30th July 2026

Drug-Induced Lupus Erythematosus

Background

Drug induced Lupus is a reaction resembling lupus that occurs after exposure to a drug.

The time between drug exposure can range anywhere between 1 month and 10 years, often leading to difficulty identifying the offending agent.

Drug induced Lupus (DIL) is categorised into three subtypes:

Drug induced systemic lupus erythematosus (DSLE)
Drug induced subacute cutaneous lupus erythematosus (SCE)
Drug induced chronic cutaneous lupus erythematosus (CCLE)

The focus of this chapter will be cutaneous manifestations of drug-induced lupus e.g. SCE, CCLE.

Epidemiology

Drug induced Lupus erythematosus is more common in older age, likely due to the increased use of medications, and shows no gender predominance in contrast to systemic lupus erythematosus (SLE), which affects females 9:1. Additionally, DIL affects patients with lighter skin compared with darker skin types. Risk of development of DIL varies based on the culprit medication. Cutaneous manifestations are not as common in DIL as they are in systemic lupus erythematous.

Aetiology

The pathophysiology of DIL differs based on the offending agent but likely a number of risk factors contribute to genetic risk such as HLA-DR4, HLA-DR0301 and complement C4 null allele. A large number of drugs have been associated with the development.

Drug induced subacute cutaneous lupus erythematosus (SCE)

Associated drugs

Anti-hypertensive medications e.g. ACE inhibitors, calcium-channel blockers
Hydrochlorothiazide
Statins
Oral anti fungal such as terbinafine
Biologic agents
Anti-epileptic medications
Proton pump inhibitors
Non-steroidal anti-inflammatory drugs

Clinical manifestations

Symptoms in DIL are milder than idiopathic SLE

Non-scarring
Ring shaped or scaly rash in sun-exposed regions of the body
Widespread
Blistering at the edges of the rash

Investigations

Bloods:

ANA: positive
antiRo/SSA and/or anti-La/SSB: positive
antihistone: positive
anti-dsDNA antibodies: absent
FBC/U&Es/LFTs: normal

Drug induced chronic cutaneous lupus erythematosus (CCLE)

Associated drugs

Fluorouracil
TNF inhibitors
Non-steroidal anti-inflammatory drugs
Tumour necrosis factor antagonists: infliximab, etanercept
Voriconazole

Clinical manifestations

CCLE is extremely rare, with an average incubation period reported of around 8 months after exposure to the culprit medication. The mean age of onset is the 6th decade of life. Most commonly CCLE presents similarly to discoid lupus, however, other presentations can occur: Lupus erythematosus timidus, lupus profundus, chilblain lupus erythematosus and Lichenoid cutaneous lupus erythematosus-lichen planus overlap syndrome.

Discoid lupus presents as red patches which evolve to form red scaly plaques. The rash progresses, leading to atrophic scarring with hyper or hypopigmentation. It most commonly occurs on the face or the ear lobes.