Navigating Multidisciplinary Care for CLE in an Evolving Landscape

Cutaneous lupus erythematosus (CLE) does not exist in a clinical vacuum. While skin disease is the defining feature, CLE frequently intersects with systemic manifestations, comorbid autoimmune conditions, and the ever-present risk of progression to systemic lupus erythematosus. Managing this complexity has historically required coordination across specialties, with dermatologists, rheumatologists, and primary care clinicians each playing a role in the care of a patient population whose needs often exceed what any single specialty can address alone. Yet in the absence of approved targeted therapies, that collaboration has had limited tools to work with, and management decisions have largely defaulted to the same narrow, off-label options regardless of disease severity or phenotype.

The question of who owns CLE therapeutically is one the field has not fully resolved. Dermatologists are often the first to diagnose and treat, given the primacy of skin involvement, but rheumatologists bring expertise in systemic disease monitoring and immunosuppressive management that is frequently essential. For patients with refractory or severe disease, navigating this divide can translate into fragmented care, delayed escalation, and outcomes that reflect the limitations of the system as much as the limitations of available therapies.

An approved targeted therapy for CLE would not just add a treatment option, it could reframe the clinical conversation. A therapy with a defined mechanism, a validated efficacy profile, and a manageable safety record would give both dermatologists and rheumatologists a shared reference point around which to organize care, set treatment goals, and evaluate response in a more structured and collaborative way. It could also expand access for patients who are currently undertreated because no specialist feels sufficiently equipped to escalate beyond standard of care.

In this segment, Joseph Merola, MD, MMSc, and Victoria Werth, MD, reflect on how CLE patients move through the health care system today, where the gaps in multidisciplinary coordination are most acute, and how the availability of a first approved targeted therapy could reshape not only treatment paradigms but the broader infrastructure of collaborative care for this disease.

References

1. Drenkard C, Barbour KE, Greenlund KJ, Lim SS. The burden of living with cutaneous lupus erythematosus. Front Med (Lausanne). 2022;9:897987. doi:10.3389/fmed.2022.897987
2. Biogen Inc. Biogen announces second positive Phase 2 litifilimab trial in cutaneous lupus erythematosus at 2026 American Academy of Dermatology Annual Meeting, showing a significant reduction in skin disease activity. Published March 28, 2026. https://investors.biogen.com/news-releases/news-release-details/biogen-announces-second-positive-phase-2-litifilimab-trial