Drug-induced lupus erythematosus

Causes and Risks:
Several medications are known to cause a syndrome that resembles systemic lupus erythematosus ( SLE ), a chronic inflammatory autoimmune disorder that may affect many organ systems. Drug-induced lupus erythematosus occurs as a result of a hypersensitivity reaction to a medication. The drug may react with cell materials to form antinuclear antibodies . Drugs that are known to cause this type of reaction in some people include procainamide, isoniazid, chlorpromazine, penicillamine, sulfasalazine, hydralazine, methyldopa, and phenytoin. In drug-induced lupus erythematosus the features of arthritis , systemic symptoms, and cardiac and pulmonary (lung) symptoms may be present. Other symptoms associated with SLE such as lupus nephritis and neurological disease are rare. Drug-induced lupus erythematosus also differs from SLE in that the course of the disease is usually not as severe as SLE; usually the symptoms resolve within a few days to weeks after stopping the medication. The sex distribution of drug-induced lupus erythematosus is equal whereas in SLE, women are affected more often than men.

Prevention:
Be aware of the risk when taking medications that are known to cause this reaction. If symptoms begin to appear, consult your health care provider about the advisability of changing medication.

Symptoms:



Signs and Tests:
The history shows use of a medication associated with drug induced lupus . An examination of the skin shows characteristic skin rash or lesions. Signs of pericarditis may be present. Listening to the chest with a stethoscope ( auscultation ) may reveal abnormal sounds such as heart murmur, pleural friction rub, or pericardial friction rub.

Tests for SLE include:

A chest X-ray may show pleuritis or pericarditis. An ECG may show heart involvement.

Treatment:
Usually symptoms resolve within several days to weeks after stopping the medication that caused the symptoms. Nonsteroidal anti-inflammatory medications are used to treat arthritis and pleurisy . Corticosteroid creams are used to treat skin rashes . Antimalarial drugs (hydroxychloroquine) are sometimes used for skin and arthritis symptoms. Sensitivity to light is treated by protective clothing, sunglasses, and sunscreen. Routine eye examinations are recommended to detect eye complications early.

Prognosis:
Symptoms usually resolve within several days to weeks after stopping the medication.

Complications:



Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms do not improve after the medication that caused the symptoms has been discontinued, or new symptoms develop.


Lupus, discoid on the face: The discoid (round or disk shaped) rash is characterized by red, raised patches with adherent scales. The skin pores (follicles) may be plugged. Scarring often occurs in older lesions. The majority (approximately 90%) of individuals with discoid lupus have only skin involvement as compared to more generalized involvement in systemic lupus erythematosis (SLE).



Lupus, discoid on a man's face: The discoid (round or disk shaped) rash is characterized by red, raised patches with adherent scales. The skin pores (follicles) may be plugged. Scarring often occurs in older lesions. Lesions are most often found in the sun exposed skin of the face, scalp, and arms. Involvement of the scalp often results in a scarring of the scalp with associated permanent hair loss.



Systemic Lupus Erythematosis: Lupus often produces a "butterfly rash" on the malar rash. This rash is usually red, smooth with no scale or crusts. Patients often have other symptoms like arthritis, fever, and muscle aches.



Lupus, rash on a female's chest: Lupus is a multi-system autoimmune disease that can affect almost any organ of the body. The skin is frequently involved. Rashes may have many different appearances. This is one manifestation seen here on the neck and chest. Lupus rashes most commonly occur in the sun-exposed skin.



Lupus is a multi-system autoimmune disease that can affect almost any organ of the body. The skin is frequently involved. Rashes may have many different appearances. These skin lesions are more characteristic of subacute or discoid lupus than the typical " butterfly rash" of systemic lupus.



Lupus, discoid - view of lesions on the chest: This close-up picture of the neck clearly shows the typical rounded appearance of discoid lupus. The whitish appearance is caused by scaling. The two dark spots are biopsy sites and are not part of the disease.



Lupus, discoid on the cheek and neck: The rash of discoid lupus may have several different appearances. This rash alone is not diagnostic of discoid lupus.







The round or disk shaped (discoid) rash of lupus produces red, raised patches with scales. The pores (hair follicles) may be plugged. Scarring often occurs in older lesions. The majority (approximately 90%) of individuals with discoid lupus have only skin involvement as compared to more generalized involvement in systemic lupus erythematosis (SLE).



The rash of lupis is round or disk shaped (discoid) and is characterized by red, raised patches with adherent scales. The skin pores (follicles) may be plugged, and scarring often occurs in older lesions. Approximately 90% of individuals with discoid lupus have only skin involvement as compared to more generalized involvement in systemic lupus erythematosis (SLE).