Reactions 1704, p194 - 2 Jun 2018
Lupus-like reaction: case report
A 68-year-old man developed lupus like reaction following
treatment with imiquimod [dosage and duration of treatment
to reaction onset not stated].
The man presented with scaly lesions on an erythematous
base on the nose, forehead and cheek. On physical
examination, lesions consistent with actinic keratoses in the
nose, cheeks and forehead areas were observed, notably an
erythematous plaque with atrophic areas and superficial
telangiectasis on the right side of the nose. He reported that
several years prior, he had received topical imiquimod in the
area for a lesion and the diagnosis could not be ascertained. He
experienced burning sensation and itching in the area, which
increased following sun exposure. On biopsy, a flattened
epidermis was noted and had an atrophic appearance in some
areas, with vacuolar degeneration of the basal layer, which
contained necrotic keratinocytes. The dermis appeared
oedematous and proliferation of activated fibroblasts and
capillaries was observed. Both the superficial and deep layers
had periadnexal lymphohistiocytic infiltrate. Periodic acid-
Schiff staining showed a moderate thickening of the basement
membrane. He was diagnosed with lupus like reaction in
imiquimod treated skin.
The man received treatment with mometasone followed by
tacrolimus and sun protection measures were recommended.
Symptomatic and clinical improvement was noted.
Author comment: "We present a case of a clinically and
histologically lupus-like reaction in imiquimod-treated skin.
This reaction is a rare side effect of topical imiquimod".
Fernandez DG, et al. Erythematous Lesion on the Nose. Actas Dermo-
Sifiliograficas 109: 173-174, No. 2, Mar 2018. Available from: URL: https://
doi.org/10.1016/j.adengl.2017.12.013 - Spain
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved