We report the first case of
Cremophor EL-induced
cutaneous lupus erythematosus-like reaction in a 40-year-old female undergoing treatment for
breast cancer. There have been four reported cases of
paclitaxel- and four cases of
docetaxel-induced cutaneous lupus reactions in the published literature [Dasanu and Alexandrescu: South Med J 2008;101:1161-1162; Adachi and Horikawa: J Dermatol 2007;34:473-476; Lortholary et al: Presse Med 2007;36:1207-1208; Chen et al: J Rheumatol 2004;31:818-820]. Our patient developed findings of a cutaneous lupus-like reaction with administration of
paclitaxel which was subsequently discontinued. She was re-challenged with
albumin-bound paclitaxel which has no
Cremophor EL compound in its formulation. This administration of
albumin-bound paclitaxel did not induce further reaction. She did not develop a
cutaneous lupus erythematosus-like reaction with three other subsequent administrations of
albumin-bound paclitaxel. The diagnosis of lupus-like reaction in our patient was made based on the development of a
malar butterfly rash sparing the nasolabial folds, the appearance of this
rash in context of recently receiving treatments with
paclitaxel, resolution of the
rash after discontinuing the
paclitaxel, and the presence of autoimmune
antibodies in the patient's serum which resolved with discontinuation of the
paclitaxel. This is the first case demonstrating that the cause of the
cutaneous lupus erythematosus-like reaction is not likely due to the
taxane component of
paclitaxel but the chemical composition of
Cremophor EL. If the chemotherapeutic agent was causing the reaction then the same reaction should be seen by
albumin-bound paclitaxel. We propose that previously reported lupus reactions may actually be due to
Cremophor EL, which consists of polyoxyethylated
castor oil, and not the chemotherapeutic agent itself.