A Heartburn Pill Taken for 10 Months Was Blamed for a 73-Year-Old Woman’s Ring-Shaped Lupus Rash

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Her doctors traced the problem to pantoprazole, a widely used acid-reducing drug she had been taking for 10 months.

The diagnosis was drug-induced subacute cutaneous lupus erythematosus, an autoimmune reaction that mainly affects the skin. The case, reported by Norbertus A. Ipenburg and Tobias E. Sangers of Leiden University Medical Center, was published in August 2026 in The New England Journal of Medicine.

Subacute cutaneous lupus erythematosus, often shortened to SCLE, is a form of lupus that mostly stays in the skin. According to DermNet, its lesions tend to appear symmetrically on sun-exposed areas such as the neck, upper trunk, and outer arms, and the face is usually unaffected.

The rash typically takes one of two forms. Some patients develop scaly patches that resemble psoriasis. Others develop annular lesions, red rings with paler centers, that can merge into polycyclic, chain-like shapes.

The woman’s lesions fit the second pattern. As summarized by the Russian science outlet N+1, the report describes ring-shaped, polycyclic lesions with firm red borders and pale centers that had been present for several months and caused a burning sensation. She had also been taking etanercept, an immune-modifying drug, for 15 years.

Blood tests showed positive antinuclear antibodies and a very high level of anti-Ro antibodies, a marker often found in SCLE. A skin biopsy from her upper back showed inflammation and cell damage at the base of the outer skin layer, a pattern consistent with lupus.

The 10-month gap between starting pantoprazole and developing the rash is one reason drug-induced cases are easy to miss. When a rash appears, patients and doctors tend to look for a new drug, not one that has been taken without trouble for most of a year.

British regulators have warned about this pattern. In a 2015 Drug Safety Update, the UK Medicines and Healthcare products Regulatory Agency (MHRA) said SCLE can appear weeks, months or even years after exposure to a proton pump inhibitor, the drug class that includes pantoprazole, omeprazole, esomeprazole and lansoprazole.

The agency described the risk as very low. It cited a Swedish case-control study that found people taking these drugs had almost three times the odds of SCLE. It also noted reported cases in which the rash returned when patients switched to a different drug in the class, and warned that a patient who reacts to one may react to another.

Proton pump inhibitors are among the most commonly used treatments for heartburn and acid reflux, and several are sold over the counter in the United States. Pantoprazole is prescribed for gastroesophageal reflux disease and conditions in which the stomach makes too much acid. MedlinePlus lists a sun-sensitive rash on the cheeks or arms, along with new or worsening joint pain, among the side effects that warrant a call to a doctor.

A 2014 study in the British Journal of Dermatology described 24 patients treated for SCLE linked to these drugs at a Danish university hospital over 19 years. Lansoprazole was the most frequent culprit, followed by omeprazole, esomeprazole and pantoprazole. The rash appeared an average of eight months after patients started the drug, with a range of one week to three and a half years, and it cleared an average of three months after the drug was stopped. Three patients reacted to more than one drug in the class.

Other medications have also been linked to drug-induced SCLE. DermNet lists thiazide diuretics, the antifungal terbinafine and calcium channel blockers among the most common.

The central step in managing drug-induced SCLE is identifying and stopping the responsible drug. The MHRA advised clinicians to consider stopping the acid reducer unless it is imperative for a serious acid-related condition, and noted that symptoms resolve in most cases once the drug is withdrawn.

In the woman’s case, doctors stopped pantoprazole and prescribed hydroxychloroquine, a drug commonly used for lupus, along with a topical steroid, clobetasol. According to the N+1 summary, her rash cleared within four months and had not returned a year after both treatments were stopped.

Sun protection is also standard advice, because ultraviolet light can worsen lupus skin lesions. The MHRA said steroids should be considered only if there are no signs of improvement after a few weeks or months.

For readers, the takeaway is not to stop a prescribed medication on their own. These drugs treat real and sometimes serious conditions. But anyone taking an acid reducer who develops a new rash, particularly ring-shaped or scaly patches on sun-exposed skin, should tell their clinician, along with how long they have been taking the drug.

A 73-year-old woman developed ring-shaped, interconnected skin lesions after 10 months on pantoprazole and was diagnosed with drug-induced subacute cutaneous lupus erythematosus.

What is subacute cutaneous lupus erythematosus?

It is a form of lupus that mainly affects the skin, often causing scaly or ring-shaped red lesions on sun-exposed areas.

Can heartburn drugs really trigger lupus-like reactions?

Yes, rarely. Regulators and case reports have linked proton pump inhibitors, including pantoprazole, to drug-induced SCLE, though the MHRA describes the risk as very low.

In reported cases, it usually clears after the triggering drug is stopped. The woman in this case was rash-free within four months.

Should people taking these drugs stop them if they get a rash?

They should not stop on their own. Anyone who develops a new rash while taking an acid reducer should contact their clinician to discuss next steps.