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Terbinafine-induced subacute cutaneous lupus erythematosus
David Farhi1, Manuelle Viguier, Anne Cosnes
1Department of Dermatology 1, Saint Louis Hospital, Paris, France.
Dermatology (Basel, Switzerland)
|December 2, 2005
Summary
Drug-induced lupus erythematosus (DILE) can be caused by terbinafine. Three cases of subacute cutaneous lupus erythematosus linked to terbinafine are presented, highlighting the need for cautious prescribing and monitoring.
Area of Science:
- Dermatology
- Rheumatology
- Pharmacology
Background:
- Drug-induced lupus erythematosus (DILE) accounts for nearly 10% of lupus erythematosus (LE) cases.
- Over 60 drugs have been implicated in iatrogenic LE.
- Terbinafine is a potential cause of drug-induced LE.
Observation:
- Three patients developed subacute cutaneous LE within seven weeks of starting terbinafine.
- Patient histories included sicca syndrome, lung carcinoma, and Kikuchi disease.
- Clinical remission was observed within 15 weeks after discontinuing terbinafine.
Findings:
- Previously, 16 cases of terbinafine-induced LE were reported, predominantly in women (13 cases).
- The median age of affected individuals was 54 years.
- Prior autoimmunity was noted in 10 cases, with 5 having pre-existing LE.
- The median time from terbinafine initiation to LE onset was 5 weeks.
- Median recovery time after terbinafine withdrawal was 8 weeks.
Implications:
- Terbinafine should be prescribed only for confirmed dermatophytosis.
- Caution and monitoring are advised for patients with pre-existing autoimmunity.
- Immediate and permanent discontinuation of terbinafine is recommended upon diagnosis of terbinafine-induced LE.