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Fleshman T, Depew I, Snider W, Cook S. Subacute Cutaneous Lupus Erythematosus Secondary to Intravenous Immunoglobulin Infusions. Cureus 2024; 16:e63217. [PMID: 39070403 PMCID: PMC11281939 DOI: 10.7759/cureus.63217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
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.
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Affiliation(s)
- Taylor Fleshman
- Dermatology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Ian Depew
- Dermatology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - William Snider
- Dermatology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Shane Cook
- Dermatology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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2
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Ashish S, Raj M, Zhuang E. Bevacizumab-Induced Cutaneous Lupus Erythematosus in a Patient With Metastatic Colon Carcinoma: A Case Report. Cureus 2024; 16:e56559. [PMID: 38646279 PMCID: PMC11028020 DOI: 10.7759/cureus.56559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Bevacizumab, an anti-vascular epidermal growth factor inhibitor, is approved for the treatment of various cancers. Hypertension, gastrointestinal perforation, bleeding manifestations, impaired wound healing, and cerebrovascular accidents are common side effects associated with the monoclonal antibody. Uncommon cutaneous reactions like exfoliative dermatitis associated with bevacizumab have been documented in the medical literature. We present an unusual case of bevacizumab-induced cutaneous lupus in a patient with metastatic colon cancer that started resolving after discontinuing chemotherapy. Timely intervention was key in preventing the progression of this chemotherapy-induced cutaneous lupus.
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Affiliation(s)
- Sethi Ashish
- Infectious Disease, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Moses Raj
- Hematology and Oncology, Allegheny Health Network, Pittsburgh, USA
| | - Eric Zhuang
- Hematology and Medical Oncology, Allegheny Health Network, Pittsburgh, USA
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3
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Au M, Heddle G, Young E, Ryan E, Graf S, Tee D, Philpott H. Anti-tumour necrosis factor-induced skin rashes in inflammatory bowel disease: a systematic review and evidence-based management algorithm. Intern Med J 2023; 53:1854-1865. [PMID: 35760771 DOI: 10.1111/imj.15859] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anti-tumour necrosis factor alpha (anti-TNF) agents are a highly effective treatment for inflammatory bowel disease (IBD). Skin lesions, including psoriasiform, eczematous and lupoid eruptions, may paradoxically result from anti-TNF use and cause significant morbidity leading to discontinuation of therapy. There are no consensus guidelines on the management of these lesions. AIMS This systematic review considers the existing evidence regarding cutaneous complications of anti-TNF therapy in IBD and the development of an algorithm for management. METHODS A systematic review was performed by searching Medline (Pubmed) and Embase for articles published from inception to January 2021. The following search terms were used 'anti-tumour necrosis factor alpha', 'infliximab', 'adalimumab', 'certolizumab', 'golimumab', 'inflammatory bowel disease', 'Crohn disease', 'Ulcerative colitis', 'psoriasis', 'psoriasiform', 'dermatitis', 'lupus', 'skin lesion' and 'skin rash'. Reference lists of relevant studies were reviewed to identify additional suitable studies. RESULTS Thirty-four studies were included in the review. Eczema can generally be managed with topical agents and the anti-TNF can be continued, while the development of lupus requires immediate cessation of the anti-TNF and consideration of alternative immunomodulators. Management of psoriasis and psoriasiform lesions may follow a step-wise algorithm where topical treatments will be trialled in less severe cases, with recourse to an alternative anti-TNF or a switch to an alternative class of biological agent. CONCLUSION Assessment of anti-TNF skin lesions should be performed in conjunction with a dermatologist and rheumatologist in complex cases. High-quality prospective studies are needed to clarify the validity of these algorithms in the future.
