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Sjögren Syndrome — SCE Dermatology MCQ

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HardConnective Tissue & VasculitisSjögren SyndromeSCE Dermatology

A patient with no previous lupus develops widespread annular photosensitive plaques six weeks after starting terbinafine. Anti-Ro/SSA is positive; complement and renal tests are normal. What is the most likely management priority?

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Correct answer: E — Withdraw terbinafine and treat the photosensitive eruption as drug-induced SCLE

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

E is correct. Terbinafine is a recognised trigger of drug-induced subacute cutaneous lupus, which often presents with annular or papulosquamous photosensitive lesions and anti-Ro antibodies but limited systemic disease. The priority is withdrawal of the culprit, rigorous photoprotection and treatment of skin inflammation, with clinical and laboratory assessment for systemic involvement. Anti-Ro does not prove idiopathic systemic lupus and is not specific to neonatal lupus. Persistent or severe disease may require antimalarial or other systemic therapy, but immediate lifelong immunosuppression before observing the withdrawal response is disproportionate.

Reference: British Association of Dermatologists guideline for cutaneous lupus erythematosus: https://doi.org/10.1111/bjd.20503