Bupropion-induced subacute cutaneous lupus erythematosus

Subacute cutaneous lupus erythematosus is a subset of cutaneous lupus erythematosus with unique immunological and clinical features. The first series of patients found to have drug-induced subacute cutaneous lupus erythemotosus were secondary to hydrochlorothiazide. Since that time, several other drugs have been implicated in the induction of subacute cutaneous lupus erythemotosus. A 44-year-old woman presented with a 9-week history of a mildly pruritic, photosensitive rash that started on her chest. One month prior to her skin outbreak she was started on bupropion for mild depression. She was noted to have multiple annular erythematous plaques on her anterior chest, shoulders, back, arms and face. The patient was advised to stop the bupropion and to start topical tacrolimus, and was encouraged to apply a broad-spectrum sunscreen. Her skin completely cleared within 1 month of initiating this treatment regimen. This case is a unique example of bupropion-induced subacute cutaneous lupus erythemotosus. Our patient exemplifies the necessity of a complete medical history, including current medications, especially when subacute cutaneous lupus erythemotosus is suspected.     

Terbinafine-induced subacute cutaneous lupus erythematosus

BACKGROUND: Recently, the induction of subacute cutaneous lupus erythematosus (SCLE) and exacerbation of systemic lupus erythematosus by terbinafine have been reported. OBJECTIVE: We describe 4 cases of SCLE, one associated with chilblain lupus, which occurred during therapy with oral terbinafine for onychomycosis. METHODS: Of 21 consecutive patients with SCLE attending the outpatient dermatology department at Muenster University clinic during a 1-year period, 4 patients with terbinafine-induced SCLE were seen. Patients were examined fully and photographed; histologic findings as well as serologic and follow-up data were evaluated. RESULTS: In addition to high titers of antinuclear antibodies (ANA) with a homogeneous pattern, anti-Ro(SS-A) antibodies were present; in 3 of 4 women, anti-La(SS-B) antibodies were also found. All patients had anti-histone antibodies as in drug-induced lupus and showed the characteristic genetic association of SCLE with the HLA-B8,DR3 haplotype; moreover, in 2 cases, HLA-DR2 was also present. After discontinuation of terbinafine, ANA titers decreased; anti-histone antibodies also became undetectable within 4(1/2) months in 3 patients concomitant with subsidence of the SCLE eruption in all patients. CONCLUSION: Terbinafine is a drug that appears to infrequently induce SCLE with high titers of ANAs and anti-histone antibodies in genetically susceptible persons.     

Managing subacute cutaneous lupus erythematosus

Managing a patient with subacute cutaneous lupus erythematosus subsequent to ultraviolet exposure is challenging to health care professionals. A discussion of the disease process, a case study, and practical strategies for patient care will be presented.     

Poikilodermatous subacute cutaneous lupus erythematosus

BACKGROUND: Subacute cutaneous lupus erythematosus (SCLE) is a distinct subset of lupus erythematosus with unique clinical, immunological and genetic features. Among the unusual variants of SCLE, there is a poikilodermic presentation. However, to date, only 1 case of poikilodermatous SCLE has been reported. OBJECTIVE: Our goal was to summarize the clinical characteristics and course as well as the pathological, laboratory and immunofluorescence findings of 4 patients with poikilodermatous SCLE. METHODS: A retrospective study was conducted including 54 patients diagnosed as having SCLE between 1980 and 2002. RESULTS: Four patients (7.4%) had SCLE. All patients were alive, and none developed severe systemic involvement in up to 36 years (median, 24 years) after the onset of disease. The most noteworthy laboratory finding was the cutaneous deposition of amyloid. CONCLUSION: Poikilodermatous SCLE represents an uncommon variant within the clinicopathological spectrum of SCLE following a favorable course, in spite of extensive cutaneous involvement. Photosensitivity is the pathomechanism explaining, theoretically, the development of both poikiloderma and cutaneous amyloidosis in such cases.     

Bullous subacute cutaneous lupus erythematosus

We describe a 59-year-old woman, with a history of autoimmune disease and disseminated uterine leiomyosarcoma, who developed a photoaggravated, blistering skin eruption. An initial rash, at the outset of treatment with chemo- and radiotherapy, resembled erythema multiforme. Review of the original skin biopsy showed it to be subacute cutaneous lupus erythematosus. There were no systemic symptoms or signs to suggest systemic lupus erythematosus. The much later photoaggravated rash consisted mainly of bullae and eventual epidermal denuding which resembled toxic epidermal necrolysis. We propose that the clinical and histological diagnosis is one of bullous subacute cutaneous lupus erythematosus in a patient with no other features of systemic lupus erythematosus.     

Oral lesions in four cases of subacute cutaneous lupus erythematosus

Patients with subacute cutaneous lupus erythematosus (SCLE) present with intense photosensitivity. Clinical patterns comprise papulosquamous or annular lesions on sun-exposed areas; although the face is usually spared. Intraoral lesions have not been reported in most case series of SCLE, but are well-documented in other forms of lupus erythematosus. This study included four female patients diagnosed with SCLE, who presented with specific oral involvement consisting of palatal patches (three cases), buccal mucosal patches (one case), gingival keratotic erythema (one case), and lip lesions (one case). All patients presented with exuberant facial lesions, a condition not often observed in SCLE. Our findings suggest that oral involvement in SCLE may not be as rare as once thought, and that patients with intense facial lesions are at particular risk of developing oral lesions.     

