Hydroxychloroquine enhanced urticarial reaction in a patient with discoid lupus erythematosus

Yuka Hirakawa, Aika Okuno, Daisaku Kimura, Takashi Okuwa, Fukumi Furukawa

Abstract


Discoid lupus erythematosus (DLE) is an autoimmune disorder that usually occurs on sun exposed areas. We describe a case of a 31-year-old man with reddish-purple, atrophic plaques on the nose and the bilateral cheeks. Histopathologic and direct immuneofluorescent studies confirmed DLE diagnosis. The skin lesion had been previously resistant to topical clobetasol propionate 0.05% and tacrolimus 0.1% since 2012, and were treated with oral hydroxychloroquine (HCQ)  (300 mg daily). Two weeks later, the diarrhea happened frequently as side effects. Then, the dcreased HCQ 200 mg daily improved the diarrhea moderately. The patient who had a history of urticaria also complained about urticarial reaction much more frequently 3 weeks later more than the start, which was improved very much by epinastine (10 mg daily) administration. CLASI (cutaneous lupus erythematsus disease area and severity index) activity score improved from 11 to 5 for 3 months. 


Keywords


hydroxychloroquine; side effect; urticarial reaction; diarrhea; discoid lupus erythematosus

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References


Wallace DJ, Gudsoorkar VS, Weisman MH, et al. New insights into mechanisms of therapeutic effects of anti-malarial agents in SLE. Nat Rev Rheumatol 2012; 8(9): 522–533. doi: 10.1038/nrrheum.2012.106.

Yokogawa N, Eto H, Tanikawa A, et al. Effects of hydroxychloroquine in patients with cutaneous lupus erythematosus : A multi-center, double-blind, randomized, parallel-group trial. Arthritis Rheumatol 2017; 69(4): 791–799. doi: 10.1002/art.40018.

Yokogawa N, Tanikawa A, Amagai M, et al. Response to hydroxychloroquine in Japanese patients with lupus-related skin disease using the cutaneous lupus erythematosus disease area and severity index (CLASI). Mod Rheumatol 2013; 23(2): 318–322. doi: 10.1007/s10165-012-0656-3.

Ikeda T, Kanazawa N, Furukawa F. Hydroxychloroquine administration for Japanese lupus erythematosus in Wakayama: A pilot study. J Dermatol 2012; 39(6): 531–535. doi: 10.1111/j.1346-8138.2011.01448.x.

Salido M, Joven B, D'Cruz DP, et al. Increased cutaneous reactions to hydroxychloroquine (Plaquenil) possibly associated with formulation change: Comment on the letter by Alarcon. Arthritis Rheum 2002; 46(12): 3392–3396. doi: 10.1002/art.10565.

Matsuda T, Nhung Thi My LY, Kambe N, et al. Early cutaneous eruptions after oral hydroxychloroquine in a LE patient: A case report and review of the literature. J Dermatol 2017. In Press.

Shimomatsu T, Kanazawa N, Mikita N, et al. The effect of hy-droxychlo roquine on lupus erythematosus-like skin lesions in MRL/lpr mice. Mod Rheumatol 2016; 26(5): 744–748. doi: 10.3109/14397595.2016.1140711.

Inaba Y, Kanazawa N, Yoshimasu T, et al. Severer lupus erythemato-sus- like skin lesions in MRL/lpr mice with homozygous Kitwsh/wsh mutation. Mod Rheumatol 2017. In Press. doi: 10.1080/14397595.2017.1341591.

Furukawa F. Hydroxychloroquine in lupus erythematosus, a new horizon of the old drug. Trends Immunol 2017. In Press.




DOI: http://dx.doi.org/10.24294/ti.v1.i3.125

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Copyright (c) 2017 Yuka Hirakawa, Aika Okuno, Daisaku Kimura, Takashi Okuwa, Fukumi Furukawa

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