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Affiliation(s)
- Minnie Au
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Georgina Heddle
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Edward Young
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Emma Ryan
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Scott Graf
- Wakefield House Rheumatology, Adelaide, South Australia, Australia
| | - Derrick Tee
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Hamish Philpott
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
- Faculty of Medicine and Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
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4
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Heddle G, Tran A, Foster-Smith E, Ball S, Sidhu S. Paraneoplastic subacute cutaneous lupus erythematosus in a patient with metastatic melanoma. Australas J Dermatol 2023; 64:138-140. [PMID: 36658678 DOI: 10.1111/ajd.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/08/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023]
Affiliation(s)
- Georgina Heddle
- SA Pathology, Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - Alain Tran
- SA Pathology, Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - Erwin Foster-Smith
- Dermatology Department, Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - Sally Ball
- SA Pathology, Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - Shireen Sidhu
- SA Pathology, Royal Adelaide Hospital, South Australia, Adelaide, Australia
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5
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Reddy R, Park A, Vandergriff T, Chong BF. Concomitant nondermatologic adverse events in patients who develop immunotherapy-induced subacute cutaneous lupus erythematosus. Dermatol Ther 2022; 35:e15906. [PMID: 36200592 DOI: 10.1111/dth.15906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rasika Reddy
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew Park
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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6
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Király Z, Szepesi Á, Sebestyén A, Kuroli E, Rencz F, Tóth B, Bokor L, Szakonyi J, Medvecz M, Hidvégi B. Immunohistochemical Study of the PD-1/PD-L1 Pathway in Cutaneous Lupus Erythematosus. Pathol Oncol Res 2022; 28:1610521. [PMID: 35979531 PMCID: PMC9377145 DOI: 10.3389/pore.2022.1610521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022]
Abstract
The pathomechanism of various autoimmune diseases is known to be associated with the altered function of programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) axis. We aimed to investigate the role of this pathway and inflammatory cell markers in subtypes of cutaneous lupus erythematosus (CLE): discoid lupus erythematosus (DLE), subacute CLE (SCLE) and toxic epidermal necrolysis (TEN)-like lupus, a hyperacute form of acute CLE (ACLE). Ten skin biopsy samples from 9 patients were analyzed with immunohistochemistry regarding the following markers: CD3, CD4, CD8, Granzyme B, CD123, CD163, PD-1, PD-L1. Our group consisted of 4 SCLE (2 idiopathic (I-SCLE) and 2 PD-1 inhibitor-induced (DI-SCLE)), 4 DLE and 1 TEN-like lupus cases. From the latter patient two consecutive biopsies were obtained 1 week apart. Marker expression patterns were compared through descriptive analysis. Higher median keratinocyte (KC) PD-L1 expression was observed in the SCLE group compared to the DLE group (65% and 5%, respectively). Medians of dermal CD4, Granzyme B (GB), PD-1 positive cell numbers and GB+/CD8+ ratio were higher in the DLE group than in the SCLE group. The I-SCLE and DI-SCLE cases showed many similarities, however KC PD-L1 expression and dermal GB positive cell number was higher in the former. The consecutive samples of the TEN-like lupus patient showed an increase by time within the number of infiltrating GB+ cytotoxic T-cells and KC PD-L1 expression (from 22 to 43 and 30%–70%, respectively). Alterations of the PD-1/PD-L1 axis seems to play a role in the pathogenesis of CLE.
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Affiliation(s)
- Zsófia Király
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- *Correspondence: Zsófia Király,
| | - Ágota Szepesi
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Anna Sebestyén
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Béla Tóth
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Laura Bokor
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - József Szakonyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Bernadett Hidvégi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
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7
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Cutaneous drug-induced lupus erythematosus: Clinical and immunological characteristics and update on new associated drugs. Ann Dermatol Venereol 2021; 148:211-220. [PMID: 34711400 DOI: 10.1016/j.annder.2021.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/24/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023]
Abstract
Cutaneous drug-induced lupus erythematosus (CDILE) is a lupus-like syndrome related to drug exposure which typically resolves after drug discontinuation. It can present as a systemic or a sole cutaneous form and different drugs may be associated with each form. CDILE pharmacoepidemiology is constantly changing. Indeed, older drugs primarily associated with systemic CDILE are no longer prescribed and new drugs associated with either cutaneous or systemic CDILE have emerged. The present study discusses the clinical and laboratory aspects of CDILE and the postulated pathogenesis, and it provides an update on implicated drugs. We performed a literature review to single out the new drugs associated with CDILE in the past decade (January 2010-June 2020). Among 109 drugs reported to induce CDILE in 472 patients, we identified anti-TNFα, proton-pump inhibitors, antineoplastic drugs, and, in particular, checkpoint inhibitors, as emerging drugs in CDILE. Most of the published studies are cases reports or small case series, and further larger studies as well as the development of validated classification criteria are needed to better understand and characterize their implication in CDILE.
