Adverse reactions of the skin to metoprolol and other beta-adrenoreceptor-blocking agents

Oral provocation tests revealed the relation between long-term oral use of metoprolol and development of psoriasiform and/or eczematous skin lesions in 3 patients. The clinical and histopathological findings in 1 case are described more in detail and are discussed. The data in the recent literature, with respect to side effects of skin due to different beta-blocking agents, are summarized. In addition, some aspects dealing with possible mechanism in the side effects of beta-blocking agents are briefly discussed. Since beta-blocking agents may cause similar side effects, as described during practolol treatment, on should still be alert to this possibility during long-term treatment with (new) beta-blocking agents, which may allow us to prevent serious damage that might occur in different organs.

Drug-induced anogenital cicatricial pemphigoid

A case of cicatricial pemphigoid (CP) with a rare primary localization on the mucosal surfaces of the anus and the vulva and on perianal skin, associated with long-term therapy with clonidine, is described. Direct immunofluorescence investigation of lesional skin suggests possible complement mediated tissue injury in between basement membrane and epidermal basal cells. The possibility is discussed that drug induced metabolic disturbance (cyclic AMP-system) at a local level at the site of the basal cells might lead to the formation of immunogens and be one of the initiating factors in subepidermal bullous immune dermatoses. It is concluded that in cases of cicatricial pemphigoid the use of drugs must be considered as one of the aetiological possibilities.

Dermatitis as a side-effect of long-term topical treatment with certain beta-blocking agents

Three groups of glaucoma patients, treated topically with various beta-blocking agents, were studied for mucocutaneous side-effects of long-term therapy. In five of eleven patients with ocular and/or periocular dermatitis as an adverse reaction to long-term treatment with metoprolol eye drops a dermatitis, reproducible by patch tests with pure metoprolol 3%, was demonstrable. Histopathological examination of positive patch tests examined in three cases showed a picture compatible with a delayed type of hypersensitivity. Four atenolol treated patients showed adverse reactions, but negative patch tests to atenolol were found. In addition new data are reported in favour of cross-reactivity between certain beta-blocking agents.

The recruitment of inflammatory cells using the skin-window technique

The chemotaxis of inflammatory cells induced by the skin-window technique using IgD as cytotaxigen or cytotaxinogen was studied in 16 patients with allergic contact dermatitis. Six patients with leg ulcer served as controls. By means of this method the recruitment of inflammatory cells with receptors for IgD could be shown.

[Pemphigus]

This review stresses particularly the role that "intercellular" antigens and antibodies, complement and lymphocytic dysfunction may play in pemphigus. In addition evidences in the literature in favour of exogenic factors inducing pemphigus are surveyed. Further an attempt is made to summarize the possibilities for the etiology and the blister formation in this disease.

Ocular cicatricial pemphigoid associated with practolol therapy

The clinical and laboratory findings in a case of serious cicatricial blistering of the ocular mucous membrane were comparable with those found in cicatricial pemphigoid (ocular mucous membrane pemphigoid).