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Marrero Castillo M, Kaufman D, Valdes Camacho J, Bourgoyne K, Jacob J, Amalraj B, Gulati N. Chlorthalidone-Induced Fixed-Drug Eruption: Unmasking an Uncommon Reaction to a Common Diuretic. Cureus 2023; 15:e46199. [PMID: 37908922 PMCID: PMC10613783 DOI: 10.7759/cureus.46199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Fixed-drug eruptions (FDEs) are dermatological reactions characterized by specific skin lesions triggered by certain medications. Our case reports commonly used medications that can cause drug-induced skin reactions. Chlorthalidone, a widely used diuretic, had not been prominently linked to FDEs. Here, we present the case of a 45-year-old African-American male who developed classic FDE skin lesions following the initiation of chlorthalidone therapy. This case underscores the imperative for further investigation and heightened awareness among healthcare professionals regarding chlorthalidone-associated FDEs. Findings suggest that such reactions might be more prevalent than previously acknowledged, underscoring the significance of prompt diagnosis and effective management of drug-induced skin responses. Notably, the patient's lesions showed complete resolution upon discontinuing the diuretic, reinforcing the causal relationship. This case is an essential reminder of the importance of vigilance in monitoring patients for adverse drug reactions, even in unlikely medications, such as chlorthalidone..
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Affiliation(s)
- Mariana Marrero Castillo
- Internal Medicine, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - David Kaufman
- Allergy and Immunology, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - Juanita Valdes Camacho
- Allergy and Immunology, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - Kesler Bourgoyne
- Allergy and Immunology, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - John Jacob
- Internal Medicine, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - Benedict Amalraj
- Internal Medicine, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - Neerja Gulati
- Pulmonary Medicine, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
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Lo Y, Tsai TF. Angiotensin II receptor blockers in dermatology: a narrative review. J DERMATOL TREAT 2022; 33:2894-2898. [PMID: 35695256 DOI: 10.1080/09546634.2022.2089332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Angiotensin II receptor blockers (ARBs) are commonly used for cardiovascular diseases, especially for patients who can't tolerate the side effects of cough and angioedema caused by angiotensin converting enzyme inhibitors (ACEIs). However, the evidence of using ARBs in dermatology is mostly anecdotal and limited to case reports or small case series. Here we present a narrative review focusing on the therapeutic use of ARBs in dermatology and adverse cutaneous reactions due to the administration of ARBs.
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Affiliation(s)
- Yang Lo
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Lo Y, Tsai TF. Angiotensin converting enzyme and angiotensin converting enzyme inhibitors in dermatology: a narrative review. Expert Rev Clin Pharmacol 2022; 15:33-42. [PMID: 35196189 DOI: 10.1080/17512433.2022.2045950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Angiotensin converting enzyme inhibitors (ACEI) are commonly used for cardiovascular diseases. The evidence supporting the use of ACEI in dermatology is limited. AREAS COVERED This review article was divided into three parts. The first part discusses ACEI in clinical use in dermatology. The second part reveals the relationship between angiotensin converting enzyme (ACE) and immune diseases, and further discusses the possible relationship between ACEI in clinical use in these diseases and ACE. The third part focuses on cutaneous adverse reactions of ACEI. EXPERT OPINION The use of ACEI in dermatology is mainly based on its properties as regulation of renin angiotensin system (RAS), but currently, with limited clinical use. The association of ACE and several diseases are well discussed, including COVID-19, psoriasis, sarcoidosis, systemic lupus erythematosus and vitiligo. The main cutaneous adverse effects of ACEI include angioedema, psoriasis and pemphigus. Plausible factors for these adverse reactions include accumulation of vasoactive mediators, preventing angiotension from binding to AT1 receptor and AT2 receptor and presence of circulating antibodies.
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Affiliation(s)
- Yang Lo
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Song G, Yoon HY, Yee J, Kim MG, Gwak HS. Antihypertensive drug use and psoriasis: A systematic review, meta- and network meta-analysis. Br J Clin Pharmacol 2021; 88:933-941. [PMID: 34611920 DOI: 10.1111/bcp.15060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 01/11/2023] Open
Abstract
AIMS Diverse genetic and/or external factors may induce psoriasis. Drug exposure is 1 such prominent external factor; antihypertensive drugs are reportedly associated with psoriasis, but study results have been inconsistent. In this context, we investigated the associations between antihypertensive drugs and incidence if psoriasis via a systematic literature review and meta-analysis. METHODS Literature search in databases such as PubMed, Embase and Web of Science was conducted on 8 January 2021, and obtained data were pooled for meta- and network meta-analysis. Fixed- or random effect models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for evaluating the strength of the associations between antihypertensive drugs and psoriasis incidence. In addition to meta-analysis, Bayesian network meta-analysis was performed. ResultsThirteen eligible studies were included for meta-analysis with 6 378 116 individuals and 8 studies for network meta-analysis with 5 615 918 individuals. All antihypertensive drugs were significantly associated with psoriasis incidence. In a meta-analysis, the pooled ORs were 1.67 (95% CI: 1.31-2.13) for angiotensin-converting enzyme (ACE) inhibitors, 1.40 (95% CI: 1.20-1.63) for β-blockers, 1.53 (95% CI: 1.23-1.89) for calcium-channel blockers (CCBs), and 1.70 (95% CI: 1.40-2.06) for thiazide diuretics. For the comparative risks of psoriasis among antihypertensive drugs in the network meta-analysis, ORs were 2.09 (95% CI: 1.39-3.18) for ACE inhibitors, 1.35 (95% CI: 0.99-1.91) for BBs, 1.53 (95% CI: 1.07-2.24) for CCBs and 1.80 (95% CI: 1.23-2.66) for thiazide diuretics. CONCLUSION This study confirmed the associations between antihypertensive drugs and psoriasis; ACE inhibitors, BBs, CCBs and thiazide diuretics increased the risk of psoriasis. Therefore, antihypertensive drug users should be carefully monitored for psoriasis.