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8
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Bains A, Rajagopal VS, Vedant D, Elhence P. A Curious Case of Drug-induced Subacute Cutaneous Lupus Erythematosus. Indian Dermatol Online J 2021; 12:772-773. [PMID: 34667773 PMCID: PMC8456261 DOI: 10.4103/idoj.idoj_864_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/23/2020] [Accepted: 03/19/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anupama Bains
- Department of Dermatology, Venereology and Leprology, AIIMS, Jodhpur, Rajasthan, India
| | - Varun S Rajagopal
- Department of Dermatology, Venereology and Leprology, AIIMS, Jodhpur, Rajasthan, India
| | - Deepak Vedant
- Department of Pathology, AIIMS, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology, AIIMS, Jodhpur, Rajasthan, India
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9
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D'Gama JD, Hashemi DA, Fedeles F. A case of paraneoplastic subacute cutaneous lupus erythematosus in a patient with metastatic melanoma. JAAD Case Rep 2021; 15:88-91. [PMID: 34458535 PMCID: PMC8377480 DOI: 10.1016/j.jdcr.2021.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - David A. Hashemi
- Harvard Combined Dermatology Residency Training Program, Harvard Medical School, Boston, Massachusetts
| | - Flavia Fedeles
- Harvard Medical School, Boston, Massachusetts
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Correspondence to: Flavia Fedeles, MD, Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Suite 200, Boston, MA 02114-2517.
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10
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Li Q, Chen K, Deng Y, Liu X, Ma G, Zeng J, Lu J, Zhao M, Wu H, Lu Q. A skin in situ immune cell detection kit for the diagnosis and classification of cutaneous lupus erythematosus. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1062. [PMID: 34422974 PMCID: PMC8339827 DOI: 10.21037/atm-21-959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 11/21/2022]
Abstract
Background Although lupus can be diagnosed by first impression, medical history, physical examination, pathological analysis and laboratory tests, the accurate classification of cutaneous lupus erythematosus (LE) is still a major challenge in the clinic, which might mislead the selection of treatments and miss the right time for the administration of therapies. The goal of this study was to establish a novel kit to assist with the diagnosis and classification of cutaneous lupus. Methods Sixty-five patients from three hospitals were included in this study, including 50 patients with LE and other similar skin diseases. We invited two dermatology specialists to make an accurate diagnosis of the subtypes of lupus based on the patient’s clinical features, laboratory examination tests, pathology manifestation analysis, medical treatments and follow-up records. Then, we used their diagnosis results as a standard to which we successively compared the consistency of each step of our diagnosis processes, including impression diagnosis, pathology diagnosis, the combined consideration of the former two diagnostic analyses, and the results of an in situ immune cell detection kit to assist in arriving at a judgement. Results By Cohen’s kappa analysis, we found that the results of the in situ immune cell detection kit had the highest consistency with the diagnoses of the two specialists, both for the diagnosis (k=0.921) and for the classification of cutaneous lupus (k=0.940). In addition, this kit enhanced the LE classification accuracy by 36.3% compared with the diagnostic accuracy of impression diagnosis combined with only pathological analysis. Conclusions This skin in situ immune cell detection kit may assist doctors in achieving a higher diagnostic performance and price ratio and enhance their diagnostic efficiency.
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Affiliation(s)
- Qianwen Li
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Kaili Chen
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Yueming Deng
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Xiguang Liu
- Department of Dermatology, Hei Long Jiang Provincial Hospital, Heilongjiang, China
| | - Guozhang Ma
- Department of Dermatology, Hei Long Jiang Provincial Hospital, Heilongjiang, China
| | - Jinrong Zeng
- Department of Dermatology, Third Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Jianyun Lu
- Department of Dermatology, Third Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Ming Zhao
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Haijing Wu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China
| | - Qianjin Lu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, China.,Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.,Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
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11
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Bitar C, Menge TD, Chan MP. Cutaneous manifestations of lupus erythematosus: A practical clinicopathologic review for pathologists. Histopathology 2021; 80:233-250. [PMID: 34197657 DOI: 10.1111/his.14440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Accurate diagnosis of connective tissue diseases is often challenging and relies on careful correlation between clinical and histopathologic features, direct immunofluorescence studies, and laboratory workup. Lupus erythematosus (LE) is a prototype of connective tissue disease with a variety of cutaneous and systemic manifestations. Microscopically, cutaneous LE is classically characterized by an interface dermatitis, although other histopathologic patterns also exist depending on the clinical presentation, location, and chronicity of the skin lesions. In this article, we review the clinical, serologic, histopathologic, and direct immunofluorescence findings in LE-specific and LE-nonspecific skin lesions, with an emphasis on lesser known variants, newly described features, and helpful ancillary studies. This review will guide general pathologists and dermatopathologists in accurately diagnosing and subclassifying cutaneous LE.
