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 803323999 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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