Topical drug-induced subacute cutaneous lupus erythematosus isolated to the hands.
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.
The Ronald O. Perelman Department of Dermatology , New York University School of Medicine , New York, New York , USA.
Sarika M
SM
Ramachandran
The Ronald O. Perelman Department of Dermatology , New York University School of Medicine , New York, New York , USA.
Jonathan S
JS
Leventhal
The Ronald O. Perelman Department of Dermatology , New York University School of Medicine , New York, New York , USA.
Loren G
LG
Franco
The Ronald O. Perelman Department of Dermatology , New York University School of Medicine , New York, New York , USA.
Adnan
A
Mir
The Ronald O. Perelman Department of Dermatology , New York University School of Medicine , New York, New York , USA.
Ruth F
RF
Walters
The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA; Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, New York, USA.
Andrew G
AG
Franks
Autoantibodies; Autoimmune Diseases; Systemic Lupus Erythematosus