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Topical drug-induced subacute cutaneous lupus erythematosus isolated to the hands
  1. Sarika M Ramachandran1,
  2. Jonathan S Leventhal1,
  3. Loren G Franco1,
  4. Adnan Mir1,
  5. Ruth F Walters1 and
  6. Andrew G Franks Jr1,2
  1. 1The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
  2. 2Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, New York, USA
  1. Correspondence to Professor Andrew G Franks, Jr; andrew.franks{at}nyumc.org

Abstract

Subacute cutaneous lupus erythematosus (SCLE) is a well-defined subtype of lupus erythematosus, characterised by photosensitivity, annular and/or psoriasiform lesions, variable systemic involvement and presence of circulating SSA/anti-Ro antibodies. SCLE may be idiopathic or drug-induced. Both the idiopathic and drug-induced forms of SCLE are analogous in their clinical, serological and histological features. Drug-induced SCLE has been reported with various oral agents, but to our knowledge this is the first reported case due to a topical medication. A 34-year-old female foot masseuse presented with a 2-month history of scaly, erythematous lesions isolated to the dorsal hands and interdigital spaces. She had used topical terbinafine, a topical antifungal cream, to her clients’ feet for a number of years. ANA and anti-SSA/Ro antibodies were positive. Physical examination, serology and histopathology were consistent with SCLE. We propose that our patient's unique presentation of SCLE may be explained by a prolonged occupational exposure to topical terbinafine as a foot masseuse. While oral terbinafine is a drug known to cause drug-induced SCLE, to our knowledge, this is the first topically induced form of the disease.

  • Autoimmune Diseases
  • Systemic Lupus Erythematosus
  • Autoantibodies

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Footnotes

  • Contributors JSL, LGF, AM, SMR, RFW and AGF had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: SMR and AGF. Acquisition, analysis and interpretation of data: JSL, AGF, AM, SMR, RFW and AGF. Drafting of the manuscript: JSL, LGF, SMR and AGF. Critical revision of the manuscript for important intellectual content: SMR and AGF. Obtained funding: AGF. Study supervision: AGF.

  • Funding The Frances and Benjamin Benenson Foundation and Lynn and William M. Silverman Donation Fund.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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