CD20-directed therapy in autoimmune diseases involving the skin: Role of rituximab

Autoimmune disorders with cutaneous involvement include lupus erythematosus, dermatomyositis, systemic sclerosis and autoimmune blistering diseases. In all of them, treatment is challenging and refractory cases are frequent. For this group of patients, the monoclonal anti-CD20 antibody rituximab has emerged as a novel therapeutic strategy that involves the transitory depletion of B cells, often resulting in dramatic clinical responses in otherwise treatment-resistant patients. Here, we review the use of rituximab in patients with autoimmune disorders involving the skin, such as lupus erythematosus and dermatomyositis, as well as in autoimmune bullous diseases, including pemphigus, mucous membrane pemphigoid, bullous pemphigoid and epidermolysis bullosa acquisita. The mode of action of rituximab, different treatment protocols, clinical responses, effects on circulating antibody levels, safety profile and future directions in B-cell-targeted therapy are summarized.