Nonpigmented fixed drug eruption induced by esomeprazole.
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.
Morais
Paulo
P
Department of Dermatovenereology, Hospital S. João, E.P.E., Porto, Portugal. paulomoraiscardoso@gmail.com
Baudrier
Teresa
T
Mota
Alberto
A
Cunha
Ana Paula
AP
Cadinha
Susana
S
Barros
Ana Margarida
AM
Azevedo
Filomena
F
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
D054328:Proton Pump Inhibitors; D009853:Omeprazole; D064098:Esomeprazole