Cutaneous manifestations of lupus erythematosus (CLE) are manifold, presenting with unspecific
skin manifestations or well-defined clinical dermatological entities. Their relation to each other as well as to
systemic lupus erythematosus is variable, yet diagnostically and therapeutically challenging. Therapeutic decisions have to be based on the activity and distribution as well as the type of skin lesions and the extent of systemic disease. Limited
skin manifestations may be amply tackled by topical
therapy, so far, mainly relying on
corticosteroids. In many cases, however, internal treatment has to be combined by using
antimalarials, in addition to strict UV-protection. The advent of topical
calcineurin inhibitors has contributed substantially to the armamentarium of external treatment options. By specifically interfering with intracytoplasmic signal transduction to activate the nuclear factor of activated T-cells (NF-AT), they are able to modulate various inflammatory mechanisms. The two available compounds,
pimecrolimus and
tacrolimus, do not induce the skin
atrophy characteristic of
corticosteroids. They have been studied in a number of case reports, but only in a few randomized, comparative studies. Both are well-tolerated, but differentially effective in the various subsets of CLE. Further studies are needed to directly compare the two compounds to each other, as well as to topical
corticosteroids, before final recommendations can be made.