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Affiliation(s)
- Carole Bitar
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tyler D Menge
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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12
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O'Kane D, McCourt C, Meggitt S, D'Cruz DP, Orteu CH, Benton E, Wahie S, Utton S, Hashme M, Mohd Mustapa MF, Exton LS. British Association of Dermatologists guidelines for the management of people with cutaneous lupus erythematosus (CLE) 2021. Br J Dermatol 2021; 185:1112-1123. [PMID: 34170012 DOI: 10.1111/bjd.20597] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Abstract
The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of cutaneous lupus erythematosus (CLE) in the presence or absence of systemic lupus erythematosus (SLE) in adults, young people and children. The document aims to: offer an appraisal of all relevant literature up to December 2020, focusing on any key developments address important, practical clinical questions relating to the primary guideline objective. provide guideline recommendations and if appropriate research recommendations.
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Affiliation(s)
- D O'Kane
- Department of Dermatology, Belfast Health & Social Care Trust, Belfast, BT9 7AB, U.K
| | - C McCourt
- Department of Dermatology, Belfast Health & Social Care Trust, Belfast, BT9 7AB, U.K
| | - S Meggitt
- Department of Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, NE1 4LP, U.K
| | - D P D'Cruz
- Louise Coote Lupus Unit, NHS Foundation Trust, Guys & St Thomas, London, SE1 9RT, U.K
| | - C H Orteu
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, NW3 2QG, U.K
| | - E Benton
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's & St Thomas, London, SE1 9RT, U.K
| | - S Wahie
- Department of Dermatology, County Durham and Darlington NHS Foundation Trust, DH1 5TW, U.K
| | | | - M Hashme
- Clinical Standards Unit, British Association of Dermatologists, London, W1T 5HQ, U.K
| | - M F Mohd Mustapa
- Clinical Standards Unit, British Association of Dermatologists, London, W1T 5HQ, U.K
| | - L S Exton
- Clinical Standards Unit, British Association of Dermatologists, London, W1T 5HQ, U.K
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13
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Cooper EE, Pisano CE, Shapiro SC. Cutaneous Manifestations of "Lupus": Systemic Lupus Erythematosus and Beyond. Int J Rheumatol 2021; 2021:6610509. [PMID: 34113383 PMCID: PMC8154312 DOI: 10.1155/2021/6610509] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022] Open
Abstract
Lupus, Latin for "wolf," is a term used to describe many dermatologic conditions, some of which are related to underlying systemic lupus erythematosus, while others are distinct disease processes. Cutaneous lupus erythematosus includes a wide array of visible skin manifestations and can progress to systemic lupus erythematosus in some cases. Cutaneous lupus can be subdivided into three main categories: acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus. Physical exam, laboratory studies, and histopathology enable differentiation of cutaneous lupus subtypes. This differentiation is paramount as the subtype of cutaneous lupus informs upon treatment, disease monitoring, and prognostication. This review outlines the different cutaneous manifestations of lupus erythematosus and provides an update on both topical and systemic treatment options for these patients. Other conditions that utilize the term "lupus" but are not cutaneous lupus erythematosus are also discussed.
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Affiliation(s)
- Elizabeth E. Cooper
- Department of Dermatology, Dell Medical School at the University of Texas, Austin 78701, USA
| | - Catherine E. Pisano
- Department of Dermatology, Dell Medical School at the University of Texas, Austin 78701, USA
| | - Samantha C. Shapiro
- Department of Medicine, Division of Rheumatology, Dell Medical School at the University of Texas, Austin 78701, USA
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14
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Hall EL, Peravali R, Patel TS. Omeprazole-Induced Subacute Cutaneous Lupus Erythematosus. JAMA Dermatol 2021; 156:1013. [PMID: 32639541 DOI: 10.1001/jamadermatol.2020.2415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elizabeth L Hall
- Kaplan-Amonette Department of Dermatology, The University of Tennessee Health Science Center, Memphis
| | - Rahul Peravali
- College of Medicine, The University of Tennessee Health Science Center, Memphis
| | - Tejesh S Patel
- Kaplan-Amonette Department of Dermatology, The University of Tennessee Health Science Center, Memphis
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15
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Kawka L, Mertz P, Chasset F, Lebrun-Vignes B, Salem JE, Arnaud L. Characterization of drug-induced cutaneous lupus: Analysis of 1994 cases using the WHO pharmacovigilance database. Autoimmun Rev 2020; 20:102705. [PMID: 33188917 DOI: 10.1016/j.autrev.2020.102705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Lou Kawka
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO), Université de Strasbourg, F-67000 Strasbourg, France
| | - Philippe Mertz
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO), Université de Strasbourg, F-67000 Strasbourg, France
| | | | - Bénédicte Lebrun-Vignes
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1421, Regional Pharmacovigilance Center, INSERM, Sorbonne Universités, F-75013 Paris, France; EA 7379 EpidermE, Université Paris-Est Créteil, UPEC, Créteil F-94010, France
| | - Joe-Elie Salem
- AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology, CIC-1421, Regional Pharmacovigilance Center, INSERM, Sorbonne Universités, F-75013 Paris, France
| | - Laurent Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO), Université de Strasbourg, F-67000 Strasbourg, France.
