Bupropion-induced subacute cutaneous lupus erythematosus

Subacute cutaneous lupus erythematosus is a subset of cutaneous lupus erythematosus with unique immunological and clinical features. The first series of patients found to have drug-induced subacute cutaneous lupus erythemotosus were secondary to hydrochlorothiazide. Since that time, several other drugs have been implicated in the induction of subacute cutaneous lupus erythemotosus. A 44-year-old woman presented with a 9-week history of a mildly pruritic, photosensitive rash that started on her chest. One month prior to her skin outbreak she was started on bupropion for mild depression. She was noted to have multiple annular erythematous plaques on her anterior chest, shoulders, back, arms and face. The patient was advised to stop the bupropion and to start topical tacrolimus, and was encouraged to apply a broad-spectrum sunscreen. Her skin completely cleared within 1 month of initiating this treatment regimen. This case is a unique example of bupropion-induced subacute cutaneous lupus erythemotosus. Our patient exemplifies the necessity of a complete medical history, including current medications, especially when subacute cutaneous lupus erythemotosus is suspected.