Lupus erythematosus and the skin.

Cutaneous manifestations of patients with lupus erythematosus (LE) are very frequent, show a great variety and can occur at any stage of the disease. The most consistent environmental trigger factors so far recognized are exposure to ultraviolet light and certain drug classes known to be capable of inducing LE in otherwise healthy individuals. A classification system has been established including clinical, histologic, photobiologic, serologic, and immunogenetic findings to better define the different cutaneous subtypes of LE. During their clinical evolution, the cutaneous manifestations vary considerably, and, therefore, the diseases which should be considered in differential diagnosis are different, according to the stages of disease development. Furthermore, 25 years of experience worldwide have revealed that individuals whose disease presentation is dominated by subacute cutaneous LE skin lesions and the presence of circulating anti-Ro/SS-A antibodies represent a rather homogeneous immunogenetic subphenotype of LE that enjoys a good prognosis over time. Treatment should be individualized according to disease severity. The majority of patients with cutaneous manifestations of LE do not require systemic immuno-suppressive/ immunomodulatory therapy and the advent of recombinant biologicals has given hope to the small percentage of patients that suffer from particularly severe skin disease activity.