clobetasol and Lupus-Erythematosus--Cutaneous

Anti-tumor necrosis factor induced lupus (ATIL) is a rare side effect reported in patients treated with anti-tumor necrosis factor medications such as infliximab, etanercept and adalimumab. Of the three, this condition has been least commonly reported secondary to adalimumab. In this report, we present a case of ATIL in a patient treated for rheumatoid arthritis (RA) with adalimumab. This report will increase physician awareness of the warning signs, diagnostic options and potential complications of ATIL. In this patient, adalimumab was discontinued and treatment was started, leading to improvement in the patient's status.

Topics: Adalimumab; Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Clobetasol; Diagnosis, Differential; Drug Therapy, Combination; Glucocorticoids; Humans; Lupus Erythematosus, Cutaneous; Male; Prednisone; Triamcinolone; Tumor Necrosis Factor-alpha

Lesions of cutaneous lupus erythematosus (CLE) are refractory to a wide range of topical or systemic therapies. The pathogenesis of CLE is multifactorial and polygenic, and many of its details remain unclear. However, immunologic evidence suggests the possible therapeutic use of tacrolimus and pimecrolimus. CLE is one of the most common dermatological autoimmune disorders worldwide, which includes systemic lupus erythematosus (SLE) with malar rash, subacute cutaneous lupus erythematosus (SCLE) and discoid lupus erythematosus (DLE).. Our aim was to determine the efficacy of topical pimecrolimus and tacrolimus in the treatment of cutaneous lupus erythematosus.. The literature was systematically reviewed. Medline, Embase, and the Cochrane Database were searched for systemic reviews, randomised controlled trials and nonrandomised clinical trials using the search terms "pimecrolimus", "Elidel", "SDZ ASM 981", "tacrolimus", "Protopic", "FK506" and "cutaneous lupus erythematosus". Studies were assessed independently by two authors.. Five studies were eligible for inclusion in this review. Only one of them was a randomised controlled trial (RCT). There was no significant difference between tacrolimus and clobetasol; however, evidence indicates the highest tolerability of tacrolimus compared with corticosteroids. This review indicates the efficacy of tacrolimus and pimecrolimus in, at least initial, cutaneous lesions of SLE. However, in SCLE and DLE lesions, the efficacy appears to be lower, perhaps due to the chronicity of those lesions.. The lack of RCTs is characteristic. Future studies should focus on efficacy, short- and long-term effects and cost-effectiveness. However, tacrolimus and pimecrolimus show efficacy, and such effort is worthwhile.

Topics: Administration, Topical; Clobetasol; Databases, Factual; Glucocorticoids; Humans; Immunosuppressive Agents; Lupus Erythematosus, Cutaneous; Randomized Controlled Trials as Topic; Skin; Tacrolimus

Cancer has been reported in patients with systemic lupus erythematosus (SLE). A possible association of the development of hematologic malignancies in patients with SLE has been suggested. In some patients, subacute cutaneous lupus erythematosus, a distinct subset of lupus erythematosus, has appeared, resolved, or both as a solid tumor-related paraneoplastic syndrome. A woman in whom a meningioma was diagnosed 44 years following the onset of subacute cutaneous lupus erythematosus is described; her skin lesions improved after starting isotretinoin therapy. The relationship between lupus erythematosus and neoplasia is summarized and the management of subacute cutaneous lupus erythematosus with retinoids is reviewed.

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Clobetasol; Dermatologic Agents; Female; Fluocinonide; Glucocorticoids; Humans; Isotretinoin; Lupus Erythematosus, Cutaneous; Meningeal Neoplasms; Meningioma

Topics: Adult; Clobetasol; Double-Blind Method; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Cutaneous; Male; Ointments; Tacrolimus; Treatment Outcome

Anti-angiogenesis is an exciting new approach to anticancer therapy. COL-3, a tetracycline derivative, is a novel anti-angiogenesis agent with potent preclinical anticancer activity. During the conduct of a phase 1 clinical trial for refractory metastatic cancer at the National Institutes of Health, we observed 3 individuals who developed phototoxicity followed by clinical and laboratory features of drug-induced lupus.. Three of 35 patients treated with COL-3 developed sunburnlike eruptions accompanied by fever and a positive antinuclear antibody titer within 8 to 29 days of starting treatment. Two of 3 had positive antihistone antibody levels and arthralgia. One patient had marked systemic manifestations including pulmonary infiltrates and elevated erythrocyte sedimentation rate remittent for more than 1 year after discontinuing COL-3 treatment. The other 2 patients' symptoms and rash abated within 2 weeks of discontinuing therapy although the serologic markers remained abnormal for the duration of follow-up.. COL-3 is the second tetracycline derivative to be implicated in the development of drug-induced lupus. A sunburnlike eruption immediately preceded or accompanied the systemic and serologic changes in these 3 patients. The rapid onset and the phototoxic appearance of the accompanying eruptions might suggest that damage to the keratinocytes caused the formation of neoantigens to which autoantibodies formed.

