Subacute Cutaneous Lupus Erythematosus Induced and Exacerbated by Proton Pump Inhibitors

Almebayadh, Mishal; Régnier‐Rosencher, E.; Carlotti, A.; Goulvestre, Claire; Guern, Véronique Le; Mouthon, Luc; Avril, Marie-Françoise; Dupin, Nicolas

doi:10.1159/000346694

Cited by 19 publications

(8 citation statements)

References 13 publications

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“…A literature review of PPI-induced CLE using the PubMed online database identified 18 case reports of PPI-induced SCLE and one case of PPI-induced DLE. 5 , 12 , 15 – 23 However, the latter case did not fulfil the proposed definition of DILE, as the discoid lesions occurred after discontinuation of pantoprazole. In a Swedish case–control study of 234 patients with SCLE, 65 had received PPIs.…”

Section: Discussionmentioning

confidence: 94%

Proton pump inhibitor‐induced subacute cutaneous lupus erythematosus

2014

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SummaryBackgroundDrug-induced subacute cutaneous lupus erythematosus (SCLE) has been known in the literature since 1985 and is increasingly recognized.ObjectivesTo identify and describe patients with proton pump inhibitor (PPI)-induced SCLE.MethodsA retrospective medical chart review of patients diagnosed with lupus erythematosus at the Department of Dermatology and Allergy Centre was carried out over a 19-year period. A causality assessment to PPI was performed using the Naranjo probability scale.ResultsTwenty-four patients with PPI-induced SCLE were identified (21 women and three men). Nineteen patients were newly identified cases, with a mean age of 61 years. These patients had 24 episodes of PPI-induced SCLE comprising lansoprazole (12), omeprazole (six), esomeprazole (four) and pantoprazole (two). Four patients had multiple episodes and three patients reacted to different PPIs. 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% of tested patients, most frequently with a speckled pattern. Positive anti-Ro/SSA antibodies were found in 73%, anti-La/SSB antibodies in 33% and antihistone antibodies in 8% of tested patients at the time of the eruption. The skin rash was often widespread with a tendency to bullous lesions and focal skin necrosis.ConclusionsWe present the largest case series of PPI-induced SCLE reported to date, and our patient cohort reveals the lack of attention to this condition. The diagnosis may be suspected on the clinical picture, and most patients have anti-Ro/SSA antibodies, while antihistone antibodies have no value in the diagnostic process. Cross-reactivity can be seen between different PPIs.

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Section: Discussionmentioning

confidence: 94%

Proton pump inhibitor‐induced subacute cutaneous lupus erythematosus

2014

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“… 7 Jones et al (2015) [ 19 ] 73, F, African-American, USA Pantoprazole Forehead, neck, back, upper and lower extremities ANA+ (speckled), SSA+, SSB−, dsDNA−, histone− Amlodipine stopped (was provided with pantoprazole initially); amlodipine restarted after 1 month 1 month 8 Hung et al (2015) [ 20 ] 60, F, UK Omeprazole Trunk, thighs, back Previous history of SCLE, ANA+, SSA+ Prednisolone and mycophenolate mofetil 4 months 9 Almebayadh et al (2013) [ 21 ] 30, M (originally from island of Martinique) Pantoprazole 1 month Trunk, lower limbs ANA+ (speckled), SSA+, SSB+, histone− 8 weeks (relapsed when pantoprazole accidently re-challenged) 10 Almebayadh et al (2013) [ 21 ] 31, F (originally from Canada) Esomeprazole (20 mg/day) (no other treatment) 7 weeks Trunk, scalp, face Pregnant, ANA+ (speckled), SSA+, SSB−, histone− After discontinuing PPI, topical steroids and hydroxychloroquine 400 mg daily were started. After 2 weeks, oral steroid added (0.25 mg/kg/day) 4 weeks 11 Almebayadh et al (2013) [ 21 ] 57, F (originally from island of Martinique) Omeprazole Few weeks Trunk, upper and lower limbs ANA+, SSA+, anti-SM, anti-RNP antibodies Not mentioned 12 W...…”