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16
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Analysis of clinical characteristics of drug-induced cutaneous lupus erythematosus in men. J Am Acad Dermatol 2020; 83:1455-1457. [DOI: 10.1016/j.jaad.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/21/2020] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
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17
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Abstract
Cutaneous adverse drug reactions produce a significant clinical, financial, and psychological burden on our healthcare industry. The importance of considering a drug reaction in the cause of any dermatitis is underscored by the diversity of clinical manifestations and the prolific rate of drug discovery and approval. We present an update on the variety of drug reactions encountered in the inpatient and outpatient setting. Immunomodulatory drugs used in oncology will be reviewed separately as their clinical manifestations cross many reaction patters and morphologies.
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Affiliation(s)
- Robert T Spaulding
- Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky, USA.
| | - Cindy E Owen
- Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Jeffrey P Callen
- Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky, USA
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18
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Bui AN, Hirner J, Singer SB, Eberly-Puleo A, Larocca C, Lian CG, LeBoeuf NR. De novo subacute cutaneous lupus erythematosus-like eruptions in the setting of programmed death-1 or programmed death ligand-1 inhibitor therapy: clinicopathological correlation. Clin Exp Dermatol 2020; 46:328-337. [PMID: 32939795 DOI: 10.1111/ced.14449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 12/30/2022]
Abstract
Immune checkpoint inhibitors (ICI) may cause eruptions resembling cutaneous autoimmune diseases. There are six cases of immunotherapy-associated subacute cutaneous lupus erythematosus (SCLE) in the literature. We present details of five patients referred to the Skin Toxicity Program at the Dana-Farber Cancer Institute/Brigham and Women's Cancer Center who developed de novo immunotherapy-associated SCLE-like eruptions, along with clinicopathological correlation and highlight potential mechanistic features and important diagnostic points. Two patients were maintained on topical corticosteroids, antihistamines and photoprotection. One had complete clearance and two had improvement with addition of hydroxychloroquine. Four patients continued their immunotherapy uninterrupted, while one had immunotherapy suspended for a month before restarting at full dose. Histopathologically, this series illustrates the temporal evolution of ICI-induced immune cutaneous reactions with SCLE subtype. Looking beyond the universally present lichenoid infiltrate, features of evolving SCLE were evident. We hypothesize that programmed death-1 blockade may induce immunological recognition of previously immunologically tolerated drug antigens, leading to epitope spreading and the SCLE phenotype.
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Affiliation(s)
- A N Bui
- Harvard Medical School, Boston, MA, USA
| | - J Hirner
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - A Eberly-Puleo
- Center for Cutaneous Oncology, Department of Dermatology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - C Larocca
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - C G Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - N R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Center for Cutaneous Oncology, Department of Dermatology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
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19
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Zhou X, Yan J, Lu Q, Zhou H, Fan L. The pathogenesis of cutaneous lupus erythematosus: The aberrant distribution and function of different cell types in skin lesions. Scand J Immunol 2020; 93:e12933. [PMID: 32654170 DOI: 10.1111/sji.12933] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/01/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
Abstract
Cutaneous lupus erythematosus (CLE) is an autoimmune disease with a broad range of cutaneous manifestations. In skin lesions of CLE, keratinocytes primarily undergo apoptosis. Interferon-κ(IFN-κ) is belonged to type I interferons (type I IFNs) and is selectively produced by keratinocytes. Recently, keratinocytes selectively produced IFN-κ is identified to be a key to trigger type I interferon responses in CLE. Other immune cells such as plasmacytoid dendritic cells (pDCs) are identified to be relevant origin of type I interferons (type I IFNs) which are central to the development of CLE lesions and responsible for mediating Th1 cell activity. Other types of cells such as neutrophils, B cells and Th17 cells also are involved in the development of this disease. The close interaction of those cells composes a comprehensive and complicated network in CLE. In this review, we discussed the aberrant distribution and function of different cells types involved in this disease and will offer a new direction for research and therapy in the near future.
