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Kleitsch J, Pandya R, Chakka S, Yan D, Lim D, Diaz D, Feng R, Werth VP. Change in disease activity needed for meaningful change in cutaneous lupus by patient characteristic: A retrospective analysis of a longitudinal database. J Am Acad Dermatol 2024; 90:406-408. [PMID: 37806526 DOI: 10.1016/j.jaad.2023.09.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Julianne Kleitsch
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Rachita Pandya
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Srita Chakka
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Daisy Yan
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Darosa Lim
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - DeAnna Diaz
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Rui Feng
- Department of Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania.
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2
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Żychowska M, Kołcz K. Dermoscopy for the Differentiation of Subacute Cutaneous Lupus Erythematosus from Other Erythematous Desquamative Dermatoses-Psoriasis, Nummular Eczema, Mycosis Fungoides and Pityriasis Rosea. J Clin Med 2024; 13:577. [PMID: 38276083 PMCID: PMC10816082 DOI: 10.3390/jcm13020577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Subacute cutaneous lupus erythematosus (SCLE) is a condition that might pose a diagnostic challenge. The aim of this study was to assess the usefulness of videodermoscopy in the differentiation of SCLE from other erythematous-desquamative dermatoses. Consecutive patients with SCLE (n = 27), psoriasis (n = 36), nummular eczema (n = 30), mycosis fungoides (n = 26), and pityriasis rosea (n = 20) referred to our Department of Dermatology were recruited for this study. A representative lesion was visualized using a Canfield D200EVO Videodermatoscope (Canfield Scientific GmbH, Bielefeld, Germany) and evaluated for the following parameters: vessels (morphology and distribution), scales (color and distribution), follicular findings, colors and morphologies, and presence of specific clues. SCLE was predominantly characterized by a polymorphous vascular pattern (92.6%) of unspecific distribution (92.6%) over a pink-red background (74.1%). Gray-brown dots were present in 10 (37.0%) cases, and pigmentation was noted in 15 (55.6%) patients, including peripheral pigmentation in 7 (25.9%) patients. Videodermoscopic evaluation showed significant differences between SCLE and psoriasis, which was characterized by regularly distributed dotted vessels. Although some common dermoscopic features with MF were noted, the presence of yellow structureless areas and red dots/globules favored the diagnosis of MF. In conclusion, a polymorphic vascular pattern, especially in association with gray-brown dots and/or peripheral pigmentation, is a valuable clue for the differentiation of SCLE from other erythematous-desquamative dermatoses.
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Affiliation(s)
- Magdalena Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
| | - Kinga Kołcz
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
- The Doctoral School, University of Rzeszow, 35-959 Rzeszow, Poland
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3
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Del Río Zanatta H, Zambrano Zambrano A, Belmont Nava P, Lizbeth Puntos Guízar C, Martinez Salazar J. Comprehensive Evaluation of Neuropsychiatric and Mucocutaneous Manifestations in the Diagnosis of Systemic Lupus Erythematosus: A Complete Clinical Approach to a Case. Cureus 2023; 15:e47380. [PMID: 38022140 PMCID: PMC10657573 DOI: 10.7759/cureus.47380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Systemic lupus erythematosus is a chronic, autoimmune, multisystemic, potentially fatal disease that commonly affects young women between puberty and menopause. It is a multifactorial disease associated with an elevated risk of premature death. The diagnosis is complex due to the broad clinical spectrum as well as the severity at the time of presentation. It is based on clinical manifestations and complementary studies of antibodies. Diagnostic criteria are not available, and classification criteria, such as the ACR/EULAR (American College of Rheumatology/European League Against Rheumatism) of 2019 are often used for diagnosis. Despite its clinical heterogeneity, SLE is an autoimmune disease that can affect multiple systems, and its early diagnosis is essential to avoid damage to vital organs and improve clinical outcomes. This case report shows atypical manifestations of a patient with neuropsychiatric and dermatological symptoms that were essential within the clinical picture to make the diagnosis of systemic lupus erythematosus.
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Collada Sánchez VL, Álvarez Criado J, Martinez Martin V, Zamora Auñon P, Espinosa Arranz E, Mayor Ibarguren A, Nacher Jimenez I, Herrero Ambrosio A. Subacute cutaneous lupus erythematosus following ribociclib therapy for metastatic breast cancer. J Oncol Pharm Pract 2023; 29:1793-1796. [PMID: 37455486 DOI: 10.1177/10781552231185855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) has been associated with drugs with different mechanisms of action, including anti-hypertensives, tumour necrosis factor-α inhibitors and even some chemotherapy medicines. In the last years, a few reports have been described in patients treated with cyclin-dependent kinase (CDK) 4/6 inhibitors, palbociclib and abemaciclib. CASE REPORT Here, we describe a case of DI-SCLE in association with ribociclib and exemestane in a woman diagnosed with metastatic breast cancer. MANAGEMENT AND OUTCOME Topical mometasone was prescribed for two weeks with complete resolution of lesions, also abemaciclib was substituted for ribociclib, and the patient had stable disease with no relapse of DI-SCLE. DISCUSSION To our knowledge, this is the first report of ribociclib-induced SCLE but based on the DI-SCLE reported cases associated others CDK4/6 inhibitors, the role of this family of drugs in dermatopathology must be further investigated.
