Rowell syndrome: does it exist?

Abstract

Conflict of interest: none declared. We read with interest the clinical case reported by Champagne et al.1 entitled ‘Severe Rowell syndrome associated with oral terbinafine’, recently published in Clinical and Experimental Dermatology. In our opinion, the described case seems to be a typical case of drug‐induced subacute cutaneous lupus erythematosus (SCLE), caused by the terbinafine the patient was taking, rather than a case of Rowell syndrome (RS). In fact, at least four of the diagnostic criteria that discriminate drug‐induced SCLE from idiopathic SCLE, reported by Marzano et al.2 in 2011, were present, including the widespread presentation and the occurrence of bullous, targetoid and vasculitic lesions. Other features, such as the slow healing of the lesions upon discontinuation of the drug and their recurrence after terbinafine re‐introduction, strongly support our hypothesis. We consider that the proposed diagnosis of RS in this case is incorrect. Moreover, we believe that the diagnostic criteria for RS, previously published by Zeitouni et al.3, are totally inadequate for RS, which could be considered a true ‘ghost syndrome’. We published a review of all the putative RS cases reported in the literature up to 2011,4 and pointed out in that review that two different conditions have been reported under the classification of RS, namely: (i) patients with an association of annular/polycyclic SCLE and erythema multiforme (EM) ‐ like lesions (as in the case reported by Champagne et al.) and (ii) in a minority of cases, a mere coincidental association between discoid LE and EM.4 As for other associations, for example those between cutaneous (C)LE and lichen planus or psoriasis, we consider that the coexistence of CLE and EM does not justify the framing of a separate syndrome as originally suggested by Rowell et al.5