Department of Anaesthesia, Intensive Care and Dermatological Sciences, Università degli Studi di Milano - U.O. Dermatologia, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Br J Dermatol. 2011 Aug;165(2):335-41. doi: 10.1111/j.1365-2133.2011.10397.x. Epub 2011 Jul 11.
Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) is a lupus variant with predominant skin involvement temporally related to drug exposure and resolving after drug discontinuation. It usually presents with annular polycyclic or papulosquamous eruptions on sun-exposed skin and shows serum anti-Ro/SSA antibodies.
To address the question whether DI-SCLE differs significantly from idiopathic SCLE by virtue of clinical features.
Ninety patients with SCLE seen in our departments from 2001 to 2010 were reviewed. Eleven of them diagnosed as having DI-SCLE were evaluated for type of skin lesions, systemic involvement, clinical course, and histopathological, direct immunofluorescence and laboratory findings. The cutaneous features were compared with those of the 79 patients with idiopathic SCLE.
The cutaneous picture was widespread in 82% of patients with DI-SCLE and in 6% of those with idiopathic SCLE [odds ratio (OR) 66·6, 95% confidence interval (CI) 11·2-394·9; P = 0·0001]. Bullous and erythema multiforme (EM)-like lesions were present in 45% of patients with DI-SCLE and in 1% of those with idiopathic SCLE (OR 65·0, 95% CI 6·5-649·6; P = 0·0001). Vasculitic lesions were observed in 45% of patients with DI-SCLE and in 3% of those with idiopathic SCLE (OR 32·1, 95% CI 5·1-201·7; P = 0·0001). Malar rash occurred in 45% of patients with DI-SCLE and in 6% of those with idiopathic SCLE (OR 12·3, 95% CI 2·8-54·9; P = 0·001). Visceral manifestations were excluded in all patients with DI-SCLE. Anti-Ro/SSA antibodies were found in all but one patient with DI-SCLE and disappeared after resolution in 73% of cases.
DI-SCLE differs from idiopathic SCLE by virtue of distinctive cutaneous features, particularly the widespread presentation and the frequent occurrence of malar rash and bullous, EM-like and vasculitic manifestations.
药物诱导的亚急性皮肤型狼疮（DI-SCLE）是一种具有皮肤表现为主的狼疮变异型，与药物暴露时间相关，停药后可缓解。其通常表现为暴露于阳光下的皮肤出现环状多形性或丘疹鳞屑性皮疹，并伴有血清抗 Ro/SSA 抗体。
探讨 DI-SCLE 是否因临床表现而与特发性 SCLE 有显著差异。
回顾了 2001 年至 2010 年在我们科室就诊的 90 例 SCLE 患者，其中 11 例诊断为 DI-SCLE，评估其皮肤病变类型、系统受累情况、临床过程以及组织病理学、直接免疫荧光和实验室检查结果。比较 DI-SCLE 患者与 79 例特发性 SCLE 患者的皮肤表现。
82%的 DI-SCLE 患者皮损广泛，而 6%的特发性 SCLE 患者皮损广泛[比值比（OR）66.6，95%置信区间（CI）11.2-394.9；P=0.0001]。DI-SCLE 患者中有 45%出现大疱性和多形红斑（EM）样皮损，而特发性 SCLE 患者中仅 1%出现[OR 65.0，95%CI 6.5-649.6；P=0.0001]。血管炎病变在 DI-SCLE 患者中占 45%，而在特发性 SCLE 患者中占 3%[OR 32.1，95%CI 5.1-201.7；P=0.0001]。DI-SCLE 患者中有 45%出现蝶形红斑，而特发性 SCLE 患者中仅 6%出现[OR 12.3，95%CI 2.8-54.9；P=0.001]。所有 DI-SCLE 患者均排除内脏表现。除 1 例外，所有 DI-SCLE 患者均存在抗 Ro/SSA 抗体，73%的病例在缓解后消失。
DI-SCLE 与特发性 SCLE 的不同之处在于其独特的皮肤表现，特别是广泛的皮损表现以及蝶形红斑、大疱性、EM 样和血管炎表现的高频发生。