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5
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Razi S, Truong TM, Sekhon P, Ouellette S, Rao BK. Subacute cutaneous lupus erythematosus with a psoriasiform presentation: A diagnostic clinical conundrum. Clin Case Rep 2023; 11:e7893. [PMID: 37736481 PMCID: PMC10509344 DOI: 10.1002/ccr3.7893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/05/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
Key Clinical Message For practitioners experiencing worsening psoriasis, subacute cutaneous lupus erythematosus (SCLE) with a psoriasiform presentation should be ruled out. Initial treatment for a presumptive diagnosis of psoriasis using hydroxychloroquine or ultraviolet phototherapy may cause SCLE to worsen. Abstract Psoriasiform subacute cutaneous lupus erythematosus is an unusual presentation scarcely reported in literature. We report a case of a 54-year-old man who presented with an itchy, papulosquamous rash of the upper extremities and face for 7 months. The initial physical examination revealed the classical morphology of psoriasis. One and a half years after the diagnosis of clinical worsening, the patient noticed a new papular eruption on the right posterior upper arm. A skin biopsy was performed, confirming a diagnosis of subacute cutaneous lupus erythematosus. This case report highlights the importance of considering rare presentations of cutaneous lupus erythematosus and therapeutic challenges in management.
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Affiliation(s)
- Shazli Razi
- Rao DermatologyAtlantic HighlandsNew JerseyUSA
- Department of Internal MedicineJersey Shore University Medical CenterNeptuneNew JerseyUSA
| | - Thu M. Truong
- Rao DermatologyAtlantic HighlandsNew JerseyUSA
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolSomersetNew JerseyUSA
- Department of MedicineRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | | | - Samantha Ouellette
- Rao DermatologyAtlantic HighlandsNew JerseyUSA
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolSomersetNew JerseyUSA
| | - Babar K. Rao
- Rao DermatologyAtlantic HighlandsNew JerseyUSA
- Center for DermatologyRutgers Robert Wood Johnson Medical SchoolSomersetNew JerseyUSA
- Department of DermatologyWeill Cornell MedicineNew YorkNew YorkUSA
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Király Z, Nagy E, Bokor L, Kovács A, Marschalkó M, Hidvégi B. The Possible Clinical Significance of a Decreased Serum Level of Soluble PD-L1 in Discoid Lupus Erythematosus, but Not in Subacute Cutaneous Lupus Erythematosus-A Pilot Study. J Clin Med 2023; 12:5648. [PMID: 37685714 PMCID: PMC10488501 DOI: 10.3390/jcm12175648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/13/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Cutaneous lupus erythematosus (CLE) is an autoimmune skin disease with various clinical forms, including the subtypes of discoid lupus erythematosus (DLE) and subacute cutaneous lupus erythematosus (SCLE). The altered function of the programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) axis in CLE pathogenesis has been suggested. Here, the soluble forms of PD-1 (sPD-1) and PD-L1 (sPD-L1) were explored in untreated DLE and SCLE. Levels of sPD-1 and sPD-L1 were determined by enzyme-linked immunosorbent assay in serums of 21 DLE, 18 SCLE, 13 systemic lupus erythematosus (SLE) patients and 20 healthy controls (HCs). Differences between patient groups and HCs, and the association between clinical activity of skin symptoms and sPD-1/sPD-L1 levels were analyzed with Mann-Whitney U-test and Spearmann's correlation. Regarding sPD-1 levels, no statistically significant differences were found between DLE and SCLE groups, nor compared to HCs. As for sPD-L1, a significantly lower level was found in the DLE group compared to the SCLE and HC groups (p = 0.027 and p = 0.009, respectively). In SLE, significantly higher sPD-1 was found compared to HCs (p = 0.002). No association between skin symptom activity and sPD-1/sPD-L1 levels was found in CLE. Alterations of the inhibitory effect of sPD-L1 on T-cell activity might elucidate the differences between DLE and SCLE.
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Affiliation(s)
- Zsófia Király
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary (M.M.); (B.H.)
| | - Eszter Nagy
- Department of Laboratory Medicine, Semmelweis University, 1094 Budapest, Hungary;
- National Institute of Locomotor Diseases and Disabilities, 1122 Budapest, Hungary
| | - Laura Bokor
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary (M.M.); (B.H.)
| | - Anikó Kovács
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary (M.M.); (B.H.)
| | - Márta Marschalkó
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary (M.M.); (B.H.)
| | - Bernadett Hidvégi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary (M.M.); (B.H.)
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7
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Khan MA, Khan FH, Khan HB, Saadeh C, Davey N. Role of Anifrolumab in Refractory Cutaneous Manifestations of Lupus Erythematosus: A Case Series and Literature Review. Cureus 2023; 15:e39553. [PMID: 37378095 PMCID: PMC10292022 DOI: 10.7759/cureus.39553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Lupus erythematosus (LE) is an autoimmune disease that presents either as a systemic (SLE) or an isolated skin disease (CLE). Currently, there is no FDA-approved medication specifically for CLE, and is treated with the same approach as SLE. We present two refractory cases of SLE with severe cutaneous manifestations unresponsive to the first-line therapy treated with anifrolumab. First, a 39-year-old Caucasian female with a known history of SLE with severe subacute CLE presented to the clinic for her refractory cutaneous symptoms. Her current regimen was hydroxychloroquine (HCQ), mycophenolate mofetil (MMF), and s/c belimumab with no improvement. Belimumab was discontinued, and she was started on anifrolumab with significant improvement. Another, a 28-year-old female with no known medical history was referred to a rheumatology clinic for elevated anti-nuclear antibody (ANA) and ribonucleoprotein (RNP) titers. She was diagnosed with SLE, and was treated with HCQ, belimumab, and MMF but failed to produce a reasonably good outcome. Hence belimumab was discontinued and anifrolumab was added instead with significant cutaneous improvement. The treatment spectrum for SLE is wide, which includes antimalarial (HCQ), oral corticosteroids (OCS), and immunosuppressants (Methotrexate-MTX, MMF, azathioprine-AZT). Anifrolumab, a type 1 IFNα receptor subunit 1 (IFNAR1) inhibitor, has been recently approved by the FDA for moderate to severe SLE while on standard therapy in August 2021. Early use of anifrolumab in moderate to severe cutaneous manifestations of SLE or CLE may result in significant improvement in patients.
