Esomeprazol-induzierter kutaner Lupus erythematodes

Zusammenfassung

Protonenpumpeninhibitoren gehören zu den weltweit am häufigsten verwendeten Arzneimitteln. Sie gelten als weitgehend sicher und nebenwirkungsarm. Wir berichten über eine 69-jährige Patientin, bei der 2 Monate nach Einleitung einer Therapie mit Esomeprazol anuläre erythematöse Plaques überwiegend an lichtexponierten Körperstellen auftraten. Anhand des klinischen Bildes, dem histologischen Befund eines Hautbioptats und dem Nachweis von Anti-Ro/SSA-Antikörpern wurde die Diagnose eines subakut kutanen Lupus erythematodes gestellt. Insbesondere der zeitliche Zusammenhang mit dem Beginn der Protonenpumpeninhibitor-Therapie begründete den hochgradigen Verdacht auf eine medikamenteninduzierte Genese. Nach Absetzen von Esomeprazol waren die charakteristischen Hautveränderungen ohne spezifische Therapie nahezu vollständig rückläufig, was die anfängliche Verdachtsdiagnose erhärtete. Beim Auftreten typischer Hautveränderungen in lichtexponierten Arealen im zeitlichen Zusammenhang mit der Einnahme von PPI sollte daher immer auch an die Möglichkeit eines medikamenteninduzierten kutanen Lupus erythematodes gedacht werden. Aufgrund der häufigen Rezidive nach erneuter Exposition sollte eine erneute Therapie mit PPI vermieden werden.

Abstract

Proton pump inhibitors are among the most commonly used drugs worldwide. They are considered to be largely safe and cause little side-effects. We report a 69-year-old woman who suffered from erythematous plaques 2 months after initiating therapy with esomeprazole. The diagnosis of subacute cutaneous lupus erythematosus was based on the clinical picture together with characteristic histological features of a skin biopsy specimen and the detection of anti-Ro/SSA antibodies. In particular, the temporal relationship with the onset of proton pump inhibitor therapy led to the high-level suspicion of a drug-induced pathogenesis. Strengthening the initially suspected diagnosis, the characteristic skin lesions resolved almost completely without specific therapy after discontinuation of the medication. If typical skin lesions occur in light-exposed areas in connection with the administration of PPI, the possibility of a drug-induced cutaneous lupus erythematosus should always be considered. Due to the frequent recurrence rate after renewed exposure, a new therapy with PPI should be avoided.

Schlüsselwörter

GERD - Lupus erythematodes - Protonenpumpeninhibitor-Therapie

Key words

gastroesophageal reflux disease - lupus erythematosus - proton pump inhibitor therapy

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