Table 7.
Summary of the 21 case reports of proton pump inhibitor-induced subacute cutaneous lupus erythematosus reported in the literature (2000–2015) as identified in PubMed
| # | Study (year) | Age (years), sex, race, country | Drug (dose) | Latency (drug intro to SCLE) | Area of onset | Clinical findings/relevant serology | Medication after discontinuation of PPI | Time to remission after accused PPI discontinuation |
|---|---|---|---|---|---|---|---|---|
| 1 | Reich and Maj (2012) [15] | 57, F, Caucasian | Lansoprazole | 3 months | Trunk, face, both extremities, V-neck area | Fatigue, leucopoenia, decreased C3 complement component, leukocyturia, erythrocyturia, ANA+, SSA+ | Prednisone 0.5 mg/kg/day and ranitidine 150 mg bid helped in remission | 4 weeks |
| 2 | Toms-Whittle et al. (2011) [16] | 85, F, UK | Omeprazole | 4 months | Upper back, upper arms, cheeks | ESR = 45 mm in 1 h, ANA+, SSA+, SSB−, histone+, dsDNA+ | Hydroxychloroquine (200 mg daily) exacerbated rash | 4 weeks |
| 3 | Toms-Whittle et al. (2011) [16] | 78, F, UK | Omeprazole | 3 months | Chest, upper back, arms, face, abdomen, legs | ANA+, SSA+, SSB+, dsDNA−, ESR = 12 mm | 12 weeks | |
| 4 | Correia et al. (2001) [17] | 73, F, Caucasian, Portugal | Pantoprazole (40 mg/day) | 2 weeks | Erythematous maculopapular eruption: face, scalp, ears, anterior V of chest | SSA+, rheumatoid factor+ | Oral histamines and prednisolone | 1 month |
| 5 | Bracke et al. (2005) [18] | 69, F, Caucasian, Belgium | Lansoprazole | 3 months | Trunk, extremities, face, neck | ESR elevated, ANA+, SSA+, histone– | No effect of oral prednisolone (32 mg/day) for 1 month and hydroxyzine for 2 months | 3 weeks |
| 6 | Bracke et al. (2005) [18] | 63, F, Belgium | Lansoprazole | 5 months | Trunk, extremities | ANA+ (speckled), SSA+, rheumatoid factor + | 1 month; no reoccurrence in next 5 years. | |
| 7 | Jones et al. (2015) [19] | 73, F, African-American, USA | Pantoprazole | Forehead, neck, back, upper and lower extremities | ANA+ (speckled), SSA+, SSB−, dsDNA−, histone− | Amlodipine stopped (was provided with pantoprazole initially); amlodipine restarted after 1 month | 1 month | |
| 8 | Hung et al. (2015) [20] | 60, F, UK | Omeprazole | Trunk, thighs, back | Previous history of SCLE, ANA+, SSA+ | Prednisolone and mycophenolate mofetil | 4 months | |
| 9 | Almebayadh et al. (2013) [21] | 30, M (originally from island of Martinique) | Pantoprazole | 1 month | Trunk, lower limbs | ANA+ (speckled), SSA+, SSB+, histone− | 8 weeks (relapsed when pantoprazole accidently re-challenged) | |
| 10 | Almebayadh et al. (2013) [21] | 31, F (originally from Canada) | Esomeprazole (20 mg/day) (no other treatment) | 7 weeks | Trunk, scalp, face | Pregnant, ANA+ (speckled), SSA+, SSB−, histone− | After discontinuing PPI, topical steroids and hydroxychloroquine 400 mg daily were started. After 2 weeks, oral steroid added (0.25 mg/kg/day) | 4 weeks |
| 11 | Almebayadh et al. (2013) [21] | 57, F (originally from island of Martinique) | Omeprazole | Few weeks | Trunk, upper and lower limbs | ANA+, SSA+, anti-SM, anti-RNP antibodies | Not mentioned | |
| 12 | Wee et al. (2012) [22] | 73, F, UK | Omeprazole (and naproxen) started 1 week before 1st flare | First flare: 1 week | Trunk, limbs | Pre-existing idiopathic SCLE, ANA+, SSA+, dsDNA− | Omeprazole and naproxen stopped by patient 5 days after the onset of flare | 2 months |
| Omeprazole (and naproxen) re-started 2 weeks before 2nd flare | 2 weeks | Omeprazole stopped; naproxen continued | 5 weeks | |||||
| 13 | Alcántara-González et al. (2011) [23] | 74, F, Spain | Esomeprazole | 3 weeks | Erythematosus papules on back; lesser extent on chest, thighs, arms | ANA+, SSA+, SSB+ | 8 weeks | |
| 14 | Dam and Bygum (2008) [8] | F, 63, Denmark | Pantoprazole | 3 days (short latency as re-exposure) | Chest, trunk | ANA−, SSA+, SSB−, histone− | 4 weeks | |
| 15 | Dam and Bygum (2008) [8] | M, 57, Denmark | Lansoprazole | 4 weeks | Trunk, upper and lower extremities | ANA+, SSA+, dsDNA+, histone−, RF+ | Treated with hydroxychloroquine, topical steroids; oral prednisolone 30 mg daily; azathioprine 100 mg daily added. Lansoprazole continued as not suspected | Died 2 years later due to other cause with active skin disease and ongoing lansoprazole treatment |
| 16 | Dam and Bygum (2008) [8] | F, 61, Denmark | Lansoprazole | 3 weeks | ANA+, SSA+, SSB−, dsDNA−, histone−, RF+ | 12 weeks | ||
| 17 | Dam and Bygum (2008) [8] | F, 50, Denmark | Omeprazole | 7 weeks | ANA+, dsDNA+, histone− | 4 weeks | ||
| 18 | Dam and Bygum (2008) [8] | F, 51, Denmark | Pantoprazole | 4–8 weeks | ANA+, SSA−, SSB−, dsDNA−, RF+ | Active SCLE up to death; death due to other cause | ||
| 19 | Mankia et al. (2010) [24] | 60, F, UK | Omeprazole | 4 months | Arms, trunk, legs | ANA+, SSA+, SSB−, histone− | Betamethasone | 1 month |
| 20 | Drago et al. (2015) [25] | 48, F, Italy | Lansoprazole | 2 months | Trunk, limbs | ANA−, SSA+ | Replaced by alginate and bicarbonate sodium | Few days |
| 21 | Panting et al. (2009) [26] | 61, F, UK | Lansoprazole | 4 weeks | Photo-exposed areas: shoulders, chest, upper arms, legs | Tired, ANA+, SSA+, SSB− | 8 weeks without topical steroids; relapse on re-administration after 5 months that resolved on drug cessation |
ANA antinuclear antibodies, bid twice daily, dsDNA antibodies to double-stranded DNA, ESR erythrocyte sedimentation rate, histone antihistone antibodies, SSA anti-Ro/SSA antibodies, SSB anti-La/SSB antibodies