Leflunomide in subacute cutaneous lupus erythematosus – two sides of a coin

BACKGROUND: Subacute cutaneous lupus erythematosus (SCLE), a distinct clinical subset of lupus erythematosus, remains a therapeutic challenge, especially in cases resistant to topical and standard systemic therapy. Leflunomide, a novel antirheumatic drug, has shown efficacy in the treatment of systemic lupus erythematosus in pilot studies. METHODS: We report two patients with SCLE who demonstrated the spectrum of possible clinical responses to leflunomide therapy. RESULTS: One patient experienced a complete clinical remission of symptoms, whereas the other developed a massive skin reaction which was distinctly related to the commencement of leflunomide therapy. CONCLUSION: To our knowledge, this is the first time that remission and deterioration of SCLE by leflunomide therapy have been described.