[Esomeprazol-induced cutaneous lupus erythematosus]

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Proton pump inhibitors (PPIs) are widely prescribed for acid-related gastrointestinal disorders.
• These medications are generally considered safe with a low incidence of adverse effects.
• Subacute cutaneous lupus erythematosus (SCLE) is an autoimmune condition affecting sun-exposed skin.

Observation:

• A 69-year-old woman developed erythematous plaques on sun-exposed areas two months after starting esomeprazole.
• Clinical presentation, skin biopsy histology, and anti-Ro/SSA antibodies confirmed SCLE.
• The temporal association between PPI initiation and SCLE onset raised suspicion of drug-induced etiology.

Findings:

• Discontinuation of esomeprazole resulted in near-complete resolution of skin lesions without specific treatment.
• This outcome strongly supported a diagnosis of PPI-induced subacute cutaneous lupus erythematosus.
• The patient's anti-Ro/SSA antibody status was consistent with SCLE.

Implications:

• Clinicians should consider drug-induced SCLE in patients presenting with characteristic skin lesions after PPI initiation.
• Awareness of this potential adverse effect is crucial for accurate diagnosis and management.
• Recurrence is common upon re-exposure, necessitating avoidance of PPIs in affected individuals.