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Clobetasol; Female; Follow-Up Studies; Glucocorticoids; Humans; Lupus Erythematosus, Cutaneous; Male; Matrix Metalloproteinase Inhibitors; Middle Aged; Neoplasm Metastasis; Ointments; Prednisone; Protease Inhibitors; Tetracyclines; Time Factors

Topics: Administration, Topical; Adult; Biopsy; Chilblains; Clobetasol; Cold Temperature; Female; Glucocorticoids; Humans; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Skin; Treatment Outcome

Topics: Administration, Topical; Citrus aurantiifolia; Clobetasol; CREST Syndrome; Diagnosis, Differential; Female; Fruit and Vegetable Juices; Glucocorticoids; Hand; Humans; Lupus Erythematosus, Cutaneous; Middle Aged; Photosensitivity Disorders; Photosensitizing Agents; Plant Structures

Terbinafine, a systemic antifungal commonly prescribed for onychomycosis (fungal infection involving the nails) has been reported to cause various cutaneous adverse effects. We describe an overlap syndrome between cutaneous lupus and erythaema multiforme induced by this medication with a review of other reported cases.

Topics: Aged, 80 and over; Anti-Inflammatory Agents; Antifungal Agents; Clobetasol; Dermatologic Agents; Diagnosis, Differential; Erythema Multiforme; Female; Humans; Lupus Erythematosus, Cutaneous; Naphthalenes; Ointments; Onychomycosis; Syndrome; Terbinafine; Treatment Outcome

Topics: Administration, Topical; Chilblains; Clobetasol; Dermatologic Agents; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Hydroxychloroquine; Lupus Erythematosus, Cutaneous; Rare Diseases; Risk Assessment; Skin Diseases, Vesiculobullous; Toes; Treatment Outcome; Young Adult

Bevacizumab is a recombinant humanized antibody against vascular endothelial growth factor (VEGF). It is approved by the Food and Drug Administration (FDA) for metastatic colorectal cancer, advanced non-small cell lung cancer, metastatic renal cell cancer and glioblastoma. Bevacizumab has also been used off label in ophthalmology for age-related macular degeneration, diabetic retinopathy, retinal vein occlusions, retinopathy of prematurity, and other chorioretinal vascular disorders. Numerous case reports have described various cutaneous reactions in response to bevacizumab therapy including acneiform eruptions and exfoliative dermatitis.. We report a case of a 63 year-old Caucasian female who presented with subacute cutaneous lupus erythematosus six weeks after initiating two intravitreal injections of bevacizumab for central serous choroidopathy.. We report the first documented case of a cutaneous lupus erythematosus eruption following bevacizumab administration as a monotherapy.

Topics: Administration, Topical; Angiogenesis Inhibitors; Anti-Inflammatory Agents; Antibodies, Monoclonal, Humanized; Bevacizumab; Choroid Diseases; Clobetasol; Female; Humans; Injections; Keratosis; Lupus Erythematosus, Cutaneous; Middle Aged; Off-Label Use; Scalp; Skin; Vitreous Body

Despite a range of available topical and systemic therapies, treatment of cutaneous lupus erythematosus (CLE) can be challenging. Objectives. To evaluate the efficacy of a specially formulated preparation of tacrolimus 0.3% in clobetasol propionate 0.05% ointment (TCPO) in the treatment of CLE.. Case notes of 13 patients with treatment-resistant CLE (11 discoid LE, 1 systemic LE and 1 subacute cutaneous LE) who had used twice-daily TCPO (TCPO group) were reviewed. These were compared with five similar patients with resistant CLE who had been given 0.1% tacrolimus ointment alone (TO group).. In the TCPO group (mean treatment duration 20 months, range 1-72), a good or excellent response was seen in five and six patients, respectively; one patient showed slight improvement. Telangiectasia and acne were observed in two patients. No systemic side-effects were noted. In the TO group (mean treatment duration 6 months, range 1-24), one patient showed good improvement and two showed slight improvement.. The results of our small retrospective study suggest that TCPO may be more effective than either 0.1% tacrolimus or clobetasol propionate 0.05% ointment monotherapy in the treatment of recalcitrant CLE. Randomized controlled trials are needed to confirm these preliminary findings.

Topics: Administration, Topical; Adult; Aged; Clobetasol; Cohort Studies; Dermatologic Agents; Drug Administration Schedule; Drug Combinations; Female; Humans; Lupus Erythematosus, Cutaneous; Male; Middle Aged; Retrospective Studies; Tacrolimus; Treatment Outcome; Young Adult