Section: Resultsmentioning

confidence: 99%

Drug-Induced Subacute Cutaneous Lupus Erythematosus Associated with Proton Pump Inhibitors

Aggarwal

2016

Drugs - Real World Outcomes

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Subacute cutaneous lupus erythematosus (SCLE) is an autoimmune disease that may be induced by proton pump inhibitors (PPIs) in at-risk populations. The US FDA does not recognize SCLE as an adverse event associated with PPIs. We queried the FDA Adverse Event Reporting System database, which contains adverse event case reports submitted by the public as well as by industry, and analyzed the data to quantify passive pharmacovigilance signals for SCLE associated with PPIs. A disproportionality analysis of the signals yielded a significant association between SCLE and PPIs. Discontinuation of PPI resulted in remission, with PPI re-challenge causing SCLE to reoccur. A follow-up analysis also yielded a significant association between SCLE and H2 receptor antagonists. We conducted a brief literature survey of published case reports and studies to discern the validity of PPI-induced SCLE signals. Healthcare prescribers and patients should be made aware that SCLE can be induced by PPIs. In such cases, PPIs should be discontinued and alternative clinical treatment sought. Regulatory bodies such as the FDA should incorporate the adverse reaction in PPI prescription labels.

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“…[ 11 ] Since then, several case reports and case series of PPI-induced SCLE have appeared in literature. [ 7 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ] PubMed search (limited to English literature) revealed 43 cases of PPI-induced SCLE, comprising 12 case reports of single patients and five reports of two or more patients. [ 7 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ] A summary of these five case series compared to current series is tabulated in Table 3 .…”

Section: Discussionmentioning

confidence: 99%

Proton pump inhibitor induced subacute cutaneous lupus erythematosus: A case series of 7 patients and brief review of literature

Singla

Kaur

et al. 2022

Indian Dermatol Online J

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Background: Subacute cutaneous lupus erythematosus (SCLE) manifests with erythematous, nonscarring, annular, or papulosquamous plaques. Proton pump inhibitors (PPIs) are increasingly being incriminated in its causation, but reports of similar nature from India are lacking. Aims: To describe the characteristics of seven patients with SCLE induced by PPIs and to review the published cases in order to provide a better perspective of the association. Materials and Methods: We describe seven patients of PPI-induced SCLE, seen over a period of 6 years. We also review the literature for additional data on PPI-induced SCLE. The selected publications were reviewed, and relevant clinical and laboratory data were extracted. Results: Of the total seven cases, there were four males and three females with a mean age of 60.2 ± 5.5 years (range 53-70 years). Nine episodes of PPI-induced SCLE were recorded in the seven patients. Of the initial episodes, esomeprazole was implicated in four, pantoprazole in two, and rabeprazole in one patient. Latency period ranged from 2 weeks to 1 year (mean 11.4 ± 16.2 weeks). Morphology was described as annular scaly plaques in six and papulosquamous in one. Antinuclear antibodies and anti-Ro antibodies were positive in all patients. Naranjo probability scale was used in all patients; two were categorized as definite and five as probable. Treatments included drug withdrawal in six patients, topical steroids in one, systemic corticosteroids in all seven, and hydroxychloroquine in one patient, used alone or in combinations. Complete remission was achieved in six cases, while one had partial remission. Limitation: Retrospective nature of this study and limited number of patients. Conclusion: PPIs can trigger SCLE.

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Subacute Cutaneous Lupus Erythematosus Induced and Exacerbated by Proton Pump Inhibitors

Cited by 19 publications

References 13 publications

Proton pump inhibitor‐induced subacute cutaneous lupus erythematosus

Proton pump inhibitor‐induced subacute cutaneous lupus erythematosus

Drug-Induced Subacute Cutaneous Lupus Erythematosus Associated with Proton Pump Inhibitors

Proton pump inhibitor induced subacute cutaneous lupus erythematosus: A case series of 7 patients and brief review of literature

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