Brown C W, Deng J S
School of Medicine, University of Pittsburgh, Pennsylvania, USA.
J Toxicol Clin Toxicol. 1995;33(6):729-33. doi: 10.3109/15563659509010639.
One of the side effects reported in patients taking thiazide diuretics is photosensitivity. We report two patients who developed lupus-like skin lesions while taking thiazide diuretics. One patient developed erythematous scaling papules, patches and plaques on the upper extremities and trunk resembling subacute cutaneous lupus erythematosus. Histopathology of a skin biopsy from the trunk showed basal cell layer liquefaction and lichenoid interface changes suggestive of lupus erythematosus. The skin lesions resolved completely within two months of discontinuing thiazide therapy. The second patient developed multiple flesh colored urticarial plaques on the trunk one year after beginning thiazide therapy. Slight lichenoid interface changes were noted on a skin biopsy, along with dense mucin deposition in the papillary and deep dermis, suggestive of tumid lupus erythematosus. The skin lesions persisted despite discontinuing thiazide therapy, necessitating systemic corticosteroid treatment. Both patients had circulating anti-SSA/Ro autoantibodies and antinuclear antibodies. These two patients illustrate that thiazide diuretics may induce a cutaneous lupus erythematosus-like adverse reaction and production of anti-SSA/Ro autoantibodies as demonstrated by immunodiffusion, immunoblot and immunoprecipitation testing.
服用噻嗪类利尿剂的患者报告的副作用之一是光敏性。我们报告了两名在服用噻嗪类利尿剂时出现狼疮样皮肤病变的患者。一名患者上肢和躯干出现红斑鳞屑丘疹、斑片和斑块，类似于亚急性皮肤型红斑狼疮。取自躯干的皮肤活检组织病理学显示基底细胞层液化和苔藓样界面改变，提示红斑狼疮。在停用噻嗪类治疗后的两个月内，皮肤病变完全消退。第二名患者在开始噻嗪类治疗一年后躯干出现多个肉色风团样斑块。皮肤活检显示轻微的苔藓样界面改变，以及乳头层和深层真皮中密集的粘蛋白沉积，提示肿胀性红斑狼疮。尽管停用了噻嗪类治疗，皮肤病变仍持续存在，需要全身使用皮质类固醇治疗。两名患者均有循环抗SSA/Ro自身抗体和抗核抗体。这两名患者表明，噻嗪类利尿剂可能会诱发皮肤红斑狼疮样不良反应，并产生抗SSA/Ro自身抗体，免疫扩散、免疫印迹和免疫沉淀检测证实了这一点。
