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Drug-induced lupus erythematosus.
G Ital Dermatol Venereol. 2014 Jun; 149(3):301-9.GI

Abstract

Drug-induced lupus erythematosus (DI-LE) is defined as an entity characterized by clinical manifestations and immunopathological serum findings similar to those of idiopathic lupus but which is temporally related to drug exposure and resolves after withdrawal of the implicated drug. Similarly to idiopathic lupus, DI-LE can be divided into systemic LE, subacute cutaneous LE (SCLE), chronic cutaneous LE (CCLE) and cutaneous LE tumidus. DI-SCLE is the most frequent variant of drug-induced cutaneous LE and presents mainly with annular-polycyclic lesions; the clinical picture is often widespread, with involvement of the lower legs that are usually spared in idiopathic SCLE. ANA and anti-Ro/SSA antibodies are typically present, whereas antihistone antibodies are uncommonly found. We have recently addressed the question whether DI-SCLE differs significantly from its idiopathic counterpart by virtue of clinical features and, based on our findings, we have suggested that the frequent occurrence of malar rash and bullous, erythema multiforme-like and vasculitic manifestations can be regarded as the hallmark of DI-SCLE. In contrast, the histology is not a useful diagnostic criterion for DI-SCLE, considering that the typical pattern of lichenoid interface dermatitis is seen only in the early stage of disease and tissue eosinophilia does not represent a differentiating histopathological feature. DI-CCLE and DI-LE tumidus, albeit possibly misdiagnosed, are rarely observed and are characterized by classic discoid lesions and erythematous-oedematous plaques on sun exposed areas, respectively. Management of DI-LE is based on the discontinuation of the offending drug; topical and/or systemic corticosteroids and other immunomodulating/immunosuppressive agents should be reserved for resistant cases.

Authors+Show Affiliations

Marzano AV
Operative Unit of Dermatology Department of Pathophysiology and Transplantation University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy - angelovalerio.marzano@policlinico.mi.it.
Tavecchio S
No affiliation info available
Menicanti C
No affiliation info available
Crosti C
No affiliation info available

MeSH

AdultAgedAged, 80 and overAntibodies, AntinuclearBiomarkersDrug Therapy, CombinationFemaleGlucocorticoidsHumansImmunologic FactorsImmunosuppressive AgentsLegLupus Erythematosus, CutaneousLupus Erythematosus, DiscoidLupus Erythematosus, SystemicMaleMiddle AgedTorsoTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24819757

Citation

Marzano, A V., et al. "Drug-induced Lupus Erythematosus." Giornale Italiano Di Dermatologia E Venereologia : Organo Ufficiale, Societa Italiana Di Dermatologia E Sifilografia, vol. 149, no. 3, 2014, pp. 301-9.
Marzano AV, Tavecchio S, Menicanti C, et al. Drug-induced lupus erythematosus. G Ital Dermatol Venereol. 2014;149(3):301-9.
Marzano, A. V., Tavecchio, S., Menicanti, C., & Crosti, C. (2014). Drug-induced lupus erythematosus. Giornale Italiano Di Dermatologia E Venereologia : Organo Ufficiale, Societa Italiana Di Dermatologia E Sifilografia, 149(3), 301-9.
Marzano AV, et al. Drug-induced Lupus Erythematosus. G Ital Dermatol Venereol. 2014;149(3):301-9. PubMed PMID: 24819757.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Drug-induced lupus erythematosus. AU - Marzano,A V, AU - Tavecchio,S, AU - Menicanti,C, AU - Crosti,C, PY - 2014/5/14/entrez PY - 2014/5/14/pubmed PY - 2014/10/11/medline SP - 301 EP - 9 JF - Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia JO - G Ital Dermatol Venereol VL - 149 IS - 3 N2 - Drug-induced lupus erythematosus (DI-LE) is defined as an entity characterized by clinical manifestations and immunopathological serum findings similar to those of idiopathic lupus but which is temporally related to drug exposure and resolves after withdrawal of the implicated drug. Similarly to idiopathic lupus, DI-LE can be divided into systemic LE, subacute cutaneous LE (SCLE), chronic cutaneous LE (CCLE) and cutaneous LE tumidus. DI-SCLE is the most frequent variant of drug-induced cutaneous LE and presents mainly with annular-polycyclic lesions; the clinical picture is often widespread, with involvement of the lower legs that are usually spared in idiopathic SCLE. ANA and anti-Ro/SSA antibodies are typically present, whereas antihistone antibodies are uncommonly found. We have recently addressed the question whether DI-SCLE differs significantly from its idiopathic counterpart by virtue of clinical features and, based on our findings, we have suggested that the frequent occurrence of malar rash and bullous, erythema multiforme-like and vasculitic manifestations can be regarded as the hallmark of DI-SCLE. In contrast, the histology is not a useful diagnostic criterion for DI-SCLE, considering that the typical pattern of lichenoid interface dermatitis is seen only in the early stage of disease and tissue eosinophilia does not represent a differentiating histopathological feature. DI-CCLE and DI-LE tumidus, albeit possibly misdiagnosed, are rarely observed and are characterized by classic discoid lesions and erythematous-oedematous plaques on sun exposed areas, respectively. Management of DI-LE is based on the discontinuation of the offending drug; topical and/or systemic corticosteroids and other immunomodulating/immunosuppressive agents should be reserved for resistant cases. SN - 0392-0488 UR - https://www.unboundmedicine.com/medline/citation/24819757/Drug_induced_lupus_erythematosus_ DB - PRIME DP - Unbound Medicine ER -