Drug-induced subacute cutaneous lupus erythematosus: evidence for differences from its idiopathic counterpart

• Published in: British journal of dermatology (1951) Vol. 165; no. 2; pp. 335 - 341
• Main Authors: Marzano, A.V., Lazzari, R., Polloni, I., Crosti, C., Fabbri, P., Cugno, M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-08-2011; Wiley-Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Dermatology; Diagnosis, Differential; Erythema Multiforme - pathology; Exanthema - pathology; Female; Fluorescent Antibody Technique, Direct; Humans; Lupus Erythematosus, Cutaneous - chemically induced; Lupus Erythematosus, Cutaneous - pathology; Male; Medical sciences; Middle Aged; Skin Diseases, Vesiculobullous - pathology; Sunlight - adverse effects; Vasculitis - pathology; Immunopathology; Connective tissue disease; Skin disease; Dermatology; Systemic disease; Idiopathic; Autoimmune disease; Subacute cutaneous lupus erythematosus
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/j.1365-2133.2011.10397.x

Summary
Background  Drug‐induced subacute cutaneous lupus erythematosus (DI‐SCLE) is a lupus variant with predominant skin involvement temporally related to drug exposure and resolving after drug discontinuation. It usually presents with annular polycyclic or papulosquamous eruptions on sun‐exposed skin and shows serum anti‐Ro/SSA antibodies.
Objectives  To address the question whether DI‐SCLE differs significantly from idiopathic SCLE by virtue of clinical features.
Methods  Ninety patients with SCLE seen in our departments from 2001 to 2010 were reviewed. Eleven of them diagnosed as having DI‐SCLE were evaluated for type of skin lesions, systemic involvement, clinical course, and histopathological, direct immunofluorescence and laboratory findings. The cutaneous features were compared with those of the 79 patients with idiopathic SCLE.
Results  The cutaneous picture was widespread in 82% of patients with DI‐SCLE and in 6% of those with idiopathic SCLE [odds ratio (OR) 66·6, 95% confidence interval (CI) 11·2–394·9; P = 0·0001]. Bullous and erythema multiforme (EM)‐like lesions were present in 45% of patients with DI‐SCLE and in 1% of those with idiopathic SCLE (OR 65·0, 95% CI 6·5–649·6; P = 0·0001). Vasculitic lesions were observed in 45% of patients with DI‐SCLE and in 3% of those with idiopathic SCLE (OR 32·1, 95% CI 5·1–201·7; P = 0·0001). Malar rash occurred in 45% of patients with DI‐SCLE and in 6% of those with idiopathic SCLE (OR 12·3, 95% CI 2·8–54·9; P = 0·001). Visceral manifestations were excluded in all patients with DI‐SCLE. Anti‐Ro/SSA antibodies were found in all but one patient with DI‐SCLE and disappeared after resolution in 73% of cases.
Conclusions  DI‐SCLE differs from idiopathic SCLE by virtue of distinctive cutaneous features, particularly the widespread presentation and the frequent occurrence of malar rash and bullous, EM‐like and vasculitic manifestations.