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Murphy and Barnes1 report the association of terbinafine therapy with cutaneous lupus erythematosus in a 26 year old women.[1] Observations such as these are important because they alert clinicians to the possibility that the observed disease is a genuine drug side effect. However, where there is epidemiological data that would help assess this possibility, this data should be published with the report.
In 1994, gross sales figures from the manufacturer suggest an estimated 100,000 patients were treated in the United Kingdom with terbinafine. According to figures quoted by Murphy and Barnes, about 100 to 150 women per 100,000 per year develop cutaneous lupus.[2,3] Based on this, in the United Kingdom alone we could expect about ten women per year to coincidentally develop cutaneous lupus during the first two months of a course of terbinafine therapy. This is the first such report of an association although more are likely to follow. These need to be critically evaluated epidemiologically. The title of the letter by Murphy and Barnes is unjustified and the conclusion that "there is a strong possibility" of a causal relationship appears overstated.
1. Terbinafine-induced lupus erythematosus. Murphy M, Barnes L, Brit J Derm 1998 138: 708-709
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Dr Rod Phillips FRACP, PhD Consultant in Paediatric Skin Disease Department of Paediatrics Royal Children's Hospital Melbourne |
Dr Margot Nash Consultant in Paediatrics Department of Paediatrics Royal Children's Hospital Melbourne |
Correspondence