Subacute lupus erythematosus-like eruption due to terbinafine: report of three cases

Abstract

Three female patients presented with a severe subacute lupus erythematosus (LE)‐like eruption due to terbinafine prescribed for suspected onychomycosis (Fig. 1). Two patients had serological evidence of autoimmune disease predisposing to photosensitivity. One patient, who had used a sunbed the day before the eruption appeared had a low titre positive speckled ANA, borderline anti‐RO antibodies, and raised anti‐RNP antibodies. The other had a positive anti‐SS‐A antibody. The third patient had neutropenia. Antihistone antibodies were negative. Histology in two cases was consistent with subacute LE. All three patients had strikingly similar eruptions that took several weeks to resolve, requiring treatment with topical clobetasol propionate and oral prednisolone. Cutaneous adverse reactions to terbinafine are usually mild, the most common being urticaria and erythema multiforme.1 There are previous reports of terbinafine induced photosensitivity, cutaneous LE‐like reactions2, 3 and erythema multiforme in patients with autoimmune disease,4 which may be a risk factor.