What are the other Names for this Condition? (Also known as/Synonyms)

• Drug-Induced CCLE
• Medication-Induced CCLE
• Medication-Induced Chronic Cutaneous Lupus Erythematosus

What is Drug-Induced Chronic Cutaneous Lupus Erythematosus? (Definition/Background Information)

• Chronic Cutaneous Lupus Erythematosus (CCLE) is a subtype of cutaneous lupus erythematosus (CLE) that form a group of longstanding autoimmune disorders affecting the skin primarily
• Drug-Induced Chronic Cutaneous Lupus Erythematosus develops secondary to the use of certain medication as an adverse reaction of the body. This condition is reportedly very rare and may occur many months after the start of medication usage
• The offending medication that triggers the lupus-like symptoms in the body includes certain non-steroidal anti-inflammatory drugs, antifungals, and cancer medication
• Drug-Induced Chronic Cutaneous Lupus Erythematosus is characterized by red skin rashes, usually on the head and neck area, arms, and chest and back (sun-exposed areas). In some cases, the mucosal membranes may be affected
• Stopping or discontinuing the use of the causative medications may decrease the progression of Drug-Induced Chronic Cutaneous Lupus Erythematosus and/or may result in the resolution of the condition. The prognosis is good in a majority of cases with adequate treatment

Who gets Drug-Induced Chronic Cutaneous Lupus Erythematosus? (Age and Sex Distribution)

• Drug-Induced Chronic Cutaneous Lupus Erythematosus is a rare form of lupus
• It may affect individuals of any age group since Drug-Induced CCLE is caused by the use of medications. The average age of onset is about 59 years
• Both males and females are affected
• No racial or ethnic group predilection is observed, and the condition is observed worldwide. However, fair-skinned people are more at risk than dark-skinned people

What are the Risk Factors for Drug-Induced Chronic Cutaneous Lupus Erythematosus? (Predisposing Factors)

The key risk factor for Drug-Induced Chronic Cutaneous Lupus Erythematosus is the use of certain medications that cause the condition as a side effect. The medications observed to induce this abnormal skin condition may include:

• Certain antifungal medication
• Chemotherapy agents such as fluorouracil
• Non-steroidal anti-inflammatory drugs (or NSAIDs)
• Tumor necrosis factor antagonists

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Drug-Induced Chronic Cutaneous Lupus Erythematosus? (Etiology)

• Drug-Induced Chronic Cutaneous Lupus Erythematosus develops from the use of certain medications/drugs that are used for various health conditions
• It is believed that the offending drug potentially causes an abnormal cell-mediated immune response in the body
• Sometimes, the appearance of signs and symptoms due to the drug may not be observed immediately after starting the medication. The condition may arise after a period of time

In general, the symptoms of Drug-Induced CCLE appear about 8 months after starting use of the particular medication.

What are the Signs and Symptoms of Drug-Induced Chronic Cutaneous Lupus Erythematosus?

The signs and symptoms of Drug-Induced Chronic Cutaneous Lupus Erythematosus may vary from one individual to another. It may be mild in some individuals or severe in others and is related to the type and usage of the drug. The signs and symptoms may include:

• The presence of red skin lesions or thickened patches; discoid lesions are usually present
• There may be loss of hair in the affected skin region
• The lesions may be painful or painless; there may be itching at the site
• The usual sites of presentation are the head and neck region (including the face), and the arms, and trunk
• Involvement of mucosal membranes may be noted; thus, ulcers can form on the genital mucosa, lips, mouth, and inside the nasal cavity
• The skin lesions may heal with scarring
• Increased or decreased skin pigmentation
• Exposure to sunlight can make the condition worse

The onset of Drug-Induced CCLE may be slow or rapid. In some cases, it may not be immediately observed but may take days and weeks to manifest. In some cases, it may even take much longer.

In general, for lupus, certain factors are known to worsen the signs and symptoms (causing flare-ups) that include:

• Trauma
• Smoking
• Certain viral infections
• Exposure to outside sunshine or inside sources of ultraviolet and visible light
• Hormonal influence

How is Drug-Induced Chronic Cutaneous Lupus Erythematosus Diagnosed?

Drug-Induced Chronic Cutaneous Lupus Erythematosus may be diagnosed using the following tests and exams:

• Complete physical examination with a comprehensive evaluation of one’s medical history (which includes the use of any drug/medication). The condition is known to get better after the stoppage of the offending medication
• Assessment of the signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood tests that include:
  • Routine blood testing (sedimentation rate/C-reactive protein)
  • Antinuclear antibody (ANA) levels blood test to look for antibodies in blood. The test is positive in up to two-thirds of the individuals
  • Serological blood test for anti-double-stranded DNA (ds-DNA); the test results are usually negative
  • Extractable nuclear antigen antibodies panel blood test to detect anti-Ro antibodies and anti-La antibodies. The test results are usually negative
  • Blood chemistry panels
• Body fluid analysis, if needed
• Skin/tissue biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed), and microscope findings, the pathologist arrives at a definitive diagnosis
• Direct immunofluorescence studies on tissue biopsies

Note: A skin biopsy will usually be done to confirm the diagnosis. Also, in a majority of individuals, blood tests will be done to rule out an internal/systemic disease.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Drug-Induced Chronic Cutaneous Lupus Erythematosus?

The complications of Drug-Induced Chronic Cutaneous Lupus Erythematosus may include:

• Secondary bacterial and fungal infection due to scratching, bleeding, and ulceration
• Eating and chewing difficulties, if mouth sores are present
• With time, scarring and atrophy of skin may be reported
• Cosmetic concerns causing severe emotional and psychological stress
• Treatment-related complications

How is Drug-Induced Chronic Cutaneous Lupus Erythematosus Treated?

The following measures may be considered in treating Drug-Induced Chronic Cutaneous Lupus Erythematosus:

• Discontinuing the medication responsible for the side effect may result in a cure or the improvement of the condition
• Avoiding the triggers causing the condition
• Topical medication and ointments
• Topical/oral retinoid therapy
• Photodynamic therapy or phototherapy
• Systemic therapy using antimalarial drugs may be necessary
• Systemic steroid therapy

Note: If any of the prescribed treatment medications or methods cause new stinging or burning symptoms, then it is important to discontinue the medication/method and immediately inform the healthcare provider.

How can Drug-Induced Chronic Cutaneous Lupus Erythematosus be Prevented?

Currently, there is no effective preventive method available for Drug-Induced Chronic Cutaneous Lupus Erythematosus. However, the following measures may be considered to help lower one’s risk for the condition:

• Drugs that cause the condition may be discontinued or alternative medication prescribed; nevertheless, this has to be decided by the healthcare expert
• Inform your physician if you are allergic to any medication
• Avoiding factors that aggravate the condition through the following measures:
  • Limiting sun exposure
  • Avoidance of smoking
  • Undertaking early treatment of viral infections
  • Addressing issues causing hormonal imbalance in the body

What is the Prognosis of Drug-Induced Chronic Cutaneous Lupus Erythematosus? (Outcomes/Resolutions)

• The prognosis for Drug-Induced Chronic Cutaneous Lupus Erythematosus is usually good in many cases upon discontinuation of the medication and adequate treatment of the skin condition when needed
• However, the prognosis may also depend upon the type of medication involved, the period of exposure to the offending medication, and the severity of the symptoms

Additional and Relevant Useful Information for Drug-Induced Chronic Cutaneous Lupus Erythematosus:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/systemic-lupus-erythematosus/