Subacute cutaneous lupus erythematosus during puva therapy for psoriasis: Case report and review of the literature

Abstract

Lesions typical of subacute cutaneous lupus erythematosus developed in an elderly woman after 6 months of PUVA (8-methoxypsoralen and longwave ultraviolet light) therapy for psoriasis. Pancytopenia, antibodies to double-stranded DNA, and hypocomplementemia developed concurrently with the appearance of the cutaneous lesions. With discontinuation of photochemotherapy, the cutaneous lesions disappeared and the pancytopenia improved.

Extracorporeal photochemotherapy for the treatment of systemic lupus erythematosus. A Pilot study

“…Importantly, ECP did not induce clinical or serologic exacerbation of SLE in any of our patients. This is in contrast to the finding of induction of connective tissue disease during psoralen ultraviolet A treatment for psoriasis (16). The mechanisms by which ECP causes clinical improvement are yet to be elucidated.…”

A systematic review of drug-induced subacute cutaneous lupus erythematosus

“…The median incubation time was 6 weeks. The mean and median overall time 30 3 cases Nitrendipine 31 1 case Diuretics Hydrochorothiazide 3,10,22 10 cases Hydrochlorothiazide + triamterene 6 3 cases Chlorthiazide 5 2 cases Beta blockers Oxprenolol 32 4 cases Acebutolol 33 1 case Angiotensin-converting enzyme inhibitors Enalapril 10 2 cases Lisnopril 10 1 case Captopril 34 1 case Cilazapril 34 1 case Antifungals 30 of 117 reported cases: 25AE6% Terbinafine 12,14-16, [35][36][37] 29 cases Griseofulvin 13 1 case Chemotherapeutics 10 of 117 reported cases: 8AE5% Docetaxel 38 3 cases Paclitaxel 24, 38 3 cases Tamoxifen 39 2 cases Capecitabine 40, 41 2 cases Antihistamines 9 of 117 reported cases: 7AE7% Ranitidine 42 7 cases Brompheniramine 42 1 case Cinnarizine + thiethylperazine 43 1 case Immunomodulators 8 of 117 reported cases: 6AE8% Leflunomide 9,17,25, 44 5 cases Interferon a and b 10, 45 3 cases Antiepileptics 3 of 117 reported cases: 2AE6% Carbamazepine 46, 47 2 cases Phenytoin 48 1 case Statins 3 of 117 reported cases: 2AE6% Simvastatin 10, 49 2 cases Pravastatin 10 1 case Biologics 2 of 117 reported cases: 1AE7% Etanercept 50 1 case Efalizumab 51 1 case Proton pump inhibitors 2 of 117 reported cases: 1AE7% Lansoprazole 52 2 cases Nonsteroidal anti-inflammatory drugs 2 of 117 reported cases: 1AE7% Naproxen 53 1 case Piroxicam 26 1 case Hormone-altering drugs 2 of 117 reported cases: 1AE7% Leuprorelin 19 1 case Anastrozole 18 1 case Ultraviolet therapy 2 of 117 reported cases: 1AE7% PUVA 54 1 case PUVA and UVB 20 1 case Others 4 of 117 reported cases: 3AE4% Bupropion…”

“…Upon discontinuation of the offending drug, the lesions typically resolved in a matter of weeks. Nine cases appeared to require active treatment for DI‐SCLE resolution: four cases induced by terbinafine, 12,14–16 two of the five reported cases caused by leflunomide, 9,17 one case caused by anastrozole, 18 one by leuprorelin, 19 and one case of psoralen plus ultraviolet A treatment 20 . Active treatments employed will be discussed below.…”

British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015

“…The rate of inducing PLE was estimated to be 50% compared with 62% with NB‐UVB in one study . Theoretically, exacerbation or induction of lupus can occur, and there are case reports of the coincidence of PUVA with the development of lupus …”

“…81 Theoretically, exacerbation or induction of lupus can occur, and there are case reports of the coincidence of PUVA with the development of lupus. [202][203][204] Drug phototoxicity In general, drug phototoxicity is not a major problem because of the overwhelming effect of psoralen photosensitization, and as long as MPD assessment is performed on the patient's drug regimen, this can be largely avoided. 200 However, pseudoporphyria can occur, as with some of the other phototoxic drugs such as the fluoroquinolones, nonsteroidals, tetracyclines and diuretics, and is more likely to occur after minor trauma and on acral sites.…”