Cutaneous lupus erythematosus

One of the primary reasons ultraviolet radiation is of interest in the context of autoimmune diseases is because of induction of photosensitive cutaneous lesions (cutaneous lupus erythematosus)82 and dermatomyositis.83 A recent global evaluation of the frequency of dermatomyositis and associated autoantibodies in referral centers around the world showed a positive correlation with the intensity of ultraviolet irradiation at those locations.84... 

Lee LA, Farris AD. Photosensitivity diseases cutaneous lupus erythematosus, J. Investig Dermatol Symp Proc.,. 4, 73, 1999. 

Bonsmann, G. et al, Terbinafine-induced subacute cutaneous lupus erythematosus, J. Amer. Acad. Dermatol., 44, 925, 2001. 

Obekrle N, Klemke CD, Sykora J, Quick S, Stumpf C, Hartmann M, Enk A, Ruzicka T, Krammer PH, Suri-Payer E, Kuhn A Low number of regulatory T cells in skin lesions of patients with cutaneous lupus erythematosus. Arthritis Rheum 2007 56 1910-1920. 

Kreuter A, Gambichler T, Breuckmann E Pawlak EM, Stiicker M, Bader A, Altmeyer P, Freitag M. (2004) Pimecrolimus 1% cream for cutaneous lupus erythematosus. JAm Acad Dermatol 51 407 10. 

Dapsone is approved for the treatment of an autoimmune blistering skin disease, dermatitis herpetiformis. This intensely pruritic eruption is characterized histologically by a dense dermal infiltration of neutrophils and subepidermal blisters. Other skin diseases in which dapsone is helpful are linear immunoglobulin A (IgA) dermatosis, subcorneal pustular dermatosis, leukocytoclastic vasculitis, and a variety of rarer eruptions in which neutrophils predominate, including some forms of cutaneous lupus erythematosus. 

Hydroxychloroquine is approved for the treatment of both systemic and cutaneous lupus erythematosus. Both chloroquine and quinacrine (Atabrine) are also effective in this skin disease. Low-dose chloroquine is used for the therapy of porphyria cutanea tarda in patients in whom phlebotomy has failed or is contraindicated. Other skin diseases in which the drugs are useful (after sunscreens and avoidance of sun exposure) include polymorphous light eruption and solar urticaria. 

Subacute cutaneous lupus erythematosus has been attributed to anastrozole (33). 

Trancart M, Cavailhes A, Balme B, Skowron F. Anastrozole-induced subacute cutaneous lupus erythematosus. Br J Dermatol 2008 158(3) 628-9. 

Pelle MT, Werth VP. Thalidomide in cutaneous lupus erythematosus. Am J Clin Dermatol. 2003 4 379-387. 

Systemic protection, as opposed to application of drug to exposed areas, should be considered when the topical measures fail. Antimalarials such as hydroxychloroquine may be effective for short periods in polymorphic light eruption and in cutaneous lupus erythematosus. 

Crowson AN, Magro CM. Lichenoid and subacute cutaneous lupus erythematosus-like dermatitis associated with antihistamine therapy. J Cutan Pathol 1999 26(2) 95-9. 

Toll A, Campo-Pisa P, Gonzalez-Castro J, Campo-Voegeli A, Azon A, Iranzo P, Lecha M, Herrero C. Subacute cutaneous lupus erythematosus associated with cinnarizine and thiethylperazine therapy. Lupus 1998 7(5) 364-6. 

Photo-induced annular or papulosquamous eruptions due to subacute cutaneous lupus erythematosus with positive antinuclear, anti-Ro, and anti-La antibodies have been reported with verapamil, nifedipine, and diltiazem (113). 

Crowson AN, Magro CM. Subacute cutaneous lupus erythematosus arising in the setting of calcium channel blocker therapy. Hum Pathol 1997 28(l) 67-73. 

Pelle MT, Callen JP. Adverse cutaneous reactions to hydroxychloroquine are more common in patients with dermatomyositis than in patients with cutaneous lupus erythematosus. Arch Dermatol 2002 138(9) 1231-3. 

A 32-year-old woman developed subacute cutaneous lupus erythematosus after exposure to the sun while taking cinnarizine and thiethylperazine for vertigo (7). A similar eruption had occurred 10 years before, after exposure to the sun, while she was taking cinnarizine only. The problem did not occur when she was not taking the drug. 

