Leflunomide in subacute cutaneous lupus erythematosus - two sides of a coin

Subacute cutaneous lupus erythematosus (SCLE), a distinct clinical subset of lupus erythematosus, remains a therapeutic challenge, especially in cases resistant to topical and standard systemic therapy. Leflunomide, a novel antirheumatic drug, has shown efficacy in the treatment of systemic lupus erythematosus in pilot studies.

We report two patients with SCLE who demonstrated the spectrum of possible clinical responses to leflunomide therapy.

One patient experienced a complete clinical remission of symptoms, whereas the other developed a massive skin reaction which was distinctly related to the commencement of leflunomide therapy.

To our knowledge, this is the first time that remission and deterioration of SCLE by leflunomide therapy have been described.