities", and "treatment". Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. The search was restricted to English literature and children. A descriptive, narrative synthesis of the retrieved articles was provided.
Results:
A variety of innate and adaptive immune responses are being investigated to explain the pathogenesis of CLE. There are a number of variations of cutaneous manifestations varying from localized malar rash as in the case of ACLE lesions and papulosquamous psoriasiform lesions as in the case of SCLE to the multiple subtypes within chronic CLE. First-line pharmacological treatments include topicals, such as typical calcineurin inhibitors and corticosteroids, or oral agents, such as glucocorticoids, antimalarial drugs, and hydroxychloroquine.
Conclusion:
CLE is inclusive of a number of subtypes that have varying dermatological manifestations in adult and pediatric populations. The current treatment modalities will change based on the newly understood molecular targets. Ongoing research on the mechanisms underlying CLE is necessary to derive new interventions for pediatric patients.
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