Are There Distinct Clinical and Pathological Features Distinguishing Idiopathic From Drug-Induced Subacute Cutaneous Lupus Erythematosus? A European Retrospective Multicenter Study

J Am Acad Dermatol. 2019 Aug;81(2):403-411. doi: 10.1016/j.jaad.2019.02.009. Epub 2019 Feb 11.

Abstract

Background: Clinical and pathologic criteria to distinguish drug-induced subacute lupus erythematosus (DI-SCLE) from idiopathic (I-SCLE) are controversial.

Objective: The aim of the survey was a retrospective analysis of a consistent number of iatrogenous and idiopathic SCLE cases, by means of clinical and histopathologic investigation.

Methods: Eleven European university dermatology units collected all diagnosed cases from January 2000 to December 2016. Board-certified dermatopathologists reviewed the histopathologic specimens. Statistical analysis included Student t test, exact test of goodness-of-fit, Fisher's exact test, and the Cochran-Mantel-Haenszel test for repeated measures.

Results: Out of 232 patients, 67 (29%) belonged to the DI-SCLE group. Patients with DI-SCLE were significantly older and reported more systemic symptoms than those with I-SCLE. No statistical differences were found for presentation pattern or serology, while histopathology showed a significant association of mucin deposition (P = .000083), direct immunofluorescence positivity for granular immunoglobulin M, and C3 deposits on the basement membrane zone (P = .0041) for I-SCLE and of leukocytoclastic vasculitis (P = .0018) for DI-SCLE.

Limitations: This is a retrospective study.

Conclusion: An integrated clinical and immunopathologic evaluation is useful to differentiate I-SCLE from DI-SCLE. Older age at onset and more frequent systemic symptoms characterize DI-SCLE. Mucin deposition and immunofluorescence findings are found in I-SCLE, and leukocytoclastic vasculitis is found in DI-SCLE.

Keywords: drug-induced subacute lupus erythematosus; histopathology study; subacute lupus erythematosus.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Age Factors
  • Antibodies, Antinuclear / blood
  • Basement Membrane / metabolism
  • Complement C3 / metabolism
  • Drug Eruptions / etiology
  • Drug Eruptions / metabolism*
  • Drug Eruptions / pathology*
  • Europe
  • Female
  • Humans
  • Immunoglobulin M / metabolism
  • Lupus Erythematosus, Cutaneous / etiology
  • Lupus Erythematosus, Cutaneous / metabolism*
  • Lupus Erythematosus, Cutaneous / pathology*
  • Male
  • Middle Aged
  • Mucins / metabolism
  • Retrospective Studies
  • Vasculitis, Leukocytoclastic, Cutaneous / etiology

Substances

  • Antibodies, Antinuclear
  • Complement C3
  • Immunoglobulin M
  • Mucins
  • SS-A antibodies