Analysis of clinical characteristics of terbinafine-induced subacute cutaneous lupus erythematosus

Terbinafine may cause subacute cutaneous lupus erythematosus (SCLE), and we aimed to analyze its clinical characteristics. We collected literatures on terbinafine-induced SCLE from 1997 to 2023 for retrospective analysis. 37 patients (33 females and 4 males) were included. The patients have a median age of 49.5 years (range 18-79) and onset time of 5 weeks (range 1-12). SCLE mainly manifested as annular erythematous (83.3%), scaly erythematous (44.4%) and maculopapular erythematous (13.9%). Mainly histopathological manifestations are lymphocytic infiltrate (55.6%), hyperkeratosis (38.9%) and keratinocyte necrosis (38.9%). Positive immunological parameters mainly include antinuclear antibody (100.0%), anti-Ro/SSA antibody (94.1%) and anti-La/SSB antibody (72.2%). Past medical history usually includes photosensitivity (33.3%), inflammatory disease (33.33%) and lupus erythematosus (12.1%). Symptoms are completely resolved within a median time of 35 days (range 7-84) after discontinuation of terbinafine and treatment with topical corticosteroids, systemic corticosteroids, hydroxychloroquine and immunosuppressant. No recurrence was observed within 12 months (range 1.5-48) of follow-up. These results suggest that terbinafine induced SCLE should be comprehensively diagnosed based on clinical symptoms, histopathological manifestations, immunological parameters, and past medical history. Terbinafine should be immediately discontinued when SCLE occurs, while systemic and topical corticosteroids combine with hydroxychloroquine may be an effective treatment.