Analysis of clinical characteristics of terbinafine-induced subacute cutaneous lupus erythematosus.

INTRODUCTION: Terbinafine may cause subacute cutaneous lupus erythematosus (SCLE), and we aimed to analyze its clinical characteristics. METHODS: We collected literature on terbinafine-induced SCLE from 1997 to 2023 for retrospective analysis. Thirty-seven patients (33 females and 4 males) were included. RESULTS: The patients have a median age of 49.5 years (range 18-79) and onset time of 5 weeks (range 1-12). SCLE is mainly manifested as annular erythematous (83.3%), scaly erythematous (44.4%), and maculopapular erythematous (13.9%). Mainly, histopathological manifestations are lymphocytic infiltrate (55.6%), hyperkeratosis (38.9%) and keratinocyte necrosis (38.9%). Positive immunological parameters mainly include antinuclear antibody (100.0%), anti-Ro/SSA antibody (94.1%), and anti-La/SSB antibody (72.2%). Past medical history usually includes photosensitivity (33.3%), inflammatory disease (33.33%), and lupus erythematosus (12.1%). Symptoms are completely resolved within a median time of 35 days (range 7-84) after discontinuation of terbinafine and treatment with topical corticosteroids, systemic corticosteroids, hydroxychloroquine, and immunosuppressant. No recurrence was observed within 12 months (range 1.5-48) of follow-up. CONCLUSION: These results suggest that terbinafine-induced SCLE should be comprehensively diagnosed based on clinical symptoms, histopathological manifestations, immunological parameters, and past medical history. Terbinafine should be immediately discontinued when SCLE occurs, while systemic and topical corticosteroids combined with hydroxychloroquine may be an effective treatment.

Dermoscopy for the Differentiation of Subacute Cutaneous Lupus Erythematosus from Other Erythematous Desquamative Dermatoses-Psoriasis, Nummular Eczema, Mycosis Fungoides and Pityriasis Rosea.

Subacute cutaneous lupus erythematosus (SCLE) is a condition that might pose a diagnostic challenge. The aim of this study was to assess the usefulness of videodermoscopy in the differentiation of SCLE from other erythematous-desquamative dermatoses. Consecutive patients with SCLE (n = 27), psoriasis (n = 36), nummular eczema (n = 30), mycosis fungoides (n = 26), and pityriasis rosea (n = 20) referred to our Department of Dermatology were recruited for this study. A representative lesion was visualized using a Canfield D200EVO Videodermatoscope (Canfield Scientific GmbH, Bielefeld, Germany) and evaluated for the following parameters: vessels (morphology and distribution), scales (color and distribution), follicular findings, colors and morphologies, and presence of specific clues. SCLE was predominantly characterized by a polymorphous vascular pattern (92.6%) of unspecific distribution (92.6%) over a pink-red background (74.1%). Gray-brown dots were present in 10 (37.0%) cases, and pigmentation was noted in 15 (55.6%) patients, including peripheral pigmentation in 7 (25.9%) patients. Videodermoscopic evaluation showed significant differences between SCLE and psoriasis, which was characterized by regularly distributed dotted vessels. Although some common dermoscopic features with MF were noted, the presence of yellow structureless areas and red dots/globules favored the diagnosis of MF. In conclusion, a polymorphic vascular pattern, especially in association with gray-brown dots and/or peripheral pigmentation, is a valuable clue for the differentiation of SCLE from other erythematous-desquamative dermatoses.

Subacute Cutaneous Lupus Erythematosus Secondary to Intravenous Immunoglobulin Infusions.

Subacute cutaneous lupus erythematosus (SCLE) is a variant of cutaneous lupus erythematosus (CLE) characterized by distinct skin lesions. Clinical manifestations typically include annular or psoriasiform skin lesions, often localized in sun-exposed areas such as the chest and back. The pathogenesis of SCLE is largely unknown, and contributing factors include genetics, environmental exposures, and immunological dysregulation. SCLE may be idiopathic or drug-induced, with common triggers being calcium channel blockers, thiazide diuretics, and terbinafine. Intravenous immunoglobulin (IVIG) treatment, frequently used in various autoimmune conditions, has a rare association with SCLE. We report a case in which this condition arose during IVIG treatment for chronic inflammatory demyelinating polyneuropathy (CIDP). Knowledge of this rare effect is beneficial to all providers who prescribe IVIG, including neurology, rheumatology, and dermatology.

Lupus Erythematosus Tumidus as a Distinct Uncommon Subtype of Cutaneous Lupus Erythematosus: A Case Report and Review.

Lupus erythematosus tumidus (LET) is an uncommon but distinct photosensitive subtype of cutaneous lupus erythematosus (CLE). It differs from discoid and subacute cutaneous lupus erythematosus (SCLE) clinically and pathologically. LET is marked by extreme photosensitivity and carries a much lower risk of progression to systemic disease. The differential diagnosis of LET includes polymorphic light eruption (PMLE) and Jessner's lymphocytic infiltration of the skin (JLIS) because of subtle alterations in the histopathology and the paucity of immunopathologic markers in LET. We report herein a case of LET with positive immunoglobulin (Ig) deposits on direct immunofluorescence (DIF) testing. LET resolved completely with strict sun avoidance and treatment with topical corticosteroids, without the sequelae of atrophy, scarring, or dyspigmentation.