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Affiliation(s)
- Muhammad Atif Khan
- Internal Medicine, University of Kansas Medical Center, Kansas City, USA
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8
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Lee D, Waseh S, Motaparthi K, Hsu S. Rowell Syndrome in a Middle-Aged Woman: A Case Report. Cureus 2023; 15:e39631. [PMID: 37388608 PMCID: PMC10305509 DOI: 10.7759/cureus.39631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Rowell syndrome (RS) is characterized by the presentation of lupus erythematosus (LE) with erythema multiforme (EM)-like lesions. It is thought to display a characteristic serologic pattern consisting of a "speckled-type" antinuclear antibody (ANA), positive anti-Ro/SSA or anti-La/SSB, or positive rheumatoid factor (RF). We report the case of a patient with subacute cutaneous lupus erythematosus (SCLE) who presented with EM-like lesions responsive to oral corticosteroids.
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Affiliation(s)
- Diane Lee
- Dermatology, Temple University Hospital, Philadelphia, USA
| | - Shayan Waseh
- Dermatology, Temple University Hospital, Philadelphia, USA
| | | | - Sylvia Hsu
- Dermatology, Temple University Hospital, Philadelphia, USA
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9
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Wang YJ, Hui HZ, Cheng JR, Mao H, Shi BJ. Subacute cutaneous lupus erythematosus after COVID-19 vaccine. Int J Rheum Dis 2023. [PMID: 36880735 DOI: 10.1111/1756-185x.14640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/02/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Ying-Jun Wang
- Department of Dermatology, Chongqing Hospital of Traditional Chinese Medicine (Chongqing Key Laboratory of Integrative Dermatology Research; Chongqing Clinical Research Center for Dermatology), Chongqing, China.,Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Hai-Zhen Hui
- Department of Dermatology, Chongqing Hospital of Traditional Chinese Medicine (Chongqing Key Laboratory of Integrative Dermatology Research; Chongqing Clinical Research Center for Dermatology), Chongqing, China.,Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Jia-Rong Cheng
- Department of Dermatology, Chongqing Hospital of Traditional Chinese Medicine (Chongqing Key Laboratory of Integrative Dermatology Research; Chongqing Clinical Research Center for Dermatology), Chongqing, China.,Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Han Mao
- Department of Dermatology, Chongqing Hospital of Traditional Chinese Medicine (Chongqing Key Laboratory of Integrative Dermatology Research; Chongqing Clinical Research Center for Dermatology), Chongqing, China.,Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Bing-Jun Shi
- Department of Dermatology, Chongqing Hospital of Traditional Chinese Medicine (Chongqing Key Laboratory of Integrative Dermatology Research; Chongqing Clinical Research Center for Dermatology), Chongqing, China
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10
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Rimmer S, Ly L, Boh E. Subacute cutaneous lupus erythematosus after mRNA-based SARS-CoV-2 vaccination. JAAD Case Rep 2023; 33:70-72. [PMID: 36742149 PMCID: PMC9884610 DOI: 10.1016/j.jdcr.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Affiliation(s)
- Sarah Rimmer
- Correspondence to: Sarah Rimmer, BS, Department of Dermatology, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112
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11
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Shah S, Esaa FS, Baughman L, Gadarowski MB, Richardson CT. Differential effect of the 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus on different cutaneous lupus subtypes. J Am Acad Dermatol 2023:S0190-9622(23)00155-X. [PMID: 36739902 DOI: 10.1016/j.jaad.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/02/2022] [Accepted: 01/15/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Shalini Shah
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Fatema S Esaa
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lauren Baughman
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
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12
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Kishibe M, Koike K, Kanno K, Ishida-Yamamoto A. Autoimmunity-related neutrophilic dermatosis after coronavirus disease 2019 vaccination: A case report and literature review. J Dermatol 2023. [PMID: 36606292 DOI: 10.1111/1346-8138.16718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/11/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023]
Abstract
Autoimmune diseases triggered by coronavirus disease 2019 (COVID-19) mRNA vaccination have been emerging. Here, we report the case of a 27-year-old Japanese man with autoimmunity-related neutrophilic dermatosis, occurring as an initial cutaneous manifestation of systemic lupus erythematosus with Sjögren syndrome after the second dose of the Pfizer/BioNTech COVID-19 vaccination. The patient presented with urticarial erythema and partially annular erythema on the trunk and extremities with severe pruritus. Histopathological analysis showed vacuolar degeneration at the dermo-epidermal junction and interstitial neutrophil infiltration. We reviewed eight patients, including the aforementioned patient, with exacerbation or new-onset of SLE after COVID-19 vaccination and found the patient had relatively mild symptoms, itchy annular erythema, and positive anti-SS-A/SS-B antibodies. COVID-19 mRNA vaccination can induce the production of type-I interferon, which plays a crucial role in the pathogenesis of SLE and may cause autoimmunity-related neutrophilic dermatosis in susceptible individuals. In the case that itchy annular erythema develops approximately 2 weeks after the vaccination, the possibility of systemic or cutaneous lupus erythematosus should be considered. For an accurate diagnosis, dermatologists should obtain a recent vaccination history and perform complete antibody profiling and skin biopsy for patients presenting with annular or erythema multiforme-like lesions.
