Poh Yih Jia, Alrashid Abdulrahman, Sangle Shirish R, Higgins Eleanor, Benton Emma, McGibbon David, D'Cruz David P
Louise Coote Lupus Unit, 111988Guy's Hospital, London, UK.
Department of Dermatology, Guy's Hospital, London, UK.
Lupus. 2022 Aug;31(9):1078-1083. doi: 10.1177/09612033221104237. Epub 2022 May 30.
There is a growing literature reporting the association between proton pump inhibitor (PPI) use and subacute cutaneous lupus erythematosus (SCLE).
To compare the clinical characteristics of a cohort of patients with PPI-induced SCLE, their clinical course and treatment with a control group of primary SCLE patients not exposed to PPI.
We conducted a matched case-control study in a tertiary referral setting at the Louise Coote Lupus Unit. There were 64 SCLE patients: 36 with PPI-induced SCLE and 28 patients with primary SCLE.
Twenty-six patients (72%) had pre-existing SLE in the PPI-induced SCLE group. Lower limb skin lesions were significantly more prevalent in the PPI group ( < 0.0001). The prevalence of anti-Ro and anti-Ro-52 antibodies was numerically higher in the PPI group (64% and 60%), respectively, compared with 46% and 42% in the primary SCLE group. Peripheral blood eosinophils were normal in all patients in the PPI group. Thirteen patients underwent skin biopsy in the PPI group and 12 had histology in keeping with SCLE. The median time to presentation was 8 months with a median resolution period of 6 weeks. PPIs were stopped in 34 patients, while 2 patients continued treatment for other clinical indications. Twelve patients received concurrent oral corticosteroids. Two patients had severe SCLE in the form of Toxic Epidermal Necrolysis requiring critical care admission and were managed with corticosteroids, IV immunoglobulin and/or belimumab.
Lower limb involvement is a pointer to PPI-induced SCLE which is likely a class effect with all PPI.
越来越多的文献报道质子泵抑制剂（PPI）的使用与亚急性皮肤型红斑狼疮（SCLE）之间存在关联。
比较一组PPI诱发的SCLE患者的临床特征、临床病程及治疗情况，并与未接触PPI的原发性SCLE患者对照组进行对比。
我们在路易丝·库特狼疮病房这一三级转诊机构开展了一项匹配病例对照研究。共有64例SCLE患者：36例为PPI诱发的SCLE患者，28例为原发性SCLE患者。
PPI诱发的SCLE组中有26例患者（72%）既往患有系统性红斑狼疮（SLE）。PPI组下肢皮肤病变更为常见（<0.0001）。PPI组抗Ro和抗Ro-52抗体的阳性率在数值上更高，分别为64%和60%，而原发性SCLE组为46%和42%。PPI组所有患者外周血嗜酸性粒细胞均正常。PPI组13例患者接受了皮肤活检，其中12例组织学检查符合SCLE。出现症状的中位时间为8个月，中位缓解期为6周。34例患者停用了PPI，2例患者因其他临床指征继续治疗。12例患者同时接受了口服糖皮质激素治疗。2例患者出现了严重的SCLE，表现为中毒性表皮坏死松解症，需要入住重症监护病房，接受了糖皮质激素、静脉注射免疫球蛋白和/或贝利尤单抗治疗。
下肢受累是PPI诱发SCLE的一个指征，这可能是所有PPI的类效应。