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Affiliation(s)
- Gonjin Song
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Ha Young Yoon
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Jeong Yee
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Myeong Gyu Kim
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Hye Sun Gwak
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
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Pratyusha K, Dawman L, Vinay K, Tiewsoh K, Sharawat IK. Dermatological manifestations in children with chronic kidney disease: a study from a North Indian tertiary care institute. Clin Exp Dermatol 2021; 46:1270-1276. [PMID: 33904201 DOI: 10.1111/ced.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dermatological manifestations due to impaired renal function in children with chronic kidney disease (CKD) are diverse and are an important cause of morbidity. AIM To determine the prevalence of dermatological manifestations in predialysis children with different stages of CKD and its association with various metabolic parameters. METHODS This cross-sectional observational study was conducted in 200 predialysis children with CKD stages 1-5 and 200 age- and sex-matched healthy controls (HCs). Detailed dermatological examination was performed to check for any pathological/physiological changes in the skin, mucosa, hair and nails, and changes were recorded in a predesigned proforma. RESULTS The median age of cases and HCs was 60.50 months (76.5% males) and 62 months (78.5% males) respectively. Skin manifestations were seen in 189 (94.5%) cases and 156 (78%) HCs (P < 0.001). The most common skin manifestation among cases was pallor (75.5%, P < 0.001) followed by xerosis (48.5%, P < 0.001), atopic diathesis (41.5%) and pruritus (13%, P < 0.001), while among HCs, the most common skin manifestation was atopic diathesis (46%), followed by pallor (24%) and xerosis (14%). Xerosis was found to be significantly associated with higher serum creatinine levels (P = 0.04) and hypocalcaemia (P = 0.03). There was no significant association found between pruritus and serum creatinine. CONCLUSION Xerosis was significantly associated with higher levels of creatinine and hypocalcaemia. Timely recognition of these symptoms and proper management can improve the quality of life in children with CKD.
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Affiliation(s)
- K Pratyusha
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - L Dawman
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K Vinay
- Department of Dermatology, Venerology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K Tiewsoh
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - I K Sharawat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, India
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Soni R, Supekar BB, Chopkar A, Mukhi J, Singh RP. Uncommon Adverse Drug Reaction to a Commonly Used Antihypertensive. Indian Dermatol Online J 2021; 12:162-164. [PMID: 33768043 PMCID: PMC7982010 DOI: 10.4103/idoj.idoj_96_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/04/2020] [Accepted: 07/24/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rajesh Soni
- Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Bhagyashree B Supekar
- Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Apoorva Chopkar
- Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Jayesh Mukhi
- Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Rajesh P Singh
- Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Nagpur, Maharashtra, India
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Lo Y, Lin LY, Tsai TF. Use of calcium channel blockers in dermatology: a narrative review. Expert Rev Clin Pharmacol 2021; 14:481-489. [PMID: 33612036 DOI: 10.1080/17512433.2021.1894128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Calcium channel blockers (CCB) are commonly used for cardiovascular diseases. The evidence supporting the use of CCB in dermatology is mostly anecdotal and limited to case reports or small case series.Areas covered: This review article is divided into two parts. The first part discusses the therapeutic use of CCB in dermatology. The second part focuses on mucocutaneous adverse reactions due to the administration of CCB.Expert opinion: The use of CCB in dermatology is mainly based on its properties as a vasodilator and the inhibition of muscle contractions, such as pernio, anal fissures, facial wrinkles, and painful leiomyoma. However, there remain other modes of action to explain its clinical use in calcinosis, keloid, pressure ulcer, and fibromatosis. Compared to oral CCB, the lack of systemic side effects would make topical use of CCB an attractive alternative in the treatment of skin diseases, but the evidence for topical CCB is still limited, and there is a lack of standardized topical formulation. The main mucocutaneous adverse effects of CCB include gingival hyperplasia, phototoxicity, eczema, psoriasis and risk of skin cancers. Plausible factors for these adverse events include CCB's photoinstability, aldosterone synthesis inhibition, disturbed calcium homeostasis and immunosuppressive properties.
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Affiliation(s)
- Yang Lo
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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