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Affiliation(s)
- Mari Kishibe
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Katsuya Koike
- Department of Dermatology, Nakashibetsu Town Hospital, Nakashibetsu, Japan
| | - Kyoko Kanno
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
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13
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Żychowska M, Reich A. Dermoscopic Features of Acute, Subacute, Chronic and Intermittent Subtypes of Cutaneous Lupus Erythematosus in Caucasians. J Clin Med 2022; 11:jcm11144088. [PMID: 35887849 PMCID: PMC9321208 DOI: 10.3390/jcm11144088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023] Open
Abstract
Cutaneous lupus erythematosus (CLE) is divided into the following four clinical subtypes: acute CLE (ACLE), subacute (SCLE), chronic CLE (CCLE) and lupus erythematosus tumidus (LET). The aim of this study was to describe the dermoscopic patterns of CLE by clinical variant. A total of 54 Caucasian patients from Poland (ACLE = 10; SCLE = 11; CCLE = 26; LET = 7) were included. The predefined parameters for dermoscopic assessment in inflammatory dermatoses were analyzed separately by two dermatologists. Under dermoscopy, all the variants of CLE showed predominantly polymorphous vessels on a pink−red background within the lesional skin. Dotted vessels, in association with other vessel morphologies, were observed more frequently in SCLE than in the other subtypes of CLE, but the difference did not reach statistical significance (p = 0.07). The findings associated with hair follicles, including rosettes (p = 0.02), follicular plugs (p = 0.01), follicular red dots (p < 0.01), perifollicular white halos (p < 0.01) and dermoscopic features corresponding to scarring, including white (p = 0.01) and pink (p < 0.01) structureless areas, were significantly more common in CCLE than in other variants of CLE. A lack of scaling, pigmentation, erosions and crusting were observed in all the cases of LET. The role of dermoscopy as an auxiliary tool in the differential diagnosis of CLE needs further elucidation.
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Khokher W, Cash A, Alom M, Iftikhar S, Kesireddy N, Abuhelwa Z, Malik A, Lynn A, Altorok N. Subacute Cutaneous Lupus as a Paraneoplastic Manifestation of Non-Hodgkin Lymphoma. J Investig Med High Impact Case Rep 2022; 10:23247096211063066. [PMID: 35225037 PMCID: PMC8891832 DOI: 10.1177/23247096211063066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Malignancies have been associated with paraneoplastic syndromes, such as dermatomyositis. Subacute cutaneous lupus erythematosus (SCLE) can occur due to a wide array of cancers. Paraneoplastic SCLE obeys McLean’s criteria and often regresses after the underlying malignancy has been treated appropriately. Anti-Ro/SSA antibodies are often present in patients with paraneoplastic SCLE; however, there have been many instances where anti-Ro may not be present. We report a case of non-Hodgkin lymphoma causing SCLE, a malignancy not previously known to be associated with paraneoplastic SCLE. We also highlight the importance of perhaps prompt chemotherapy to treat the underlying malignancy, as a failure to do so may lead to worse patient outcomes.
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Affiliation(s)
| | - Ayla Cash
- The University of Toledo College of Medicine and Life Sciences, OH, USA
| | - Modar Alom
- Baylor University Medical Center, Dallas, TX, USA
| | | | | | | | - Ahmad Malik
- Ross University School of Medicine, Miramar, FL, USA
| | - Amy Lynn
- Promedica Toledo Hospital, OH, USA
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15
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Pratumchart N, Chanprapaph K, Topibulpong N, Tankunakorn J. Subacute Cutaneous Lupus Erythematosus-Like Eruption Induced by Durvalumab: A Case Report and Literature Review. Clin Cosmet Investig Dermatol 2022; 15:51-62. [PMID: 35046689 PMCID: PMC8763206 DOI: 10.2147/ccid.s344445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/21/2021] [Indexed: 12/31/2022]
Abstract
Reports of immune-related adverse events caused by programmed cell death-ligand 1 (PD-L1) inhibitor have been emerging. Herein, we report a subacute cutaneous lupus erythematosus (SCLE)-like eruption presented after the treatment of durvalumab in a patient with extensive-stage small cell lung carcinoma. A 74-year-old Thai man was referred to our department after experiencing multiple dusky red to brownish papules and patches with scale and erosions on photo-distributed areas after receiving 3 infusion cycles of durvalumab. Histological finding revealed epidermal atrophy with interface changes and superficial perivascular infiltration of lymphocytes. Serum antinuclear antibodies (ANA) was 1:320 and anti-Ro/Sjogren's-syndrome-related antigen A (anti-Ro/SSA) antibodies were positive (2+). Based on the history and clinicopathological correlation, the diagnosis of SCLE-like eruption due to durvalumab was made. To the best of our knowledge, this is the first case of durvalumab-induced SCLE.
