Lichenoid eruptions due to the H2-receptor antagonists roxatidine and ranitidine

Hypersensitivity reaction to ranitidine: description of a case and review of the literature

Ranitidine is an H2-receptor antagonist which is usually well tolerated. Hypersensitivity reactions to ranitidine, as well as other H2 antihistamines, have been rarely described. We report the case of a 47-year-old woman who developed an anaphylactic reaction to ranitidine used as intravenous premedication before anesthesia induction. The patient's history revealed that previous use of oral ranitidine for a peptic ulcer disease did not cause any adverse reaction. Intradermal test with ranitidine at a dilution of 1:100 gave an intense positive reaction. The protective role of H2-receptor antagonists as premedication is still unclear and should be carefully reconsidered on the basis of the available controversial evidence and the possible risk of hypersensitivity reactions.

Drug eruption caused by ranitidine hydrochloride (Zantac) which showed a strong reaction in a drug-induced lymphocyte stimulation test

An 80-year-old male who developed a generalized papular erythema-type drug eruption after being treated with ranitidine hydrochloride is herein reported. The duration from the intake of the medicine to the onset of the eruption was 3 days, and the eruption remained unchanged for a week after withdrawal of the medicine and even after the eruption itself was treated. A diagnosis of drug eruption by ranitidine hydrochloride was confirmed based on a strongly-positive reaction of a drug-induced lymphocyte stimulation test (DLST).

Activity of cathepsin B, D and L in rat cerebrum after cimetidine and famotidine administration

Cathepsins are lysosomal enzymes that are used a sensitive markers in various toxicological investigations. The purpose of this study was to evaluate and compare the influence of cimetidine and famotidine on the cerebral cortex, particularly on the activity of cortical cathepsin B, D and L in the frontal lobe of rat brain. The drugs were administered intraperitoneally, twice a day, for six weeks to male Wistar rats in two doses. The initial dose was 2.85 mg/kg for cimetidine and 0.285 mg/kg for famotidine. The second dose was 10 times higher. Control animals were injected with 0.9% NaCl. Half of the animals from each of the drug-treated and control groups were sacrificed on the 42nd day of the experiment. The remaining animals were raised for another 6 weeks without any xenobiotics, and sacrificed on the 84th day. The frontal lobe of the right cerebral hemisphere was taken for biochemical investigation. The activities of free and bound fractions of cathepsin B, D and L were evaluated spectrophotometrically in cortical homogenates. The activity of bound fraction of cathepsin D and L decreased significantly in animals exposed to the higher dose of cimetidine and sacrificed on the 42nd day. Also significant elevation of the free fraction of cathepsin L was noted in the same group of rats. Cathepsin activities were normalized during the next six weeks. No behavioural changes were noted among the observed animals. Unlike cimetidine, famotidine did not change profiles of the cerebral cathepsins.

Lichenoid dermatitis--treatment with pulsed dye laser: a case study

BACKGROUND AND OBJECTIVES

Both the diagnosis and the treatment of lichenoid dermatosis are often difficult and can be time-consuming. There are now more and more publications about the use of laser systems--especially the flashlamp-pumped pulsed dye laser--in the treatment of inflammatory dermatoses, although the laser's exact mechanism of action in these cases is not yet clear.

STUDY DESIGN/PATIENTS AND METHODS

We report on a female patient with lichenoid dermatitis that was presumably drug-induced (roxatidine, H(2) receptor antagonists). After a 10-month treatment with local corticosteroids, without significant clearance the drug was discontinued and the pulsed dye laser was used (wavelength 585 nm, pulse duration 450 microseconds).

RESULTS

Six laser treatments resulted in complete clearance of the lesions. No recurrence occurred during the follow-up period of 54 months. Scars were not observed. A post-operative biopsy showed no evidence of lichenoid dermatitis.

CONCLUSIONS

The pulsed dye laser seems to accelerate the clearance of presumably drug induced corticosteroid-resistant lichenoid dermatoses. No permanent pigmental changes or scarring were observed.

Lichenoid and subacute cutaneous lupus erythematosus-like dermatitis associated with antihistamine therapy

The authors report the occurrence of lichenoid and/or subacute lupus erythematosus-like eruptions in a group of patients receiving agents with antihistaminic properties. In 1 of the patients the eruption clinically resembled lichen planus, while in 5 patients the eruption resembled subacute cutaneous lupus erythematosus (SCLE). At a light microscopic level all cases showed a lichenoid dermatitis and in 4 cases the lesions were interpreted as representing subacute lupus-like eruptions by virtue of the presence of alternating cell poor and lichenoid interface dermatitis, suprabasilar lymphocytosis around degenerating keratinocytes, and dermal mucinosis. Despite the resemblance at a clinical and light microscopic level to SCLE, anti-Ro seropositivity could not be established in any of the cases. One case, however, did demonstrate antihistone antibodies in concert with a high antinuclear antibody titer. A causal association was implicated by virtue of lesional resolution following drug withdrawal. The association of cutaneous eruptions resembling SCLE with antihistamine intake is seemingly a novel one. The possible pathogenetic basis of the eruptions is discussed.