title: Leflunomide-associated skin ulceration.
abstract: OBJECTIVE
  To report a case of skin ulceration as a result of treatment with leflunomide for rheumatoid arthritis.
  
  
  METHODS
  A 78-year-old white woman developed bilateral leg ulcers after 6 months of treatment with leflunomide for rheumatoid arthritis. A history of leg ulcers after methotrexate therapy had been documented. Serologic and diagnostic tests did not support an alternate process. Other medications prescribed were oral ethinyl estradiol 0.05 mg/d, felodipine 5 mg/d, and paroxetine 20 mg/d, for which no documented correlation with the skin breakdown could be made.
  
  
  CONCLUSIONS
  This is the first published case describing a possible relationship between the use of the immunosuppressant agent leflunomide and skin ulceration.
  
  
  CONCLUSIONS
  Skin breakdown and ulceration is a recognized adverse effect of drugs with immunosuppressant activity such as methotrexate. Leflunomide, a newer agent prescribed in the treatment of rheumatoid arthritis, may now be listed among the drugs in this category associated with this adverse drug effect.
authors.affiliation: Department of Pharmacy Practice, Bouve College of Health Sciences, Northeastern University, Boston, MA 02215-5400, USA. cmccoy@caregroup.harvard.edu
authors.forename: Christopher M
authors.initials: CM
authors.lastname: McCoy
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000077339:Leflunomide; D012883:Skin Ulcer / Q000139:chemically induced* / Q000209:etiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007555:Isoxazoles; D000077339:Leflunomide