Terbinafine-induced subacute cutaneous lupus erythematosus in two patients with systemic lupus erythematosus successfully treated with topical corticosteroids

Abstract

So far in the literature there have been reported only 5 patients with a recognized and well-documented history of systemic lupus erythematosus (SLE) who developed SCLE after terbinafine introduction. Here we report two women suffering from SLE who developed SCLE after initiation of oral terbinafine for onychomycosis. Skin lesions in both of them were extensive, located on the trunk, and upper and lower extremities. No exacerbation of SLE symptoms was observed at that time. Despite severe skin lesions, patients revealed good response to topical corticosteroids within a few weeks. The systemic review of the literature and our experience on terbinafine-induced SCLE developing in patients with SLE allowed to create a description for this special subset: a) terbinafine-induced SCLE usually develop in 1–8 weeks after terbinafine introduction, b) skin lesions are usually severe, disseminated including lower extremities, c) patients present Ro/SS-A La/SS-B antibodies, but anti-histone antibodies are rarely observed, d) exacerbation of SLE symptoms is rather not observed, e) eruptions clear within 2–8 weeks, f) withdrawal of terbinafine and topical corticosteroids should be considered as a first-line therapy in these cases, g) terbinafine should be carefully used in patients suffering from SLE.

Oral antifungal therapy: Emerging culprits of cutaneous adverse drug reactions

“…It also enhances the cytotoxic reaction dependent on anti-Ro antibodies and keratinocyte damage typical of SCLE. [ 9 ] In our patient, clinical features along with a low positive ANA titre were consistent with SCLE. The symptoms resolved within 10 days of stopping terbinafine.…”

<p>Terapi lesi oral pasien sindrom Stevens-Johnson disertai lupus eritematosus sistemik</p><p>Oral lesion therapy in patients with Stevens-Johnson syndrome with systemic lupus erythematosus</p>

“…[8][9][10] Efek yang ditimbulkan ADR dapat berupa eritema sampai efek samping berat yang mengancam jiwa seperti Stevens Johnson Sindrome (SJS) 11 dan ADR juga dapat memicu terjadinya sistemik lupus eritematous (SLE) pada penderitanya. [12][13][14][15] SJS merupakan reaksi mukokutan akut, ditandai oleh nekrosis epidermis luas dengan keterlibatan minimal 2 membran mukosa yang dipicu oleh obat, jarang karena infeksi dan keganasan. 16 SLE adalah suatu kondisi inflamasi yang berhubungan dengan gangguan autoimun, sistem tubuh menyerang jaringannya sendiri yang menyebabkan kerusakan multiorgan ditandai dengan 4 dari 11 kriteria seperti ruam malar, ruam diskoid, fotosensitifitas, ulser pada rongga mulut, artritis, serositis, gangguan renal, gangguan neurologi, gangguan hematologi, gangguan imunologis, antibodi antinuclear (ANA).…”

Subacute Cutaneous Lupus Erythematosus-Like Drug Eruption Related to Terbinafine in a Male

“…Patients with a history of, or a predisposition to, autoimmune or collagen vascular diseases are inclined to develop druginduced SCLE due to terbinafine therapy. 6,7 There have been reports of patients with systemic lupus erythematosus (SLE) who developed SCLE after terbinafine therapy. 4,6 Although an exacerbation of SLE is not commonly observed in the setting of terbinafine-induced SCLE, one case described a terbinafine-induced flare in a patient with bullous lupus erythematosus.…”

“…6,7 There have been reports of patients with systemic lupus erythematosus (SLE) who developed SCLE after terbinafine therapy. 4,6 Although an exacerbation of SLE is not commonly observed in the setting of terbinafine-induced SCLE, one case described a terbinafine-induced flare in a patient with bullous lupus erythematosus. 5,6 In addition, one case of SCLE that developed during terbinafine therapy for onychomycosis was associated with chilblain lupus.…”