Although patients treated with etanercept commonly develop new antinuclear antibodies or anti-double-stranded DNA antibodies, there were no reports of cutaneous or systemic lupus erythematosus in early clinical trials. However, since then, at least eight cases have been reported, including five patients with a lupus-like syndrome, two with acute discoid lupus, and one with subacute cutaneous lupus erythematosus (26-29). All were women and they developed their first symptoms 6 weeks to 14 months after the first injection of etanercept. Antinuclear and/or anti-DNA antibodies were positive in most of them. Etanercept was withdrawn in all patients with features of systemic lupus erythematosus, and the symptoms resolved within 2-8 weeks. The skin lesions also improved with local glucocorticoids, despite continued etanercept treatment in two patients with discoid lupus or subacute cutaneous lupus erythematosus. This suggests that etanercept-induced autoantibodies are sometimes associated with clinical autoimmune disease. 

Bleumink GS, ter Borg EJ, Ramselaar CG, Ch Strieker BH. Etanercept-induced subacute cutaneous lupus erythematosus. Rheumatology (Oxford) 2001 40(11) 1317-19. 

Miyagawa S, Okuchi T, Shiomi Y, Sakamoto K. Subacute cutaneous lupus erythematosus lesions precipitated by griseofulvin. J Am Acad Dermatol 1989 21(2 Pt 2) 343-6. Erratum in J Am Acad Dermatol 1990 22(2 Pt 2) 345. 

Ross S, Ormerod AD, Roberts C, Dwyer C, Herriot R. Subacute cutaneous lupus erythematosus associated with phenytoin. Clin Exp Dermatol 2002 27(6) 474-6. 

Cutaneous lupus erythematosus attributed to terbinafine has been reported in two previously healthy women (55,56). In the first patient, the lesions improved but did not resolve completely in the second the symptoms resolved completely with appropriate therapy and the patient remained disease-free after withdrawal of all medication. 

Exacerbation of lupus erythematosus has been reported during terbinafine therapy (55-57,61). Of 21 consecutive patients with subacute cutaneous lupus erythematosus who attended an outpatient dermatology department in Germany during 1 year, 4 had terbinafine-associated disease (62). In addition to high titers of antinuclear antibodies with a homogeneous pattern, anti-Ro(SS-A) antibodies were present in three of the four women, anti-La(SS-B) antibodies were also found. All the... 

Bonsmann G, Schiller M, Luger TA, Slander S. Terbmafme-induced subacute cutaneous lupus erythematosus. J Am Acad Dermatol 2001 44(6) 925-31. 

Among 21 women who took thahdomide, secondary amenorrhea occurred in four who took it for refractory cutaneous lupus erythematosus and in one who took it for aphthous ulcers (84). Menstruation resumed 2-3 months after withdrawal of thalidomide, and in one case amenorrhea recurred after reintroduction, in association with raised serum concentrations of pituitary gonadotrophins. 

Four of thirteen women who took thalidomide for cutaneous lupus erythematosus developed amenorrhea (85). In one case a biopsy showed severe ovarian atrophy and absence of ova or follicles. In another case rechallenge with thalidomide 50 mg/day resulted in amenorrhea, which resolved on withdrawal. 

Parodi A, Romagnoli M, Rebora A. Subacute cutaneous lupus erythematosus-hke eruption caused by hydrochlorothiazide. Photodermatol 1989 6(2) 100-2. 

Reed BR, Huff JC, Jones SK, Orton PW, Ix e LA, Norris DA. Subacute cutaneous lupus erythematosus associated with hydrochlorothiazide therapy. Ann Intern Med 1985 103(1) 49-51. 

Manifestations in the skin are nearly as common as those involving the musculoskeletal system. " The most well known of these is the butterfly rash, which occurs over the bridge of the nose and the malar eminences. The classic butterfly rash is seen in approximately one-half of patients and often is observed after sun exposure. In fact, photosensitivity is common to many SLE patients who present with cutaneous manifestations. Skin lesions characteristic of discoid lupus occur in 10% to 20% of patients with SLE and may occur without other clinical or serologic evidence of lupus. Some individuals are said to develop subacute cutaneous lupus erythematosus, the nature of whose lesions falls between discoid (one type of chronic... 

Patel P, Werth V. Cutaneous lupus erythematosus A review. Dermatol Clin 2002 20 373-385. 

Photosensitivity. Skin reddening due to an abnormal reaction to sunlight. A characteristic symptom of systemic autoimmune diseases (e.g. systemic lupus erythematosus, mixed connective tissue disease), cutaneous and subacute cutaneous lupus erythematosus. 

Subacute cutaneous lupus erythematosus (SCLE). A chronic remitting form of dermatitis characterized by severe photosensitivity and Ro/SS-A and La/SS-B autoantibodies. 

Angotti C (2004) Immunology of cutaneous lupus erythematosus. Clin Dermatol, 22(2) ... 

The antimalarial medications are prescribed to treat cutaneous lupus erythematosus. The nurse would not question this medication. 

Toms-Whittle LM, John LH, Buckley DA. Drug-induced subacute cutaneous lupus erythematosus associated with omeprazole. Clin Exp Dermatol 2011 36 281-3. 

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