Secukinumab induced subacute cutaneous lupus erythematosus
Dear Editor, Drug induced lupus erythematosus (DILE) is a well known entity first described as an adverse effect of hydrochlorothiazide, terbinafine, and TNF alfa inhibitors. Among the possible drugs associated with DILE, recently an association with IL 17 inhibitors has been reported, highlighting new and little known side effects of biological therapies. We present a case of a 62 year old man with a history of plaque psoriasis, previously treated with methotrexate, acitretin and antiTNF alfa, switched on treatment with secukinumab 300 mg due to a loss of efficacy of other drugs. After the fourth dose at week 4, he developed a generalized itchy rash with multiple scaly erythematous plaques localized on his trunk, neck, and back; in addition, a widespread desquamation associated with severe blepharitis and mild ectropium, not present at the beginning of therapy, was observed on the face (Figure 1A,B) Lesions were first interpreted as an early onset of erythrodermic psoriasis; photosensitive dermatitis and drug reaction were also considered in the differential diagnosis. The dermoscopic examination (DermLite3G, 20x) showed telangiectatic vessels, with erythematous background, some yellowish areas and minimal desquamation, contrary to classical dermoscopic psoriatic criteria (Figure 1C) Therefore, either a severe seborrheic dermatitis or a subacute lupus was considered in differential diagnosis. Two punch biopsies of 4 mm on two patches of the back, skin swab, and microbiological research of fungi were performed, with blood tests analysis and complete study of autoimmunity. Results showed positivity of antinuclear
Dermatologic therapy