title: Livedo reticularis and thrombotic purpura related to the use of diphenhydramine associated with pyrithyldione.
abstract: We describe the case of a young woman who habitually took large doses of a combination of diphenhydramine and pyrithyldione. She complained of arthralgia, painful recurring plaques and nodules, together with persistent reticular purpuric mottling and areas of necrosis on her legs. There were positive antinuclear antibodies and rheumatoid factor and histologically massive thrombosis of the dermal vessels without signs of vasculitis. Other cases of similar adverse reactions attributed to this drug combination used as a hypnotic have been described.
authors.affiliation: Department of Dermatology, Hospital General de Alicante, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Morell
authors.forename: R
authors.initials: R
authors.lastname: Botella
authors.forename: J F
authors.initials: JF
authors.lastname: Silvestre
authors.forename: I
authors.initials: I
authors.lastname: Betlloch
authors.forename: M R
authors.initials: MR
authors.lastname: Alfonso
authors.forename: M D
authors.initials: MD
authors.lastname: Ruiz
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000139:chemically induced / Q000473:pathology; D004155:Diphenhydramine / Q000009:adverse effects*; D004338:Drug Combinations; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D011696:Purpura, Thrombocytopenic / Q000139:chemically induced* / Q000150:complications; D011728:Pyridones / Q000009:adverse effects*; D012075:Remission, Spontaneous; D017445:Skin Diseases, Vascular / Q000139:chemically induced* / Q000150:complications
chemical_list: D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D011728:Pyridones; C005589:pyrithyldione; D004155:Diphenhydramine