Terbinafine-induced subacute cutaneous lupus erythematosus

BACKGROUND: Nearly 10% of lupus erythematosus (LE) are drug induced. More than 60 different drugs are involved in iatrogenic LE. We report herein 3 cases of terbinafine-induced LE. OBSERVATIONS: Three patients receiving terbinafine for a suspected dermatophytic infection developed a subacute cutaneous LE, within 7 weeks following terbinafine introduction. The patients' medical history included sicca syndrome, lung carcinoma and Kikuchi disease, respectively. Clinical remission occurred within 15 weeks following terbinafine withdrawal. DISCUSSION: Sixteen cases of terbinafine-induced LE have been previously reported, including 13 women. The median age was 54 years. Prior autoimmunity was reported in 10 cases, including 5 pre-existing LE. The median delay between terbinafine introduction and LE onset was 5 weeks. The median time until clinical recovery following terbinafine withdrawal was 8 weeks. CONCLUSION: Terbinafine should be prescribed only in patients with proven dermatophytosis. We recommend cautious monitoring in patients with pre-existing autoimmunity. The diagnosis of terbinafine-induced LE should lead to the immediate and definitive withdrawal of the drug.     

Terbinafine-induced subacute cutaneous lupus erythematosus

Terbinafine is a synthetic oral allylamine that is used for systemic treatment of microscopy- or culture-proven dermatophyte infections of skin and nails. It is normally well-tolerated and side effects include transient gastrointestinal symptoms and skin reactions that can occur in up to 2.3% of treated patients. Subacute cutaneous lupus erythematosus (SCLE) is a skin reaction that has been reported secondary to use of a variety of drugs. The number of reports of SCLE with terbinafine is limited. We demonstrate 2 patients in one dermatology clinic who presented with a predisposing autoimmune diathesis within 3 months of each other.     

Terbinafine-induced subacute cutaneous lupus erythematosus

Oral terbinafine is licensed for use in onychomycosis after positive confirmation of infection. We describe five cases of subacute cutaneous lupus erythematosus associated with terbinafine therapy. All cases had positive antibodies to extractable nuclear antigens, predominantly anti-Ro, and several had a history of pre-existing autoimmune disease. Terbinafine should only be prescribed after confirmation of infection by microscopy or culture.     

Nitrendipine-induced subacute cutaneous lupus erythematosus

A 66-year-old man presented with widespread annular and bullous subacute cutaneous lupus erythematosus (SCLE), developed after starting treatment for hypertension with the calcium channel blocker nitrendipine. A few days after withdrawal of the drug, while cutaneous manifestations were improving, left hemiparesis occurred. Laboratory investigations showed, in addition to anti-Ro, anti-La and anti-histone antibodies, the presence of lupus anticoagulant, anticardiolipin antibodies, prolonged APTT and thrombocytopenia. On the basis of the spontaneous regression of the patient's skin lesions after discontinuation of the drug, a possible relationship between nitrendipine intake, the clinical events and the biological findings is discussed.     

Pathogenesis of subacute cutaneous lupus erythematosus

Subacute cutaneous lupus erythematosus (SCLE) is a photosensitive form of lupus‐specific skin lesion that is strongly associated with the presence of anti‐Ro/SSA autoantibody. The pathogenesis of SCLE includes genetic, environmental and immunologic factors. Recent studies provide strong evidence for the involvement of innate and cell‐mediated immunity, underlying the important role of plasmacytoid dendritic cells, interferon‐α and antibody‐dependent cell cytotoxicity. In addition, a variety of cytokines, chemokines and adhesion molecules have been found to participate in the expansion phase of the autoimmune effector mechanisms. This article summarizes the recent immunological findings and reviews the current mechanisms which are implied in the development of the disease.     

幼儿亚急性皮肤型红斑狼疮一例

患儿女,3岁,因周身红斑伴瘙痒2个月于2013年7月5日入院。2个月前,患者接种麻疹疫苗后,眉间出现一处1分硬币大小的红斑,呈靶形损害伴瘙痒,后皮疹逐渐增大,中央消退,先后就诊多家医院,诊断为多形红斑、药疹,给予口服氯雷他定及鱼腥草颗粒;外用炉甘石洗剂等治疗,病情好转,但停药后反复发作。自发病来,无发热、乏力、关节及肌肉疼痛、雷诺现象,无脱发、口腔溃疡等不适。既往体健,无慢性病史。家族中无类似病史……     

Ticlopidine-induced subacute cutaneous lupus erythematosus: A case report and literature review

Many drugs have been reported to induce lupus in a minority of patients. Ticlopidine hydrochloride inhibits platelet aggregation and is widely used for the prevention of thrombosis. There have been only a few reports of ticlopidine-induced lupus. Here, we review 13 previously reported cases and describe the case of a 71-year-old man with ticlopidine-induced subacute cutaneous lupus erythematosus. His diagnosis was supported by the appearance of papulosquamous skin lesions on sun-exposed areas and detectable anti-Ro/SS-A antibodies, shortly after drug initiation as well as the gradual resolution of these symptoms after the discontinuation of ticlopidine. Our case highlights that when a patient presents with subacute cutaneous lupus erythematosus-like skin lesions, ticlopidine should be considered as a potential causative agent.