Amlodipine

Abstract

Photodistributed telangiectasia and acquired dermal melanocytosis: case reportAn approximately 5-year-old girl developed photodistributed telangiectasia and acquired dermal melanocytosis during treatment with amlodipine for BP control.The girl, who was diagnosed with nephrotic syndrome at the age of 4 years, started receiving prednisolone. In view of poor response, a biopsy was performed and the pathological report indicated focal segmental glomerulosclerosis with acute tubular injury. Ciclosporin [cyclosporin] 3 mg/kg/day was therefore added to the ongoing prednisolone therapy. Amlodipine 0.5mg twice daily [route not stated] was added in the following month for BP control. Partial remission of nephrotic syndrome was achieved. She was referred a clinic one year later to evaluate an asymptomatic progressive skin rash that had persisted for several months. Physical examination revealed symmetrically distributed disseminated erythematous macules on the cheeks, chest, extensor sides of the forearms and upper arms and upper back. She also had a moon face and hypertrichosis. Dermoscopic examination revealed telangiectasia and brownish pigmentation. The clinical impression was drug-induced photodistributed reaction. Prednisolone, ciclosporin and amlodipine were considerd as possible suspects based on her medication history. The other differential diagnoses were idiopathic telangiectasia, poikiloderma associated with a connective tissue disorder and cutaneous mastocytosis. Therefore, an incision biopsy with direct immunofluorescence was performed. A section of the right arm skin showed a normal epidermis and minimal dermal inflammation. Mild vascular dilatation was present in the upper dermis. The CD117 and toluidine blue stains did not show an increase in mast cells. Scattered pigmented cells were noted in the reticular dermis that highlighted for melanin and melan-A staining but negative for iron staining. Direct immunofluorescence was negative. The pathological diagnosis was telangiectasia and dermal melanocytosis. The photodistributed telangiectasia and dermal melanocytosis were attributed to amlodipine.Consequently, amlodipine was replaced by hydralazine and labetalol [labetalol hydrochloride]. Prednisolone and ciclosporin were continued; the dosage of ciclosporin was adjusted as per her body weight. The skin eruption improved gradually, and there was almost no telangiectasia at the 6-month follow-up. The pigmentation also improved, and only some light brownish macules remained on the upper arms.