Systemic lupus erythematosus and cutaneous manifestations: emerging treatment approaches

Systemic lupus erythematosus (SLE) is a chronic and complex autoimmune disease associated with significant morbidity and a relapsing–remitting course. Diagnosis and management remain challenging because of heterogeneous clinical presentations and variable treatment responses, reflecting the underlying immune dysregulation driving disease pathogenesis. Cutaneous lupus erythematosus (CLE) may occur as an isolated skin disorder or as part of the broader clinical spectrum of SLE. The skin is the second most frequently affected organ system in SLE. Cutaneous manifestations occur in 70%–85% of patients during the disease course and represent the initial presenting feature in up to one-quarter of patients. CLE can occur as a manifestation of SLE or independent of systemic disease. The clinical significance of cutaneous manifestations lies in their diagnostic value, prognostic associations with systemic disease activity, and therapeutic implications for patient management. Cutaneous manifestations frequently present early and can serve as the sole clue to SLE, helping establish diagnosis before systemic involvement. Certain lesions, such as acute cutaneous lupus erythematosus, vasculitis, and bullous lupus, correlate with systemic disease activity and severity, while others, such as discoid lupus erythematosus, may predict more localized disease but carry a risk of permanent scarring. This review provides a comprehensive overview of the spectrum of cutaneous manifestations of SLE, focusing on their underlying pathophysiology, diagnostic relevance, and current management approaches.