Drug-induced subacute cutaneous lupus erythematosus: a paradigm for bedside-to-bench patient-oriented translational clinical investigation

Abstract

At least 71 patients have been reported in which their otherwise typical subacute cutaneous lupus erythematosus (SCLE) skin lesions were felt to have been temporally associated with the systemic administration of a drug. The mean age of this cohort of drug-induced SCLE (DI-SCLE) patients was 59 years of age which is somewhat older than the mean age of previously reported idiopathic SCLE patient cohorts. Patients had been taking the suspected triggering drug for weeks to years before the onset of SCLE skin lesions. In addition, it was not unusual for 2-3 months to be required for resolution of the SCLE skin lesions following discontinuation of the triggering drug. A relatively large number of drugs representing different pharmacological classes have been implicated in the induction of SCLE. The drug classes that were more frequently encountered were those used for the treatment of cardiovascular disease, especially hypertension. Calcium channel blockers were especially common in this regard. Elderly individuals being treated for hypertension are often taking multiple classes of drugs that have been implicated in triggering SCLE (thiazide diuretics, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, beta-blockers). An approach to the management of DI-SCLE is presented. Ro/SS-A autoantibodies tended to remain present in the blood after resolution of drug-induced SCLE skin lesions. A common link between the disparate group of drug structures implicated in triggering SCLE is their tendencies to produce photosensitivity and lichenoid drug reactions. This leads to the speculation that DI-SCLE could represent a photo-induced isomorphic/Köebner response in an immunogenetically predisposed host.

Anti-thyroid drug-induced lupus: a case report and review of the literature

“…The patient in the case had a MMI medication and typical joint symptoms one month later which was accord with the literature description. Pertinent literature told that DIL was generally observed from 2 weeks to 3.2 years after exposure to a specific drug (3,18). We promptly discontinued MMI therapy and administered non-steroidal anti-inflammatory drugs.…”

A case of subacute cutaneous lupus erythematosus as a result of ranibizumab (Lucentis) treatment

“…[12] Many medications have been implicated, including hydrochlorothiazides, calcium channel blockers, angiotensin-converting enzyme inhibitors, statins and a growing number of anti-tumor necrosis factor agents and monoclonal antibody medications such as efalizumab. [3] A 2009 review by Sontheimer et al , reviewed 71 published cases of drug-induced SCLE. [3] This is the first recorded case of SCLE following ranibizumab treatment.…”

“…[3] A 2009 review by Sontheimer et al , reviewed 71 published cases of drug-induced SCLE. [3] This is the first recorded case of SCLE following ranibizumab treatment.…”

Drug-Induced Lupus Erythematosus

“…Instead, the astute clinician should consider the diagnosis in the setting of the development of at least one clinical feature of SLE in a patient who has been on a medication known to cause DILE for at least 1 month. Symptoms may develop 1 month to more than a decade after starting a medication, making the diagnosis difficult at times (Sontheimer, Henderson, & Grau, 2009). Furthermore, in drug-induced SCLE, systemic manifestations including renal or central nervous system involvement are often absent.…”