Multiple eruptive dermatofibromas in patients with systemic lupus erythematosus treated with prednisone.
Solitary dermatofibromas are a common occurrence, especially on the lower limbs of young women, while multiple dermatofibromas (MDF) are rare, accounting for less than 0.3% of all dermatofibromas and may suddenly develop in immunosuppressed patients. We report a patient with systemic lupus erythematosus (SLE) who developed MDF while she was taking oral prednisone. A 46-year-old woman presented in 1989 complaining of photosensitivity, arthralgias, fatigue, malaise and dyspepsia. The patient denied fever, Raynaud's phenomenon, oral ulcer and hair loss. On examination she presented a typical SLE malar rash. Erythrocyte sedimentation rate (ESR) was elevated (54 mm/h). Speckle patterned IgG/IgM antinuclear antibodies were present at 1/1280 titer. Antibodies anti Ro/SSA were detected by counterimmunelectrophoresis up to 1/8 titer. Other laboratory findings were negative or within normal limits. Systemic lupus erythematosus was diagnosed and the patient given 50 mg/day prednisone. After a few months, both clinical symptoms and immunologic parameters improved. Eighteen months later, prednisone was replaced by 500 mg/day hydroxychloroquine. In 1994, she presented again with malar rash, arthralgias and facial hyperpigmentation. Prednisone 15 mg/day was reintroduced and hydroxychloroquine stopped being a possible cause of the facial hyperpigmented macules. In 1996, while she was taking 5 mg/day prednisone, several nodules developed on her limbs within a few months. On examination we observed 16 firm, slightly elevated 3-15-mm wide brown nodules on her arms, legs and trunk. A biopsy specimen of a lesion of the trunk revealed an epidermal seborrheic-keratosis-like hyperplasia with dermal fibrosis and fibroblastic proliferation (Fig. 1). Dermatofibroma was diagnosed.
Massone
C
C
Di.S.E.M., Section of Dermatology, University of Genoa, Italy. rebdermo@unige.it
Parodi
A
A
Virno
G
G
Rebora
A
A
D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D003875:Drug Eruptions / Q000473:pathology*; D005260:Female; D018219:Histiocytoma, Benign Fibrous / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects* / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000473:pathology*
D000893:Anti-Inflammatory Agents; D011241:Prednisone