Topical Calcineurin Inhibitors: An Update on Their Use in Cutaneous Lupus Erythematosus

Lupus erythematosus is a multisystem disorder which frequently manifests in the skin. Acute, sub-acute and chronic cutaneous lupus erythematosus represent distinctive patterns of clinical and histological presentation with varying degrees of association with systemic disease. Skin involvement in lupus erythematosus can cause significant morbidity creating a source of considerable distress to patients. A variety of therapeutic agents including topical corticosteroids and systemic immunosuppression have been used in cutaneous lupus, but many lesions are treatment-resistant and prolonged use may be limited by side-effects. The topical calcineurin inhibitors, tacrolimus and pimecrolimus, inhibit T-cell activation limiting inflammation and offer a treatment option for patients with cutaneous lupus erythematosus. This article reviews existing literature documenting their use in this population. Although there is a lack of randomised control trial data, successful treatment of patients with varying patterns of cutaneous lupus erythematosus is described. Treatment is generally well-tolerated and can be combined with traditional treatment regimens.