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Affiliation(s)
- Xinyu Zhou
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Jinli Yan
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Qianjin Lu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, Second Xiangya Hospital of Central South University, Changsha, China
| | - Honghao Zhou
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Lan Fan
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
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20
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Wang L, Chen SY, Ju Q. A case of recombinant human follitropin alfa-induced subacute cutaneous lupus erythematosus presenting with erythema multiforme-like lesion. Lupus 2020; 29:1824-1825. [PMID: 32847460 DOI: 10.1177/0961203320954528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lanqi Wang
- Department of Dermatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, PR China
| | - Selena Ying Chen
- Department of Dermatology, University of California-San Diego, La Jolla, CA, USA
| | - Qiang Ju
- Department of Dermatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, PR China
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21
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McNamara K, Hughes OB, Strowd LC. Cutaneous drug eruptions including serum sickness-like reaction, symmetrical drug-related intertriginous and flexural exanthema, and drug-induced lupus. Clin Dermatol 2020; 38:641-647. [PMID: 33341198 DOI: 10.1016/j.clindermatol.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cutaneous manifestations of drug reactions are common yet vary widely in their appearance and degree of internal organ involvement. Serum sickness--like reactions, symmetrical drug-related intertriginous and flexural exanthem, granulomatous drug eruption, pseudolymphoma, and drug-induced lupus are medication-induced conditions with dermatologic presentations. Many of the conditions discussed are relatively rare but nonetheless demand our attention and understanding. Some of the conditions presented may be more likely encountered in the hospital setting, as is the case with serum sickness-like reactions and drug-induced lupus, whereas others may present to outpatient clinic for diagnosis. Given the similarities in clinical history of patients presenting with these conditions, an understanding of the clinical presentation, pathophysiology, culprit medications, histologic appearance, and serologic characteristics is warranted to correctly diagnose and manage these uncommon adverse reactions. We also discuss how to differentiate some of these conditions from more serious mimickers, as in the case of pseudolymphoma drug reaction mimicking a true lymphoma and drug-induced lupus mimicking acute systemic lupus erythematosus.
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Affiliation(s)
- Kyle McNamara
- Wake Forest University School of Medicine, Department of Dermatology, Winston-Salem, North Carolina, USA
| | - Olivia Bosshardt Hughes
- Wake Forest University School of Medicine, Department of Dermatology, Winston-Salem, North Carolina, USA
| | - Lindsay Chaney Strowd
- Wake Forest University School of Medicine, Department of Dermatology, Winston-Salem, North Carolina, USA.
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22
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Hu YQ, Mu ZL, Zhang JZ. Erythema multiforme-like drug eruption in a patient with systemic lupus erythematosus treated with leflunomide. Dermatol Ther 2020; 33:e13382. [PMID: 32255229 DOI: 10.1111/dth.13382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Yu-Qing Hu
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Zhang-Lei Mu
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | - Jian-Zhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, China
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23
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Abstract
Introduction: There is a growing list of drugs implicated in inducing both subacute and chronic forms of cutaneous lupus erythematosus. It is important to recognize these drugs in order to quickly treat patients with drug induced disease.Areas covered: This paper reviews the current literature describing drugs implicated in causing cutaneous lupus erythematosus. A Pubmed search was used to compile a list of medications implicated up to August 2019. It reviews new classes of drugs identified as causing cutaneous lupus erythematosus, the pathophysiology of the disease process, and current recommendations for treatment of the disease.Expert opinion: Many drugs have been identified as inducing lupus, and many more continue to be described in new reports. Further research is needed to understand this phenomenon, which will aid in the diagnosis and treatment of affected patients.
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Affiliation(s)
- Robert Borucki
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria P Werth
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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24
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Chasset F, Francès C. Current Concepts and Future Approaches in the Treatment of Cutaneous Lupus Erythematosus: A Comprehensive Review. Drugs 2019; 79:1199-1215. [DOI: 10.1007/s40265-019-01151-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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