Imiquimod
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First report of subacute cutaneous lupus erythematosus, and retinitis? A 56-year-old woman developed subacute cutaneous lupus erythematosus (SCLE) and retinitis during treatment with imiquimod for lichenoid actinic keratitis. The woman received topical 5% imiquimod cream daily. After three applications, she developed arthralgias and myalgias, associated with significant erythema at the sites of application. Imiquimod was discontinued and the woman received steroids; her rash resolved. After 8 weeks she re-presented with a scaling eruption on her chest and back. Biopsy findings were consistent with subacute lupus erythematosus. She received hydroxychloroquine, which was ineffective. Chloroquine was than initiated, but discontinued due to a progressive loss of visual acuity which was later diagnosed as severe autoimmune retinitis [time to reaction onset not stated]. Cyclophosphamide was tried, but discontinued due to herpes zoster. Mycophenolate mofetil and intensive steroid treatment resolved the skin lesions, and stopped progression of her visual loss. At 5-year follow-up she was still receiving therapy with mycophenolate mofetil and steroids to maintain her vision. Author comment: "A causative role for imiquimod in precipitating SCLE in this patient is suggested because her symptoms began soon after initiation of the drug. . . The onset of her retinitis may have been triggered by imiquimod or related instead to an underlying predisposition to autoimmunity." Burnett TJ, et al. Development of subacute cutaneous lupus erythematosus associated with the use of imiquimod to treat actinic keratoses. Journal of Drugs in 803038872 Dermatology 9: 1022-4, No. 8, Aug 2010 - USA
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of cutaneous lupus erythematosus, or retinitis, associated with imiquimod. The WHO ADR database contained 5 reports of cutaneous lupus erythematosus, but no reports of retinitis, associated with imiquimod.
0114-9954/10/1320-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 25 Sep 2010 No. 1320
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