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Affiliation(s)
- Nathathai Pratumchart
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nuttapong Topibulpong
- Division of Oncology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jutamas Tankunakorn
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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16
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Keyes E, Jobanputra A, Feng R, Grinnell M, Vazquez T, Diaz D, Werth VP. Comparative responsiveness of cutaneous lupus erythematosus patients to methotrexate and mycophenolate mofetil: A cohort study. J Am Acad Dermatol 2021; 87:447-448. [PMID: 34537250 PMCID: PMC10233728 DOI: 10.1016/j.jaad.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/26/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Emily Keyes
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Anisha Jobanputra
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Rui Feng
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madison Grinnell
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Thomas Vazquez
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - DeAnna Diaz
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
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17
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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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18
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Rakita U, Grushchak S, Guo L, Braniecki M, Mehta S. Atypical Subacute Cutaneous Lupus in a Patient on Apixaban Anticoagulation Therapy: A Case Report and Review of the Literature. Cureus 2021; 13:e16571. [PMID: 34434672 PMCID: PMC8380169 DOI: 10.7759/cureus.16571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Abstract
Subacute cutaneous lupus erythematosus (SCLE) is a rare cutaneous lupus erythematosus (CLE) subtype manifesting in middle-aged Caucasians with photo-distributed papulosquamous or annular lesions. Drug-induced SCLE (DI-SCLE) forms present in a similar manner but direct oral anticoagulants are rarely implicated. We report an unusual case of SCLE in a 37-year-old African American patient with a history of unprovoked deep vein thromboses (DVT) who presented with new-onset photoprotected polymorphic lesions two months after the initiation of apixaban anticoagulation therapy. Our case demonstrates the heterogeneous nature of SCLE presentation and highlights the possibility of apixaban as a potential causative agent of DI-SCLE in immunogenetically susceptible individuals. Moreover, we hypothesize on the etiopathogenesis of our patient’s atypical presentation.
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Affiliation(s)
- Uros Rakita
- Dermatology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Solomiya Grushchak
- Department of Dermatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Lily Guo
- Dermatology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Marylee Braniecki
- Department of Dermatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Shilpa Mehta
- Department of Dermatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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19
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Nowsheen S, Crum O, Hughes S, Wentland AL. Cutaneous lupus erythematosus mimicking radiation dermatitis in a patient with breast cancer. JAAD Case Rep 2021; 15:64-66. [PMID: 34401433 PMCID: PMC8358281 DOI: 10.1016/j.jdcr.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Somaira Nowsheen
- Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin.,Department of Dermatology, University of California San Diego, San Diego, California
| | - Olivia Crum
- Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin
| | - Sarah Hughes
- Department of Pathology, Gundersen Health System, La Crosse, Wisconsin.,Department of Dermatology, Gundersen Health System, Onalaska, Wisconsin
| | - Amy L Wentland
- Department of Dermatology, Gundersen Health System, Onalaska, Wisconsin
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20
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Affiliation(s)
- David J Kurtyka
- Georgetown University School of Medicine, Washington, District of Columbia
| | | | - Katherine T Burke
- Georgetown University School of Medicine, Washington, District of Columbia.,Department of Dermatology, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia
| | - Michael A Cardis
- Georgetown University School of Medicine, Washington, District of Columbia.,Department of Dermatology, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia
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21
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Abstract
BACKGROUND Tissue resident memory T cells (TRMs) persist long-term in peripheral tissues without recirculation, triggering an immediate protective inflammatory state upon the re-recognition of the antigen. Despite evidence incriminating the dysregulation of TRMs in autoimmune diseases, few studies have examined their expression in cutaneous lupus erythematosus (CLE). OBJECTIVES We aimed to examine whether there are differences among TRM populations in CLE depending on different clinical conditions, such as the CLE subtype or association with systemic lupus erythematosus, and to determine the effect of type I interferon (IFN) on the development of TRMs in CLE. METHODS CLE disease activity was evaluated using the Cutaneous Lupus Erythematosus Disease Area and Severity Index. The expression of the TRM markers CD69 and CD103 in CLE lesions was evaluated by immunofluorescence. Flow cytometry was performed on peripheral blood mononuclear cells after IFNα treatment. RESULTS The number of TRMs expressing either CD69 or CD103 was significantly higher in CLE lesions than in control skin; however, it was not significantly different between discoid lupus erythematosus and subacute CLE, or dependent on the presence of concomitant systemic lupus. Lesional severity was not correlated with an increase in TRMs in CLE. IFNα treatment induced a conspicuous increase in CD69 expression in skin-homing T cells, more profoundly in CD4+ T cells than in CD8+ T cells. CONCLUSIONS Skin TRMs, either CD69 or CD103-positive cells, showed increased levels in the lesional skin of CLE, and IFNα increased the expression of CD69 in T cells.
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Affiliation(s)
- Hyeon-Jung Gu
- Department of Health Science and Technology, Gachon Advanced Institute for Health Science & Technology, Gachon University, Incheon, Korea
| | - Shinyoung Song
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - YunJae Jung
- Department of Health Science and Technology, Gachon Advanced Institute for Health Science & Technology, Gachon University, Incheon, Korea.,Department of Microbiology, Gachon University College of Medicine, Incheon, Korea
| | - Hee Joo Kim
- Department of Dermatology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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22
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Behera B, Kumari R, Gochhait D, Ayyanar P. Dermoscopic Appearance of an Annular Subacute Cutaneous Lupus Erythematosus. Dermatol Pract Concept 2021; 11:e2021013. [PMID: 33747626 DOI: 10.5826/dpc.1102a13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Biswanath Behera
- Department of Dermatology and Venereology, AIIMS, Bhubaneswar, India
| | - Rashmi Kumari
- Department of Dermatology, Venereology and Leprology, JIPMER, Puducherry, India
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23
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Uzuncakmak TK, Bayazit S, Askin O, Engin B, Ugurlu S, Sar M, Serdaroglu S. Alendronate induced subacute cutaneous lupus erythematosus successfully treated with intravenous immunoglobulin. Dermatol Ther 2020; 33:e14477. [PMID: 33125828 DOI: 10.1111/dth.14477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Abstract
The subacute cutaneous lupus erythematosus (SCLE) is a distinct subtype of lupus erythematosus (LE) representing specific clinical and serological features. Almost 20%-30% of the cases with SCLE are predicted to associated with medications. Thiazide diuretics, terbinafine, antiepileptic, and proton pump inhibitors are the best-known drugs to induce drug-related SCLE. Herein we want to present a 65-year-old female with alendronate induced SCLE, resistant to classical therapies, and respond well to intravenous immunoglobulin (IVIG), suggesting that IVIG could be an alternative treatment in patients resistant to classical treatment protocols.
