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Thiazide diuretic‐induced subacute cutaneous lupus‐like syndrome
Author(s) -
Jones S.K,
Reed B.R.,
Lee L.A.,
Huff J.C.,
Norris D.A.
Publication year - 1985
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.1985.tb12982.x
Subject(s) - antigen , antibody , immunology , medicine , keratinocyte , thiazide , chemistry , pharmacology , diuretic , in vitro , biochemistry
Specific anti‐nuclear antibodies are useful in identifying subsets of lupus erythematosus (LE) and may be directly involved in the aetiology of keratinocyte damage seen in cutaneous LE lesions. In support of this, UV irradiation has been shown to induce ( in vitro ) expression of SSA, RnP and Sm antigens on keratinocyte cell surfaces, and antibodies to these antigens induce mononuclear cell lysis of cells coated with the relevant antigen. In addition, human skin grafted on to nude mice binds anti‐SSA antibody in vivo , this being increased by UV irradiation. Several drugs are recognized to induce anti‐nuclear antibodies in man, and thiazides are known as inducers of phototoxic and photoallergic dermatitis. We describe five patients who developed photosensitive eruptions with clinical and histological features of subacute cutaneous LE, and antibodies to SSA/Ro antigen, whilst taking thiazides. These all cleared with discontinuation of the drug and topical therapy. In one case, anti‐SSA antibodies have disappeared, and in another rechallenge with the drug produced a further photo‐eruption. To date, no patients on thiazide diuretics (n = 14) who have not developed a rash have been found to have anti‐SSA antibodies. Thus, this seems to represent a new type of photo‐drug reaction. Possible mechanisms may include induction of antibody to thiazide‐protein complexes which crossreact with SSA, the potentiation of epidermal cytotoxicity, and the increased production or cell surface expression of SSA antigen. Data relating to these hypotheses will be presented.