By Gary M. White, MD
Subacute cutaneous lupus erythematosus (SCLE) is a variant of lupus in which SSA (Ro) and SSB (La) antibodies are positive. It tends to occur in older woman, preferentially affects the trunk, and tends to have a papulosquamous morphology.
Red, scaly, annular lesions, often on the upper trunk of a middle-aged woman, is typical. Lesions may appear as and be misdiagnosed as psoriasis.
Various drugs have been reported to induce subacute cutaneous lupus erythematosus (SCLE). The most compelling include terbinafine, hydrochlorothiazide and proton pump inhibitors (PPIs), e.g. omeprazole. See here.
In one study of 24 patients with PPI-induced SCLE [BJD Feb 2014], most were females and the mean age was 61 years. The offending PPIs were lansoprazole (12), omeprazole (6), esomeprazole (4) and pantoprazole (2). Several patients reacted to more than one PPI. The incubation period was on average 8 months (range 1 week to 3.5 years) and the resolution period was on average 3 months (range 4 weeks to 8 months). Antinuclear antibodies were positive in 61%, most frequently with a speckled pattern. Positive anti-Ro/SSA antibodies were found in 73% and anti-La/SSB antibodies in 33%.
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