SP0193 WIN: SKIN AND RHEUMATIC DISEASES
Authors: Annegret Kuhn
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> The main underlying mechanisms of skin manifestations in rheumatic diseases include autoimmune responses, auto-inflammatory processes, and tissue-specific alterations. In psoriasis, therapies targeting T cell activation, T cell migration, or neutralization of disease-related cytokines are highly effective. However, targeted therapies still need to be developed in less frequent autoimmune diseases, such as systemic lupus erythematosus (SLE), systemic sclerosis (SSc), or dematomyositis (DM). <h3>Objectives:</h3> To provide an update for rheumatologists on the management of skin manifestations in autoimmune diseaes based on recent insights into the pathogenesis. <h3>Methods:</h3> Several agents are approved for the treatment of SLE, including the monoclonal antibody belimumab, a B lymphozyte stimulator-specific inhibitor, but no drugs have been licensed specifically for the treatment of skin manifestations in this disease. The aim of the European guideline was to achieve a broad consensus on treatment strategies for patients with cutaneous lupus erythematosus (CLE) by a European subcommittee. In total, 16 European participants were included in this project and agreed on all recommendations. <h3>Results:</h3> First-line treatment options in CLE include topical corticosteroids or calcineurin inhibitors; in patients with disfiguring and widespread disease, systemic agents need to be applied. The first-line systemic treatment is antimalarials, but some patients are therapy-resistant and immunosuppressive agents, such as methotrexate, are used as alternative therapeutic option. In 2011, the monoclonal antibody belimumab was introduced for SLE as an adjunct therapy for patients with autoantibody-positive disease who despite standard therapy show high disease activity, intolerance of other treatments, or an unacceptably high need for corticosteroids. So far, a validated skin score has not been used to confirm the efficacy of belimumab on mucocutaneous manifestations. In SSc, the therapeutic modalities are even more limited. Treatment with endothelin-receptor antagonists has been proven to reduce the occurrence of new digital ulcers in SSc patients but has no or limited effect on healing of digital ulcers. DM is a further idiopathic autoimmune disease characterized by inflammation of the muscles and skin, which is treated with immunosuppressives. Corticosteroids are still the first-line treatment for muscle involvement in DM, but skin lesions often flare by reduction or discontinuation. <h3>Conclusion:</h3> In summary, there is a high unmet need for new therapeutic strategies focusing on skin involvement in systemic autoimmune diseases. Therefore, innovative designs of randomized controlled trials based on the pathogenesis are warranted to develop new therapies for patients with skin manifestations in rheumatic diseases. <h3>References:</h3> [1] Kuhn A, Landmann A, Bonsmann G. The skin in autoimmune diseases - unmet needs. Autoimmun Rev 2016;15:948-954 [2] Kuhn A, Aberer E, Bata-Csoergő Z, et al. S2k guideline for treatment of cutaneous lupus erythematosus - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol 2017;31:389-404 [3] Smith V, Scirè CA, Talarico R, et al. Systemic sclerosis: state of the art on clinical practice guidelines. RMD Open 2018;4:e000782 [4] Sunderkoetter C, Nast A, Worm M, et al. Guidelines on dermatomyositis - excerpt from the interdisciplinary S2k guidelines on myositis syndromes by the German Society of Neurology. J Dtsch Dermatol Ges 2016;14:321-338 [5] Tamirou F, Arnaud L, Talarico R, et al. Systemic lupus erythematosus: state of the art on clinical practice guidelines. RMD Open 2018;4:e000793 <h3>Disclosure of Interests:</h3> Annegret Kuhn Grant/research support from: Biogen, Galderma, GlaxoSmithKline, LeoPharma, Speakers bureau: La Roche Posay