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Cutaneous Lupus Erythematosus: Review and Considerations for Older Populations

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Abstract

Though more common earlier in life, increasing attention is being focused on the development of cutaneous lupus erythematosus (CLE) in patients with advancing age. Studies show that CLE is more common in older populations than previously thought, and all CLE subtypes are possible in this group. Just like patients in the third or fourth decade of life, CLE may appear alongside or independent of systemic lupus erythematosus. Older populations manifesting CLE for the first time seem to have a lower risk of progression to systemic disease than younger peers, and are more commonly White. CLE must be carefully distinguished from other skin conditions that have a predilection for presentation in older populations, including rosacea, lichen planus, and other autoimmune conditions such as dermatomyositis or pemphigus/pemphigoid. It is thought that most CLE in older populations is drug-induced, with drug-induced subacute cutaneous lupus erythematosus being the most common subtype. Management of CLE in older patients focuses on eliminating unnecessary medications known to induce CLE, and otherwise treatment proceeds similarly to that in younger patients, with a few special considerations.

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Authors and Affiliations

  1. Penn State College of Medicine, Hershey, PA, USA

    Briana Heinly

  2. Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Astia Allenzara

  3. Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA

    Matthew Helm & Galen T. Foulke

  4. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA

    Galen T. Foulke

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Correspondence to Galen T. Foulke.

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Funding

Dr Galen Foulke is supported by a Dermatology Foundation Medical Dermatology Career Development Award.

Conflicts of interest/competing interest

Dr Astia Allenzara’s spouse is employed by LatigoBio pharmaceuticals. Dr Galen Foulke has served as a consultant to Astra Zeneca, the manufacturer of anifrolumab. Dr Matthew Helm and Briana Heinly have no conflicts of interest to disclose.

Author contributions

Briana Heinly performed the full literature review and drafted all parts of the manuscript. Dr Foulke also did portions of the literature review, provided multiple rounds of edits, and played a major role in the revision of the manuscript. Dr Helm and Dr Allenzara both provided expert clinical critique of the paper, provided additional sources, and revised the manuscript prior to submission. All authors read and approved the final manuscript.

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Heinly, B., Allenzara, A., Helm, M. et al. Cutaneous Lupus Erythematosus: Review and Considerations for Older Populations. Drugs Aging 41, 31–43 (2024). https://doi.org/10.1007/s40266-023-01079-5

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