Minocycline-induced DRESS: evidence for accumulation of the culprit drug.
BACKGROUND
Minocycline-induced drug rash with eosinophilia and systemic symptoms (DRESS) may have a prolonged course, especially in African and African-American patients.


OBJECTIVE
To determine if a prolonged course of minocycline-induced DRESS was associated with an accumulation of the culprit drug.


METHODS
We determined plasma and skin levels of minocycline in patients with minocycline-induced DRESS. We investigated the genetic polymorphisms of enzymes potentially involved in the detoxification of the drug, glutathione S-transferases and UDP-glucuronosyltransferases.


CONCLUSIONS
We demonstrated the persistence of minocycline in the plasma and/or in the skin of 7 out of 9 patients with skin phototypes V-VI. As pigmented skin contains more melanin, this could promote the formation of a melanin-minocycline complex, which could explain the severe and prolonged DRESS which may occur in this subgroup of patients.
Maubec
Eve
E
Department of Dermatology, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
Wolkenstein
Pierre
P
Loriot
Marie-Anne
MA
Wechsler
Janine
J
Mulot
Claire
C
Beaune
Philippe
P
Revuz
Jean
J
Roujeau
Jean-Claude
JC
D000152:Acne Vulgaris / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D044383:Black People; D002851:Chromatography, High Pressure Liquid; D004342:Drug Hypersensitivity / Q000201:enzymology / Q000208:ethnology / Q000235:genetics*; D004802:Eosinophilia / Q000139:chemically induced* / Q000208:ethnology / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D005982:Glutathione Transferase / Q000235:genetics*; D006801:Humans; D008297:Male; D008543:Melanins / Q000032:analysis; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects* / Q000493:pharmacokinetics; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic; D017384:Sequence Deletion; D012867:Skin / Q000473:pathology; D012880:Skin Pigmentation; D013577:Syndrome; D001741:Black or African American
D000900:Anti-Bacterial Agents; D008543:Melanins; D005982:Glutathione Transferase; D008911:Minocycline