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Fumaric acid esters in cutaneous lupus erythematosus Fumaric acid esters (FAEs), established immunomodulatory agents in the treatment of psoriasis and multiple sclerosis, have been investigated for their therapeutic potential in cutaneous lupus erythematosus (CLE). 1–3 Data from a prospective, open-label phase II pilot study as well as supportive case reports suggest that FAEs may show clinically meaningful effects in patients with refractory CLE, including discoid lupus erythematosus (DLE).4–5 The proposed mechanism involves modulation of pro-inflammatory cytokine pathways and activation of the NRF2-mediated antioxidant response, contributing to reduced skin inflammation and lesion severity. In the available case reports and clinical studies, treatment with FAEs was generally well tolerated, with a favourable safety profile. These preliminary findings underscore the potential role of FAEs as a systemic therapeutic option in CLE and support further evaluation in randomized controlled trials to establish efficacy, safety, and long-term outcomes.Case 1: A 52-year-old patient with DLE A 52-year-old female with refractory DLE was treated orally with FAEs, consisting of 30 mg dimethyl fumarate and 75 mg monoethyl fumarate salts per tablet, administered at a dose of 1–3 tablets per day. 5 After 6 months of treatment, the Revised Cutaneous Lupus Disease Area and Severity Index (RCLASI) scores improved significantly. The disease relapsed after discontinuation but improved upon re-initiation, supporting FAEs as a promising option in therapy-resistant DLE.5 References Kuhn A, Aberer E, Bata-Csörgő 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(3):389–404. doi: 10.1111/jdv.14053Worm M, Zidane M, Eisert L, et al. S2k guideline: diagnosis and management of cutaneous lupus erythematosus - part 2: therapy, risk factors and other special topics. J Dtsch Dermatol Ges. 2021;19(9):1371–95. doi: 10.1111/ddg.14491Kuhn A, Landmann A, Bonsmann G. Fumaric acid esters: a new therapeutic option for skin manifestations in lupus erythematosus? Br J Dermatol. 2017;176(2):301–02. doi: 10.1111/bjd.14938Kuhn A, Landmann A, Patsinakidis N, et al. Fumaric acid ester treatment in cutaneous lupus erythematosus (CLE): a prospective, open-label, phase II pilot study. Lupus. 2016;25(12):1357–64. doi: 10.1177/0961203316644335Tsianakas A, Herzog S, Landmann A, et al. Successful treatment of discoid lupus erythematosus with fumaric acid esters. J Am Acad Dermatol. 2014;71(1):e15–7. doi: 10.1016/j.jaad.2013.12.004Learning Objectives At the end of this workshop participants will be able to:Describe preventive strategies in CLEDiscuss topical and systemic treatment options and experimental therapeutic approaches in CLEReview current therapeutic guidelines for CLEDescribe the RCLASI as a validated scoring system for disease activity and damage in CLECase 2: A Caucasian female with systemic lupus erythematosus developed a new photosensitive eruption A Caucasian female with systemic lupus erythematosus (SLE) treated for several years with hydroxychloroquine developed a new photosensitive eruption. 1 On closer questioning she was taking over the counter omeprazole intermittently. She did not respond to stopping omeprazole and received a short course of prednisone because of the severity of the eruption. Methotrexate and mycophenolate mofetil were not effective in controlling her widespread eruption.2 She was then prescribed lenalidomide, which controlled her skin disease. New therapies targeting type I interferons (IFN) are being evaluated for cutaneous lupus erythematosus (CLE). Phase 2 CLE and SLE trials have been successful with several treatment approaches, including targeting pDCs, type I IFN receptor, TLR7/8, and TYK2/JAK1 inhibitor.3 Learning Objectives At the end of this workshop participants will be able to:Discuss risk factors for drug-induced CLEDiscuss treatment paradigm for refractory CLEReview new therapeutic approaches for CLEReferences Keyes E, Grinnell M, Vazquez T, et al. Drug-induced subacute cutaneous lupus erythematosus in previously diagnosed systemic lupus erythematosus patients: a case series. JAAD Case Rep. 2021;12:18–21. doi: 10.1016§§§§1/j.jdcr.2021.03.048Keyes E, Jobanputra A, Feng R, et al. Comparative responsiveness of cutaneous lupus erythematosus patients to methotrexate and mycophenolate mofetil: a cohort study. J Am Acad Dermatol. 2022;87(2):447–48. doi: 10.1016/j.jaad.2021.09.017Lim D, Kleitsch J, Werth VP. Emerging immunotherapeutic strategies for cutaneous lupus erythematosus: an overview of recent phase 2 and 3 clinical trials. Expert Opin Emerg Drugs 2023;28(4):257–73. doi: 10.1080/14728214.2023.2273536