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.