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Affiliation(s)
- Tugba Kevser Uzuncakmak
- Department of Dermatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Samet Bayazit
- Department of Dermatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ozge Askin
- Department of Dermatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Burhan Engin
- Department of Dermatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Serdal Ugurlu
- Department of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Sar
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Server Serdaroglu
- Department of Dermatology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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24
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Russell-Goldman E, Nazarian RM. Subacute cutaneous lupus erythematosus with positive anti-Ro antibodies following palbociclib and letrozole treatment: A case report and literature review. J Cutan Pathol 2020; 47:654-658. [PMID: 32119141 DOI: 10.1111/cup.13673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/12/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022]
Abstract
Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) is an uncommon but well-described phenomenon, most often seen in association with antihypertensives and antifungal medications. In recent years, rare reports of DI-SCLE have been described in patients being treated with targeted therapies. Herein, we describe a case of DI-SCLE in association with palbociclib and letrozole treatment for metastatic breast cancer. This report is the first known case of DI-SCLE with positive anti-Ro antibodies in this setting. We also summarize the literature describing DI-SCLE in association with targeted therapies to date and its possible association with dysregulation of the vascular endothelial growth factor pathway.
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Affiliation(s)
| | - Rosalynn M Nazarian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
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25
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Cornacchia MA, Coromilas AJ, Gallitano SM, Frank RC, Halasz CL. Subacute cutaneous lupus erythematosus induced by gemcitabine in 2 patients with pancreatic cancer. JAAD Case Rep 2019; 5:596-601. [PMID: 31317065 PMCID: PMC6611081 DOI: 10.1016/j.jdcr.2019.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | | | - Richard C Frank
- Department of Hematology-Oncology, Norwalk Hospital, Norwalk, Connecticut
| | - Charles L Halasz
- Department of Dermatology, Columbia University, New York, New York
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26
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Fernandes M, Taulaigo AV, Vidal C, Agostini P, Riso N, Moraes‐Fontes MF. Heterogeneous lupus-specific lesions and treatment outcome, in a single patient, over a period of time. Clin Case Rep 2019; 7:865-871. [PMID: 31110705 PMCID: PMC6509922 DOI: 10.1002/ccr3.2105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 01/26/2023] Open
Abstract
The report highlights the importance of strict clinico-histological correlations when skin biopsies are performed in diagnostic doubt in systemic lupus erythematosus. Furthermore, PUVA is never indicated in autoimmune conditions involving photosensitivity, due to high potential for internal and cutaneous aggravation of the disease, as the authors observed in this case.
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Affiliation(s)
- Melissa Fernandes
- Unidade de Doenças Auto-imunes/Serviço de Medicina 7.2, Hospital de Curry CabralCentro Hospitalar Universitário de Lisboa CentralLisboaPortugal
| | - Anna V. Taulaigo
- Unidade de Doenças Auto-imunes/Serviço de Medicina 7.2, Hospital de Curry CabralCentro Hospitalar Universitário de Lisboa CentralLisboaPortugal
| | - Carolina Vidal
- Unidade de Doenças Auto-imunes/Serviço de Medicina 7.2, Hospital de Curry CabralCentro Hospitalar Universitário de Lisboa CentralLisboaPortugal
- Serviço de Medicina InternaHospital do Divino Espírito SantoPonta Delgada, AçoresPortugal
| | - Patrick Agostini
- Laboratório de Anatomia PatológicaCentro Hospitalar Universitário do AlgarveFaro‐PortimãoPortugal
| | - Nuno Riso
- Unidade de Doenças Auto-imunes/Serviço de Medicina 7.2, Hospital de Curry CabralCentro Hospitalar Universitário de Lisboa CentralLisboaPortugal
| | - Maria Francisca Moraes‐Fontes
- Unidade de Doenças Auto-imunes/Serviço de Medicina 7.2, Hospital de Curry CabralCentro Hospitalar Universitário de Lisboa CentralLisboaPortugal
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27
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Affiliation(s)
- Meera Tarazi
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kumpol Aiempanakit
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Victoria P. Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
- Correspondence to: Victoria P. Werth, MD, Department of Dermatology, University of Pennsylvania, Perelman Center for Advanced Medicine, Suite 1-330A, 3400 Civic Center Boulevard, Philadelphia, PA 19104.
