Drug-induced subacute cutaneous lupus erythematosus in previously diagnosed systemic lupus erythematosus patients: A case series

Keyes, Emily; Grinnell, Madison; Vazquez, Thomas; Diaz, DeAnna; Thomas, Preethi; Werth, Victoria P.

doi:10.1016/j.jdcr.2021.03.048

Cited by 7 publications

(8 citation statements)

References 7 publications

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“…It has been reported that patients with pre-existing SLE may have an increased susceptibility to DI-SCLE. 26 Involvement of the lower extremities has been suggested to be suspicious for DI-SCLE. 27 On the other hand, a systematic review reported that DI-SCLE and idiopathic SCLE are indistinguishable clinically, immunologically and histologically.…”

Section: Discussionmentioning

confidence: 99%

Proton pump inhibitor induced subacute cutaneous lupus erythematosus: Clinical characteristics and outcomes

Poh

Alrashid

Sangle

et al. 2022

Lupus

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Background There is a growing literature reporting the association between proton pump inhibitor (PPI) use and subacute cutaneous lupus erythematosus (SCLE). Aims To compare the clinical characteristics of a cohort of patients with PPI-induced SCLE, their clinical course and treatment with a control group of primary SCLE patients not exposed to PPI. Methods We conducted a matched case–control study in a tertiary referral setting at the Louise Coote Lupus Unit. There were 64 SCLE patients: 36 with PPI-induced SCLE and 28 patients with primary SCLE. Results Twenty-six patients (72%) had pre-existing SLE in the PPI-induced SCLE group. Lower limb skin lesions were significantly more prevalent in the PPI group ( p < 0.0001). The prevalence of anti-Ro and anti-Ro-52 antibodies was numerically higher in the PPI group (64% and 60%), respectively, compared with 46% and 42% in the primary SCLE group. Peripheral blood eosinophils were normal in all patients in the PPI group. Thirteen patients underwent skin biopsy in the PPI group and 12 had histology in keeping with SCLE. The median time to presentation was 8 months with a median resolution period of 6 weeks. PPIs were stopped in 34 patients, while 2 patients continued treatment for other clinical indications. Twelve patients received concurrent oral corticosteroids. Two patients had severe SCLE in the form of Toxic Epidermal Necrolysis requiring critical care admission and were managed with corticosteroids, IV immunoglobulin and/or belimumab. Conclusion Lower limb involvement is a pointer to PPI-induced SCLE which is likely a class effect with all PPI.

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Section: Discussionmentioning

confidence: 99%

Proton pump inhibitor induced subacute cutaneous lupus erythematosus: Clinical characteristics and outcomes

Poh

Alrashid

Sangle

et al. 2022

Lupus

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“…Moreover, it usually takes weeks to many months for drug induced-SCLE to develop after the initiation of the offending medication. 11,12 The pathomechanism of rifaximin-induced sunburn is poorly understood due to the paucity of cases. In general, UVB rays (290-320 nm) can induce photosensitisation more efficiently than UVA rays (340-400 nm) in the absence of an exogenous photosensitiser.…”

Section: Discussionmentioning

confidence: 99%

Severe Sunburn-Like Adverse Cutaneous Drug Reaction in a Patient on Treatment with Rifaximin: A Rare Case of Acute Phototoxic Drug Reaction

Mahajan¹,

Singh²,

Thakur³

et al. 2022

EMJ Dermatol

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This paper describes an unreported case of a rifaximin-induced phototoxic reaction in an otherwise healthy 24-year-old female (skin type: V). The patient developed malaise, chills, and facial swelling with accompanying redness and itching that began within a day of initiating treatment with rifaximin (200 mg twice daily), and progressively increased over the next 3–4 days. The patient revealed that they had been lying in the sun for hours due to the chills they were experiencing. Over the next 10 days they developed an exaggerated, acute, sunburn-like phototoxic reaction, with blistering over the exposed skin. A skin biopsy showed no evidence of vasculopathy, endothelial damage, or extravasation of red blood cells. The patient was treated successfully with oral prednisolone (30 mg per day for a week), topical mometasone furoate (0.1%) cream applied twice daily, levocetirizine (5 mg per day taken orally), zinc oxide (20.0%) cream applied every 3 hours during daytime, and strict sun avoidance. The possible pathomechanism of rifaximin-induced sunburn is also discussed here.

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“…The most common causes of drug-induced SCLE are proton-pump inhibitors (PPIs), antihypertensives (especially thiazide diuretics and calcium channel blockers), anticonvulsants, and antibiotics. 37,38 Recently, cases of patients with preexisting SLE who subsequently developed SCLE after exposure to antihypertensives or PPIs have been described. 37 It should be noted that SLE patients on systemic corticosteroids are often placed on PPIs prophylactically to prevent gastrointestinal side effects.…”

Section: Subacute Cutaneous Lupus Erythematosusmentioning

confidence: 99%

“…37,38 Recently, cases of patients with preexisting SLE who subsequently developed SCLE after exposure to antihypertensives or PPIs have been described. 37 It should be noted that SLE patients on systemic corticosteroids are often placed on PPIs prophylactically to prevent gastrointestinal side effects. Adding to the risk of drug-induced SCLE is the fact that there are several over-the-counter forms of PPIs now available to the public in the USA.…”

Section: Subacute Cutaneous Lupus Erythematosusmentioning

confidence: 99%

Cutaneous Involvement in Systemic Lupus Erythematosus: A Review for the Rheumatologist

2022

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The majority of patients with systemic lupus erythematosus (SLE) have cutaneous manifestations at some point in their disease. The skin findings in lupus erythematosus are classified as lupus-specific or lupus-nonspecific based on histopathologic findings. Lupus-specific skin diseases include chronic cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and acute cutaneous lupus erythematosus. There are subsets of skin lesions within each group and the likelihood of associated SLE varies amongst them. Lupus nonspecific lesions are more common in patients with SLE and tend to coincide with active systemic disease. Lupus nonspecific lesions may be seen as a feature of another disease process, including other connective tissue diseases. It is important for the rheumatologist to be familiar with the spectrum of cutaneous disease in lupus erythematosus to help prognosticate the likelihood of systemic disease and ensure patients receive timely dermatologic care with the goal of controlling disease activity to prevent damage.

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Drug-induced subacute cutaneous lupus erythematosus in previously diagnosed systemic lupus erythematosus patients: A case series

Cited by 7 publications

References 7 publications

Proton pump inhibitor induced subacute cutaneous lupus erythematosus: Clinical characteristics and outcomes

Proton pump inhibitor induced subacute cutaneous lupus erythematosus: Clinical characteristics and outcomes

Severe Sunburn-Like Adverse Cutaneous Drug Reaction in a Patient on Treatment with Rifaximin: A Rare Case of Acute Phototoxic Drug Reaction

Cutaneous Involvement in Systemic Lupus Erythematosus: A Review for the Rheumatologist

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