Drug-induced subacute cutaneous lupus erythematosus in previously diagnosed systemic lupus erythematosus patients: A case series

Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) is subacute cutaneous lupus erythematosus (SCLE) in which the disease onset is associated with the ingestion of an offending medication. It is estimated that approximately one-third of all SCLE cases are drug-induced.1 Idiopathic SCLE and DI-SCLE are serologically, histopathologically, and clinically identical, with both characterized by widespread erythematous annular-polycyclic or papulosquamous psoriasiform lesions.2 DI-SCLE symptoms can arise weeks to years after exposure to a number of medications, including proton-pump inhibitors (PPIs), antihypertensives, antibiotics, and anticonvulsants. A lesser-known phenomenon is a lupus-associated flare or change in lupus phenotype associated with medication initiation in a person who has already been diagnosed with systemic lupus erythematosus (SLE). Cases of patients with previous diagnoses of idiopathic SCLE in remission being exacerbated by PPIs and patients with autoimmune connective tissue diseases developing DI-SCLE after PPI use have been reported.3,4 Here, we present the cases of 3 patients with previous diagnoses of SLE without SCLE skin manifestations developing DI-SCLE after using PPIs or antihypertensives. This pattern has rarely been described in the literature to date and suggests a phenomenon of which clinicians should be aware.