Diagnosing systemic disease requires connecting the dots from the microscope to the bedside, according to Mayo Clinic dermatologist and dermatopathologist Olayemi Sokumbi, MD, FAAD.
In this Next Steps in Derm interview, in partnership with the ODAC Dermatology Conference, Dr. Sokumbi outlines how she makes diagnostic decisions, including thinking beyond the skin. As a dermatologic detective of sorts, find out how she puts the story together to make an accurate diagnosis. Hear how a comprehensive picture can impact prognosis and treatment. In addition, Dr. Sokumbi shares how considering other organ systems helped her accurately diagnose multicentric reticulohistiocytosis.
Further Reading
If you want to read more about systemic diseases with skin findings, check out the following articles published in the Journal of Drugs in Dermatology:
Resident Rounds. Part III: Multicentric Reticulohistiocytosis Presenting as Granuloma Annulare
CASE REPORT
A 56-year-old female presented with a 6-month history of asymptomatic red plaques on her hands. She had an underlying history of arthritis in her hands and feet. She was initially treated for granuloma annulare with topical steroids, but no improvement was noted.
Examination of the bilateral dorsal hands showed multiple violaceous plaques, some with an annular appearance (Figures 1 and 2). No nail involvement was noted.
Complete blood cell count, rheumatoid factor assay, and serum protein electrophoresis were within normal limits. Lipid concentration panel showed hypercholesterolemia. Radiographs of the bilateral hands revealed narrowing of the proximal and distal interphalangeal joint spaces.
The Role of JAK Inhibitors in the Treatment of Cutaneous Lupus Erythematosus: A Review
ABSTRACT
Cutaneous lupus erythematosus (CLE), a manifestation of the chronic autoimmune disease lupus erythematosus (LE), showcases diverse clinical, immunologic, and histologic attributes. CLE can be further categorized into subtypes — acute (ACLE), subacute (SCLE), or chronic (CCLE) — with each class characterized by distinct features, including the degree of cutaneous involvement, lesion duration, and associated laboratory findings. While conventional treatments, including photoprotective strategies, topical corticosteroids, and antimalarial agents, have proven effective for some, recent immunomodulatory therapies offer alternative avenues. Janus kinase (JAK) inhibitors, in particular, have gained attention due to their demonstrated efficacy in the management of various autoimmune disorders. Dysregulation of the JAK/signal transducer and activator of transcription (STAT) signaling pathway has been implicated in the pathogenesis of CLE, further underscoring the promise of JAK inhibitors as an adjunctive therapy alongside systemic immunosuppression. This systematic review aims to discuss the diagnosis and categorization of CLE and its subtypes, elucidate the intricacies of intracellular signaling within the JAK/STAT pathway, and discuss the current applications of JAK inhibitors in the treatment of autoimmune disease. Supported by cases, randomized control trials, basic science articles, and other reviews in the literature, this review provides evidence for the use of the JAK/STAT pathway as a therapeutic target. Nevertheless, the role of JAK inhibitors and their therapeutic properties warrant further scrutiny through rigorous investigation and comprehensive randomized control trials to ascertain safety and efficacy.
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