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28
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Samotij D, Szczęch J, Werth VP, Furukawa F, Kuhn A, Szepietowski JC, Reich A. Disease severity and prophylactic measures in patients with cutaneous lupus erythematosus: results of a worldwide questionnaire-based study. Postepy Dermatol Alergol 2018; 35:192-8. [PMID: 29760621 DOI: 10.5114/ada.2018.75242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 01/29/2017] [Indexed: 01/17/2023] Open
Abstract
Introduction Due to a wide array of dermatologic manifestations, assessment of disease severity in cutaneous lupus erythematosus (CLE) remains challenging. Given a need for some standardization in this field, we conducted a worldwide questionnaire-based study among physicians experienced in CLE management. Aim We asked about CLE assessment, their prophylactic measures advised to patients, and treatment recommendations. Material and methods A total of 83 completed questionnaires were received. Participating physicians recommended assessing disease severity at each patient’s visit (39.1%), monthly (4.9%) or at least every third month (17.3%). Almost half of the responding physicians (47.0%) waited 2–3 months before identifying a specific treatment option as not effective. Results The vast part of the participants informed their patients about of the risks of sun exposure and advised adequate preventive measures. Smoking was less frequently a matter of discussion between physicians and their patients. Recommendations for the timing of CLE severity assessment likely depends on disease severity and the type of therapeutic intervention. Conclusions Proper patient education about effective prophylactic measures should be included during routine CLE patient consultations.
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29
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Abstract
Subacute cutaneous lupus erythematosus is a clinically distinct form of cutaneous lupus erythematosus, with age of onset typically in the second to fifth decades. Eleven cases have been reported in childhood, and we present the first known case of subacute cutaneous lupus erythematosus in identical twins. Although flares are typically photo-induced, we present an annular eruption typical of subacute cutaneous lupus erythematosus with concurrent pinworm infestation, with recurrence of disease with cutaneous larva migrans. The patient's identical twin had a similar eruption with pinworm infection. This case highlights the possibility of parasitic infestation as a trigger for subacute cutaneous lupus erythematosus in genetically susceptible individuals.
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Affiliation(s)
- Michael A Montuno
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ann A Church
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jennifer J Schoch
- Division of Pediatric Dermatology, Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Israel D Andrews
- Division of Pediatric Dermatology, Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, USA
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30
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Abstract
Systemic lupus erythematosus (lupus, SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, which bind to antigens and are deposited within tissues to fix complement, resulting in widespread systemic inflammation. The studies presented herein are consistent with hyperpolarized, adenosine triphosphate (ATP)-deficient mitochondria being central to the disease process. These hyperpolarized mitochondria resist the depolarization required for activation-induced apoptosis. The mitochondrial ATP deficits add to this resistance to apoptosis and also reduce the macrophage energy that is needed to clear apoptotic bodies. In both cases, necrosis, the alternative pathway of cell death, results. Intracellular constituents spill into the blood and tissues, eliciting inflammatory responses directed at their removal. What results is “autoimmunity.” Ultraviolet (UV)-A1 photons have the capacity to remediate this aberrancy. Exogenous exposure to low-dose, full-body, UV-A1 radiation generates singlet oxygen. Singlet oxygen has two major palliative actions in patients with lupus and the UV-A1 photons themselves have several more. Singlet oxygen depolarizes the hyperpolarized mitochondrion, triggering non-ATP-dependent apoptosis that deters necrosis. Next, singlet oxygen activates the gene encoding heme oxygenase (HO-1), a major governor of systemic homeostasis. HO-1 catalyzes the degradation of the oxidant heme into biliverdin (converted to bilirubin), Fe, and carbon monoxide (CO), the first three of these exerting powerful antioxidant effects, and in conjunction with a fourth, CO, protecting against injury to the coronary arteries, the central nervous system, and the lungs. The UV-A1 photons themselves directly attenuate disease in lupus by reducing B cell activity, preventing the suppression of cell-mediated immunity, slowing an epigenetic progression toward SLE, and ameliorating discoid and subacute cutaneous lupus. Finally, a combination of these mechanisms reduces levels of anticardiolipin antibodies and protects during lupus pregnancy. Capping all of this is that UV-A1 irradiation is an essentially innocuous, highly manageable, and comfortable therapeutic agency.
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Affiliation(s)
- H McGrath
- Veterans Administration, New Orleans, LA, USA
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31
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Tiao J, Feng R, Carr K, Okawa J, Werth VP. Using the American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria to determine the diagnosis of systemic lupus erythematosus (SLE) in patients with subacute cutaneous lupus erythematosus (SCLE). J Am Acad Dermatol 2016; 74:862-9. [PMID: 26897388 DOI: 10.1016/j.jaad.2015.12.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 12/01/2015] [Accepted: 12/10/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Approximately 50% of patients with subacute cutaneous lupus erythematosus (SCLE) meet criteria for systemic lupus erythematosus (SLE). The Systemic Lupus International Collaborating Clinics (SLICC) developed new SLE criteria to improve the American College of Rheumatology (ACR) criteria but the SLICC criteria have not been evaluated in patients with SCLE. OBJECTIVE We sought to determine how patients with SCLE/SLE meet the ACR and SLICC criteria to compare the 2 sets of criteria. METHODS This was a retrospective analysis of 107 patients with SCLE enrolled in a database at the University of Pennsylvania. RESULTS Patients with SCLE/SLE were more likely than those with only SCLE to have oral ulcers, positive anti-double-stranded DNA antibodies, and positive antinuclear antibody test findings using both sets of criteria. Patients with SCLE/SLE were also more likely to have low complement using the SLICC criteria. There was a statistically insignificant increase in individuals meeting the SLICC criteria. LIMITATIONS Not all patients received comprehensive laboratory testing. CONCLUSIONS Most patients with SCLE who formally meet criteria for SLE do so based on the laboratory and mucocutaneous criteria. Neither the ACR nor SLICC criteria distinguish patients with SCLE and major internal disease from patients with SCLE without major internal disease.
