Acne Keloidalis‐like Lesions on the Scalp Associated with Antiepileptic Drugs

Abstract

A man developed acne keloidalis-like lesions in the scalp during treatment with diphenylhydantoin and carbamazepine for epilepsy. These drugs were suspected to play a role in the pathogenesis of this skin disease in an unusual location, based on clinical evidence and on the in vitro test, mast cell degranulation (MCD).

Update on primary cicatricial alopecias

“…347 Acne mechanica from sports helmets, 352 hair length, 352,356 and hair impaction (''pseudofolliculitis nuchae'' 352 ) 351,355 are largely dispelled notions. Illustrative aspects of pathogenesis may be suggested by the reported occurrence of drug-induced acne keloidalis in white males who were treated with the anticonvulsants diphenylhydantoin and carbamazepine together (1 case) 357 and cyclosporine (4 cases). 358,359 Common to these drug regimens are cutaneous adverse effects that may simulate aspects of acne keloidalis that occur de novo.…”

Drug-Induced Acneiform Eruption

“…One case of keloidal acne of the scalp has been described during treatment with phenytoin and carbamazepine. [46] A case of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) after barbiturate initiation was reported and the authors speculated on a potential link that could not be proved. [48] …”

“…However, several reports favor a significant role for antiepileptic drugs in acne occurrence. [43][44][45][46][47][48] Classically, the acne is inflammatory with widespread papulopustules. One case of keloidal acne of the scalp has been described during treatment with phenytoin and carbamazepine.…”

“…[43][44][45][46][47][48] The genuine liability of these drugs in acne remains controversial and imputability must be cautiously documented. Indeed, Greenwood et al [49] did not observe any difference in acne severity and sebum excretion rate between patients receiving anticonvulsants and healthy control subjects.…”

What′s new in cicatricial alopecia?

“…Graham-Little syndrome has been reported following hepatitis B vaccination, [41] AK has been associated with anticonvulsant and ciclosporin therapy, [42,43] and drug-induced cases of AM, [44] CCLE [45] have been described. Similarly, occurrence of LPP is reported after ingestion of gold, [46] hepatitis B vaccination [41] and hepatitis C infection.…”