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Do steroid hormones have an important role on cutaneous lupus physiopathology?

Brasileiro A, Campos S, Fidalgo A - An Bras Dermatol (2015)

View Article: PubMed Central - PubMed

Affiliation: Centro Hospitalar Lisboa Central, Hospital S. António dos Capuchos, Lisbon, Portugal.

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Sir, An 80-year-old-Caucasian-woman has been followed during the last 25 years for cutaneousdiscoid lupus erythematosus (CDLE) without systemic involvement... Sustained therapeuticefficacy was observed over one-year follow-up despite maintenance of letrozole therapy... Nosignificant side effects have occurred... Lupus erythematosus (LE) has three major subtypes: systemic lupus erythematosus (SLE),subacute lupus erythematosus (SCLE) and cutaneous discoid lupus erythematosus (CDLE)... Hormonal-influenced mechanisms might also play a role in LE... The skinis an independent steroidogenic organ, and cutaneous steroidogenesis has effects on localimmunologic activity... Letrozole is a third-generation aromatase inhibitor indicated for hormone-sensitive breastcancer in postmenopausal women... Its anti-oestrogenic effects induce nearly completesuppression of aromatization in all tissues... Theoretically, aromatase inhibitors should bebeneficial in lupus patients, once they reduce cutaneous estradiol production whichstimulates inflammatory pathways... Conversely, in our patient, letrozole paradoxicallyaggravated the disease, perhaps due to iatrogenic hormonal imbalance, which points towardsa pathogenic role for cutaneous hormonal dysregulation in CLE... Whether the cutaneous disease will have the samebehaviour as in our patient remains unknown... Further studies are warranted to access theeffect of aromatase inhibitors in CLE patients.

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A: Multiple well-defined erythematous plaques distributed over convex areas of theface; B: Marked inflammatory infiltration of the scalp with follicular plugging,adherent scale and alopecia
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f01: A: Multiple well-defined erythematous plaques distributed over convex areas of theface; B: Marked inflammatory infiltration of the scalp with follicular plugging,adherent scale and alopecia

Mentions: Four years ago she underwent radical left mastectomy for carcinoma ductal insitu with positive oestrogen receptors, followed by hormonotherapy withletrozole 2,5mg/day. A month later there was pronounced cutaneous worsening and the lesionsbecame refractory to previously effective therapies (Figure1). There were no other recently started medications or systemic complaints;routine blood laboratory tests and autoimmunity antibodies were within normal range.Acitretin 25mg/day was attempted but there was further clinical worsening andimmunosuppressive therapies were contraindicated by the recent malignant neoplasia.Thalidomide 50mg/day was then combined with previous therapies, with marked clinicalimprovement within two weeks, allowing the discontinuation of systemic steroids andhydroxychloroquine (Figure 2). Sustained therapeuticefficacy was observed over one-year follow-up despite maintenance of letrozole therapy. Nosignificant side effects have occurred.


Do steroid hormones have an important role on cutaneous lupus physiopathology?

Brasileiro A, Campos S, Fidalgo A - An Bras Dermatol (2015)

A: Multiple well-defined erythematous plaques distributed over convex areas of theface; B: Marked inflammatory infiltration of the scalp with follicular plugging,adherent scale and alopecia
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4631249&req=5

f01: A: Multiple well-defined erythematous plaques distributed over convex areas of theface; B: Marked inflammatory infiltration of the scalp with follicular plugging,adherent scale and alopecia
Mentions: Four years ago she underwent radical left mastectomy for carcinoma ductal insitu with positive oestrogen receptors, followed by hormonotherapy withletrozole 2,5mg/day. A month later there was pronounced cutaneous worsening and the lesionsbecame refractory to previously effective therapies (Figure1). There were no other recently started medications or systemic complaints;routine blood laboratory tests and autoimmunity antibodies were within normal range.Acitretin 25mg/day was attempted but there was further clinical worsening andimmunosuppressive therapies were contraindicated by the recent malignant neoplasia.Thalidomide 50mg/day was then combined with previous therapies, with marked clinicalimprovement within two weeks, allowing the discontinuation of systemic steroids andhydroxychloroquine (Figure 2). Sustained therapeuticefficacy was observed over one-year follow-up despite maintenance of letrozole therapy. Nosignificant side effects have occurred.

View Article: PubMed Central - PubMed

Affiliation: Centro Hospitalar Lisboa Central, Hospital S. António dos Capuchos, Lisbon, Portugal.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, An 80-year-old-Caucasian-woman has been followed during the last 25 years for cutaneousdiscoid lupus erythematosus (CDLE) without systemic involvement... Sustained therapeuticefficacy was observed over one-year follow-up despite maintenance of letrozole therapy... Nosignificant side effects have occurred... Lupus erythematosus (LE) has three major subtypes: systemic lupus erythematosus (SLE),subacute lupus erythematosus (SCLE) and cutaneous discoid lupus erythematosus (CDLE)... Hormonal-influenced mechanisms might also play a role in LE... The skinis an independent steroidogenic organ, and cutaneous steroidogenesis has effects on localimmunologic activity... Letrozole is a third-generation aromatase inhibitor indicated for hormone-sensitive breastcancer in postmenopausal women... Its anti-oestrogenic effects induce nearly completesuppression of aromatization in all tissues... Theoretically, aromatase inhibitors should bebeneficial in lupus patients, once they reduce cutaneous estradiol production whichstimulates inflammatory pathways... Conversely, in our patient, letrozole paradoxicallyaggravated the disease, perhaps due to iatrogenic hormonal imbalance, which points towardsa pathogenic role for cutaneous hormonal dysregulation in CLE... Whether the cutaneous disease will have the samebehaviour as in our patient remains unknown... Further studies are warranted to access theeffect of aromatase inhibitors in CLE patients.

No MeSH data available.


Related in: MedlinePlus