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

• Drug-Induced SCLE
• Medication-Induced SCLE
• Medication-Induced Subacute Cutaneous Lupus Erythematosus

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

• Subacute cutaneous lupus erythematosus (SCLE) is a subtype of cutaneous lupus erythematosus that form a group of autoimmune disorders affecting primarily the skin
• Drug-Induced Subacute Cutaneous Lupus Erythematosus (DI-SCLE ) manifests as a subclass of SCLE, secondary to the use of certain medication as an adverse reaction of the body
• The offending medication that triggers the lupus-like symptoms in the body includes certain non-steroidal anti-inflammatory drugs, antifungals, and hypertensive medication
• Drug-Induced Subacute Cutaneous Lupus Erythematosus is characterized by the presence of scaly papules and plaques on the arms and trunk. The skin eruptions can get worse on sun exposure
• Stopping or discontinuing the use of such medications may decrease the progression of Drug-Induced Subacute 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 Subacute Cutaneous Lupus Erythematosus? (Age and Sex Distribution)

• Drug-Induced Subacute Cutaneous Lupus Erythematosus is a rare form of lupus

• It may affect individuals of any age group since the condition is caused by the use of medications
• Both males and females are affected
• No racial or ethnic group predilection is observed, and the condition is observed worldwide. However, a majority of the cases are reported from Europe (nearly 70% of them), and some from North America (about 17%)

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

The key risk factor for Drug-Induced Subacute 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 oral antifungal medications
• Hypertensive medication, including angiotensin-converting-enzyme inhibitors and calcium channel blockers
• Medications used to treat epilepsy
• Monoclonal antibodies
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Platelet aggregation inhibitors
• Proton pump inhibitors

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 Subacute Cutaneous Lupus Erythematosus? (Etiology)

• Drug-Induced Subacute 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

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

The signs and symptoms of Drug-Induced Subacute 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:

• Presence of papulosquamous red rashes in the form of papules and scales
• Over time, the lesions become plaques with a central clearing; this is called annular plaques. Due to this, they do not heal with a scar
• The skin lesions may be itchy and may involve the arms, chest, and back

The onset of Drug-Induced SCLE 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.

Certain factors can worsen the signs and symptoms (causing flare-ups), and these include:

• Exposure to sunlight
• Smoking
• Certain viral infections
• Hormonal influence

How is Drug-Induced Subacute Cutaneous Lupus Erythematosus Diagnosed?

Drug-Induced Subacute 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
  • Serological blood test for anti-double-stranded DNA (ds-DNA)
  • Extractable nuclear antigen antibodies panel blood test to detect anti-Ro antibodies and anti-La antibodies
  • Blood chemistry panels
• Body fluid analysis
• 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: Skin biopsy is usually not necessary in many cases; however, if required, a skin biopsy may be undertaken. Also, in a majority of individuals, no elaborate testing may be needed, apart from examination of the clinical signs and symptoms.

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 Subacute Cutaneous Lupus Erythematosus?

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

• Secondary bacterial and fungal infection due to scratching, bleeding, and ulceration
• Cosmetic concerns causing emotional and psychological stress

How is Drug-Induced Subacute Cutaneous Lupus Erythematosus Treated?

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

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

Note: If any 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 Subacute Cutaneous Lupus Erythematosus be Prevented?

Currently, there is no effective preventive method available for Drug-Induced Subacute 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
• 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 Subacute Cutaneous Lupus Erythematosus? (Outcomes/Resolutions)

• The prognosis for Drug-Induced Subacute 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 Subacute Cutaneous Lupus Erythematosus:

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

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