Terbinafine-induced subacute cutaneous lupus erythematosus

Background: Recently, the induction of subacute cutaneous lupus erythematosus (SCLE) and exacerbation of systemic lupus erythematosus by terbinafine have been reported. Objective: We describe 4 cases of SCLE, one associated with chilblain lupus, which occurred during therapy With Oral terbinafine for onychomycosis. Methods: Of 21 consecutive patients with SCLE attending the outpatient dermatology department at Muenster University clinic during a 1-year period, 4 patients with terbinafine-induced SCLE were seen. Patients were examined fully and photographed; histologic findings as well as serologic and follow-up data were evaluated. Results: In addition to high titers of antinuclear antibodies (ANA) with a homogeneous pattern, anti-Ro(SSA) antibodies were present; in 3 of 4 women, anti-La(SS-B) antibodies were also found. All patients had antihistone antibodies as in drug-induced lupus and showed the characteristic genetic association of SCLE with the HLA-B8,DR3 haplotype; moreover, in 2 cases, HLA-DR2 was also present. After discontinuation of terbinafine, ANA titers decreased; anti-histone antibodies also became undetectable within 4 1/2 months in 3 patients concomitant with subsidence of the SCLE eruption in all patients. Conclusion: Terbinafine is a drug that appears to infrequently induce SCLE with high titers of ANAs and anti-histone antibodies in genetically susceptible persons.