Drug-Induced Lupus Erythematosus Treatment & Management

  • Author: Ivan D Camacho, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 27, 2012
 

Medical Care

Symptoms of drug-induced lupus erythematosus (DILE) usually clear within weeks of stopping the culprit drug; however, residual antibodies may persist for extended periods after discontinuance of the identified causative agent. Generally, no other specific treatments are known.

If patients with DILE are given anti-inflammatory medication, this may mask the symptoms and thus potentially result in misdiagnosis. Low doses of systemic corticosteroids may be prescribed for short periods if the symptoms of DILE are severe (eg, polyarthritis resulting in debilitating inflammation in many joints simultaneously).

No specific activity restrictions are recommended. Normal activity may resume when arthralgias and myalgias resolve.

Monitor antinuclear antibody levels—anti-ssDNA, anti-dsDNA, and antihistone antibody levels—serum complement levels, and urinalysis findings. Continue to monitor cardiac, renal, and pulmonary function if any of these were initially involved.

Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Ivan D Camacho, MD  Assistant Professor of Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami, Leonard M Miller School of Medicine; Medical Director of Dermatology Clinic, Jackson Memorial Hospital

Ivan D Camacho, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Florida Medical Association, International Society of Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Catharine Lisa Kauffman, MD, FACP  Georgetown Dermatology and Georgetown Dermpath

Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Royal Society of Medicine, Society for Investigative Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Arden E Fredeking  Georgetown University School of Medicine

Arden E Fredeking is a member of the following medical societies: American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Palomar Medical Technologies Stock None; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment; Abbott Laboratories Grant/research funds Independent contractor; UpToDate Salary Employment; Biogen Grant/research funds Independent contractor; Clinuvel Independent contractor; Covan Basilea Pharmaceutical Grant/research funds Independent contractor; ISDIN None Consulting; TenX BIopharma Grant/research funds Independent contractor

Michael J Wells, MD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

References

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Erythematous macules and papules are seen on face, upper chest, and arms in photodistribution.
Dermis contains interface and superficial and deep perivascular lymphohistiocytic infiltrate (×100, hematoxylin-eosin).
Parakeratosis, apoptosis, and basal vacuolization (×200, hematoxylin-eosin).
Table 1. Comparison of Findings Between Drug-Induced Lupus Erythematosus and Systemic Lupus Erythematosus
FindingsSLEDILE
ClinicalAverage age of onset of 20-30 y



Affects blacks more than whites



Female-to-male ratio of 9:1



Average age of onset of 50-70 y



Affects whites more than blacks



Female-to-male ratio of 1:1



Laboratory Antihistone antibodies in 50%



Anti-dsDNA present in 80%



C3/C4 levels decrease



Cutaneous findings in >75%



Raynaud phenomenon in 50%



Antinuclear antibodies in >95%



Antihistone antibodies in >95%



Anti-ssDNA present



Anti-dsDNA rare C3/C4 levels normal



Cutaneous findings in ~25%



Raynaud phenomenon in 25%



Antinuclear antibodies in >95%



Immunofluorescence HistopathologyDirect immunofluorescence reveals granular deposition of IgG at dermoepidermal junction



Lymphohistiocytic interface dermatitis



Apoptosis basal vacuolization



Same as SLE



Same as SLE



DILE = drug-induced lupus erythematosus, IgG = immunoglobulin G; SLE = systemic lupus erythematosus.
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