Department of Dermatology (Pavillon Tarnier), Hôpital Cochin, APHP, Université René Descartes, Paris, France.
Dermatology. 2013;226(2):119-23. doi: 10.1159/000346694. Epub 2013 Mar 23.
Subacute cutaneous lupus erythematosus (SCLE) can be induced by numerous drugs. We report 3 cases of SCLE induced by proton pump inhibitors (PPIs).
To highlight a rare cutaneous side effect induced by a frequently prescribed drug such as a PPI.
Case 1 was a 30-year-old man who developed multiple annular plaques over the trunk and lower limbs 1 month after the initiation of pantoprazole. Antinuclear antibodies (ANA) were positive with anti-Ro/SSA and anti-La/SSB antibodies, and histology confirmed the diagnosis. Clinical improvement was achieved 8 weeks after the discontinuation of pantoprazole and the introduction of a treatment combining topical steroids and hydroxychloroquine. Lesions relapsed when pantoprazole was accidentally rechallenged. The second case was a 31-year-old woman, 28 weeks pregnant, who presented erythematous annular plaques over the trunk 7 weeks after starting esomeprazole. ANA and anti-Ro/SSA antibodies were positive, and the histology was compatible with SCLE. Fetal ultrasound was normal. She was treated with topical and oral steroids and hydroxychloroquine. Clinical improvement was achieved 4 weeks after the discontinuation of esomeprazole. The third case was a 57-year-old woman with systemic erythematosus lupus presenting annular and psoriasiform lesions on the trunk for 15 months. She was treated successively with hydroxychloroquine, azathioprine, mycophenolate mofetil and methotrexate with prednisone. A review of her drug history revealed the introduction of omeprazole a few weeks before the first appearance of skin lesions and omeprazole was contraindicated.
SCLE should systematically be suspected in case of eruption after the introduction of PPI. The risk of fetal cardiac complications is important in pregnant women.
亚急性皮肤型狼疮（SCLE）可由多种药物引起。我们报告了 3 例由质子泵抑制剂（PPIs）引起的 SCLE 病例。
强调一种经常开处方的药物（如质子泵抑制剂）引起的罕见皮肤副作用。
病例 1 为一名 30 岁男性，在开始使用泮托拉唑 1 个月后，躯干和下肢出现多个环形斑块。抗核抗体（ANA）阳性，伴有抗 Ro/SSA 和抗 La/SSB 抗体，组织学证实了诊断。停用泮托拉唑并引入联合局部皮质类固醇和羟氯喹治疗后，8 周后临床症状改善。当泮托拉唑意外重新使用时，病变复发。第二个病例是一名 31 岁女性，怀孕 28 周，在开始使用埃索美拉唑后 7 周出现红斑性环形斑块。ANA 和抗 Ro/SSA 抗体阳性，组织学符合 SCLE。胎儿超声正常。她接受了局部和口服皮质类固醇和羟氯喹治疗。停用埃索美拉唑 4 周后，临床症状改善。第三个病例是一名 57 岁女性，患有系统性红斑狼疮，15 个月来躯干出现环形和银屑病样病变。她先后接受羟氯喹、硫唑嘌呤、霉酚酸酯和甲氨蝶呤联合泼尼松治疗。回顾她的用药史，发现她在皮肤病变首次出现前几周开始使用奥美拉唑，且奥美拉唑是禁忌的。
在使用质子泵抑制剂后出现皮疹时应系统怀疑 SCLE。孕妇胎儿心脏并发症的风险很重要。