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MESH Headings
- Adult
- Aged
- Antibodies, Antinuclear/immunology
- Cohort Studies
- Cooperative Behavior
- Databases, Factual
- Diagnosis, Differential
- Female
- Humans
- Lupus Erythematosus, Cutaneous/classification
- Lupus Erythematosus, Cutaneous/diagnosis
- Lupus Erythematosus, Cutaneous/immunology
- Lupus Erythematosus, Systemic/classification
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/immunology
- Male
- Middle Aged
- Practice Guidelines as Topic/standards
- Retrospective Studies
- Rheumatology/standards
- Risk Assessment
- Societies, Medical/standards
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Affiliation(s)
- Janice Tiao
- Corporal Michael J. Crescenz Philadelphia Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rui Feng
- Biostatistics and Epidemiology at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kasey Carr
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joyce Okawa
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Corporal Michael J. Crescenz Philadelphia Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
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32
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Abstract
Subacute cutaneous lupus erythematosus (SCLE) is a type of lupus erythematosus having distinct characteristic clinical, serologic, and genetic features. Other than the commonly occurring papulosquamous and annular polycyclic lesion, rarely it may present as erythema multiformae, toxic epidermo necrolysis like lesion (Rowell syndrome), erythroderma, and generalized poikiloderma. Herein, we report a case of SCLE presenting as erythroderma.
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Affiliation(s)
- Varadraj V Pai
- Department of Dermatology, SDM College of Medical Sciences, Dharwad, India
| | - Kn Naveen
- Department of Dermatology, SDM College of Medical Sciences, Dharwad, India
| | - Sb Athanikar
- Department of Dermatology, SDM College of Medical Sciences, Dharwad, India
| | - Us Dinesh
- Department of Pathology, SDM College of Medical Sciences, Dharwad, India
| | - Priyanka Reshme
- Department of Dermatology, SDM College of Medical Sciences, Dharwad, India
| | - Ra Divyashree
- Department of Dermatology, SDM College of Medical Sciences, Dharwad, India
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33
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Jenkins D, McPherson T. Paraneoplastic subacute cutaneous lupus erythematosus associated with cholangiocarcinoma. Australas J Dermatol 2014; 57:e5-7. [PMID: 25367767 DOI: 10.1111/ajd.12251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/03/2014] [Indexed: 12/22/2022]
Abstract
Subacute cutaneous lupus erythematosus (SCLE) is a dermatosis that occurs in genetically predisposed individuals. The exogenous stimulus that triggers this condition is usually unknown; however, medication is often implicated. Malignancy is a rare cause. We present a case of paraneoplastic SCLE to cholangiocarcinoma and briefly review the features of this interesting entity.
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Affiliation(s)
- David Jenkins
- Dermatology Department, Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, UK
| | - Tess McPherson
- Dermatology Department, Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, UK
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34
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Abstract
Lupus erythematosus (LE) is a chronic, autoimmune, multisystem disease that displays many diverse symptoms in which localized cutaneous LE (CLE) is on one end of the spectrum and severe systemic LE (SLE) on the other end. The underlying cause of LE is unknown but the etiology is thought to be multifactorial and polygenic. CLE is a disfiguring, chronic skin disease, with a significant impact on the patients’ everyday life. CLE are further divided into three main subsets: Acute CLE (ACLE), subacute CLE (SCLE) and chronic CLE (CCLE), where classic discoid LE (DLE) is the most common form. These subsets are defined by clinical symptoms, average duration of symptoms and histological and serological findings, although, the three subtypes can have overlapping clinical features. CLE patients display well-defined skin lesions, often in sun-exposed areas. The disease often has a chronic and relapsing course that can be induced or aggravated by UV light. It is important to confirm a CLE diagnosis histopathologically by a biopsy and in that there are several differential diagnoses and because CLE is a chronic disease in which regular follow-up is important and systemic treatment is sometimes indicated.
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Affiliation(s)
- Carina M Grönhagen
- Institute of Environmental Medicine, Unit of Occupational and Environmental Dermatology, Karolinska Institutet, Stockholm, Sweden
| | - Filippa Nyberg
- Uppsala University Hospital, Department of Dermatology, Uppsala, Sweden
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Lamond NWD, Younis T, Purdy K, Dorreen MS. Drug-induced subacute cutaneous lupus erythematosus associated with nab-paclitaxel therapy. ACTA ACUST UNITED AC 2013; 20:e484-7. [PMID: 24155645 DOI: 10.3747/co.20.1546] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Drug-induced lupus erythematosus (dile) syndromes are documented complications of chemotherapeutic agents, including paclitaxel. Subacute cutaneous lupus erythematosus (scle) is a distinct dile syndrome presenting with characteristic annular or papulosquamous skin lesions in a photosensitive distribution with associated high anti-ssa titres. Previously, dile syndromes complicating paclitaxel therapy have been attributed to polyethoxylated castor oil (Kolliphor EL: BASF, Ludwigshafen, Germany), the biologic solvent included in the drug's original formulation (Taxol: Bristol-Myers Squibb, Montreal, QC), rather than the parent chemotherapy molecule. Here, we report a characteristic case of drug-induced scle complicating treatment with nanoparticle albumin bound (nab)-paclitaxel (Abraxane: Celgene, Summit, NJ, U.S.A.), a solvent-free taxane formulation. The pertinent English-language literature is also discussed. This case report is the first to link solvent-free paclitaxel with scle, and it suggests that the parent molecule is responsible for the reaction.
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Affiliation(s)
- N W D Lamond
- Department of Medicine, Dalhousie University, Halifax, NS
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