Lupus eritematoso cutáneo subagudo (LECSA): a propósito de 17 casos con anticuerpo anti-Ro positivo / Subacute cutaneous lupus erythematosus (SCLE): 17 patients with anti-Ro antibodies

Se presentan, analizan y comparan con otras series los hallazgos dermatológicos, clínicos, histopatológicos e inmunológicos de 17 casos de lupus eritematoso cutáneo subagudo (LECSA) con anticuerpos (Ac) anti-Ro positivos.Las manifestaciones dermatológicas de nuestros pacientes fueron lesiones papuloescamosas policíclicas, más frecuentes que las psoriasiformes. Se localizaban preferentemente en miembros superiores, dorso y zonas de exposición sola. Presentaban un borde eritematovesiculoso bien delimitado. Otras lesiones adoptaron la forma de reloj de arena. Estas manifestaciones fueron recurrentes con períodos de actividad y calma. También fueron relevantes la fotosensibilidad, la hipopigmentación y, en algunos casos, discreta atrofia. Histopatológicamente lo más destacable fue la degeneración vacuolar de la capa basal de queratinocitos y la ausencia de hiperqueratosis folicular, diferenciándose del lupus eritematoso discoide crónico (LEDC). Las restantes lesiones se parecían a las del lupus eritematosos sistémico (LES), pero con menor intensidad. Hubo poco engrosamiento de la menbrana basal PAS positiva, y el infiltrado linfocitario subpapilar y perivascular fue escaso. En algunos casos se demostró edema dérmico alcian blue positivo, poniendo de manifiesto la presencia de mucina. A diferencia de lo relatado por otros autores, encontramos discreta atrofia en 4 pacientes. Lo más significativo de los exámenes inmunológicos fue la presencia del Ac anti-Ro en el 100% de los enfermos y el anti-La solo en el 17,6%. Fue criterio de inclusión para esta serie tener anti-Ro positivo con anti-ADN y anti-Sm negativos. El FAN fue positivo en el 70%. Con respecto a las manifestaciones clínicas generales, se observaron artritis/artralgias en el 100% de los casos. Las lesiones fueron simétricas, no erosivas ni deformantes. Un solo enfermo tuvo pleuresia y glomerulonefritis crónica difusa...

Clinical, histopathologic, and immunological findings in 17 patients with subacute cutaneous lupus erythematosus (SCLE) and Roantibodies are described. Skin manifestations consisted of recurrent, polycyclical, circumscribed papulosquamous, psoriasiform, or hourglass-like lesions with vesiculoerythematous borders, mainly on the upper limbs, back, and sun-exposed areas. Photosensitivity, hypopigmentation, and occasionally mild atrophy were also noted. Histopathologic features included vacuolar degenerative changes involving keratinocyte basement membrane. Unlike chronic discoid lupus erythematosus lesions, follicular hyperkeratosis was absent. Although other characteristics were similar to those seen in systemic lupus erythematosus patients, specimens from SCLE showed less basement membrane thickening and inflammatory cell infiltrates. A few samples revealed positive alcian blue staining for dermal mucin. Only four patients had moderateatrophy. Since only Ro-positive, and DNA- and Sm-negative patients were assessed, immunological studies showed Ro antibodies in 100%of cases and La antibodies in 17.6%. FAN measurements using rat liver and Hep-2 cells were positive in 70% of patients. SCLE was associated with symmetrical, non-erosive, and non-deforming arthritis/arthralgia in all patients, vasculitis in three (17.8%), Raynaud’s syndrome in two (11.8%), pleuritis and chronic glomerulonephritis in one, and panniculitis in one. Ro antibody screening tests were reviewed.

Lúpus eritematoso cutâneo subagudo / Subacute cutaneous lupus erythematosus

O lúpus eritematoso cutâneo subagudo (LECS) é observado em cerca de 10 por cento dos pacientes com LE e foi caracterizado em 1979, por Sontheimer. A fotossensibilidade é marcante e o curso clínico relativamente benigno com febre, astenia e envolvimento do sistema nervoso central. O comprometimento renal é raro e quando ocorre é de forma discreta. O tratmento na maioria dos pacientes consiste de protetores solares, corticosteróides tópicos e antimaláricos.

Subacute cutaneous lupus erythematosus (SCLE) is in about 10% of patients with LE and it was characterized, in 1979, by Sontheimer. This subset exhibits prominent photosensitivity and relatively benign course. Fever, malaise and central nervous system involvement occur. Renal disease is mild and infrequent. SCLE condition in most patients is controlled with sunscreens, topical corticosteroid and antimalarial drugs.