title: Nonpigmented fixed drug eruption induced by esomeprazole.
abstract: A 56-year-old white woman developed a distinctive skin eruption over her mammary, lumbosacral, and pubic areas 2 weeks after the start of esomeprazole therapy for dyspeptic symptoms. Skin biopsy disclosed a spongiotic dermatitis with predominantly lymphocytic dermal infiltrate. Treatment with a tapering dose of corticosteroid and withdrawal of the suspected drug led to a rapid resolution of the eruption without residual dyschromia. Patch testing with esomeprazole 2% in petrolatum was negative at 48 and 72 hours but became positive on day 6. Oral-controlled provocation test induced the reappearance of the lesions over the mammary areas, confirming the putative involvement of this drug. Therefore, the patient was diagnosed as having a nonpigmented fixed drug eruption associated with esomeprazole. This compound is a proton-pump inhibitor developed as the S-isomer of omeprazole to improve its pharmacokinetic properties. Reports of cutaneous reactions to proton-pump inhibitors are quite common, but reports of such reactions to esomeprazole are rare, which demonstrates the need for higher clinical awareness and knowledge of reactions to these drugs.
authors.affiliation: Department of Dermatovenereology, Hospital S. João, E.P.E., Porto, Portugal. paulomoraiscardoso@gmail.com
authors.forename: Paulo
authors.initials: P
authors.lastname: Morais
authors.forename: Teresa
authors.initials: T
authors.lastname: Baudrier
authors.forename: Alberto
authors.initials: A
authors.lastname: Mota
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Cunha
authors.forename: Susana
authors.initials: S
authors.lastname: Cadinha
authors.forename: Ana Margarida
authors.initials: AM
authors.lastname: Barros
authors.forename: Filomena
authors.initials: F
authors.lastname: Azevedo
mesh_terms: D003875:Drug Eruptions / Q000473:pathology*; D064098:Esomeprazole; D004942:Esophagitis, Peptic / Q000188:drug therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009853:Omeprazole / Q000009:adverse effects* / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012880:Skin Pigmentation; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors; D009853:Omeprazole; D064098:Esomeprazole