title: Lupus erythematosus induced by medications, ultraviolet radiation, and other exogenous agents: a review, with special focus on the development of subacute cutaneous lupus erythematosus in a genetically predisposed individual.
abstract: Exogenous agents implicated in or suspected of precipitating subacute cutaneous lupus erythematosus (SCLE) and lupus erythematosus (LE) are reviewed. An illustrative case of environmentally induced SCLE is presented. A previously healthy 30-year male homozygous for the tumor necrosis factor-alpha (TNF-alpha) 308. A promoter allele developed SCLE after spending several hours removing fertilizer- and pesticide-containing hay from an agricultural barn in the springtime. The cutaneous eruption soon resolved, only to reappear 3 weeks later on the day the patient re-entered the barn. An environmental agent present in the barn, coupled with springtime ultraviolet light, likely triggered the disease in this immunogenetically susceptible individual.
authors.affiliation: Department of Dermatology, University of Pennsylvania Health System, Philadelphia V.A. Hospital, Philadelphia, PA 19104, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Shapiro
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Sosis
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Junkins-Hopkins
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Werth
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D064420:Drug-Related Side Effects and Adverse Reactions; D004781:Environmental Exposure / Q000009:adverse effects*; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D007150:Immunohistochemistry; D007306:Insecticides / Q000009:adverse effects*; D008178:Lupus Erythematosus, Cutaneous / Q000139:chemically induced* / Q000235:genetics* / Q000473:pathology; D008297:Male; D018570:Risk Assessment; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics; D014466:Ultraviolet Rays / Q000009:adverse effects
chemical_list: D007306:Insecticides; D014409:Tumor Necrosis Factor-alpha