Bisphosphonate-Induced Cutaneous Adverse Events: The Difficulty of Assessing Imputability through Patch Testing

Abstract

Background: Cutaneous adverse drug reactions (CADRs) due to bisphosphonates (BPs) have been scarcely described in the literature. Objective: To discuss the diagnostic value and limitations of cutaneous provocation tests with BPs. Methods: A descriptive case series study with a control group of CADRs due to BPs studied using patch testing from 2005 to 2010 is presented. Results: Patient 1 showed a positive D4++ with alendronate at 1% in petrolatum and D4+++ with alendronate at 1 and 0.1% in water. Patient 2 showed a positive intradermal test D3++ with alendronate at 0.1% in water. Patient 3 showed a positive patch test D4+ with ibandronate at 1% in petrolatum and D4++ with ibandronate at 1% in water, and a positive intradermal test D3+++ with ibandronate at 0.1% in water. Conclusion: Establishing a correct interpretation of a patch test reaction is difficult based just on cutaneous test results. Too high concentrations of the drug can cause irritation and too low concentrations can be responsible of false-negative test reactions.

Alendronate induced subacute cutaneous lupus erythematosus successfully treated with intravenous immunoglobulin

“…Although biphosphonates were reported to be safe, mild‐severe adverse events have been reported affecting multisystems such as gastrointestinal system, musculoskeletal system, and ocular side effects, atrial fibrillation, hepatitis, and cutaneous adverse drug reactions 16 . The most common cutaneous reactions with alendronate were pruritus, urticaria, contact dermatitis, photosensitivity, toxic epidermal necrolysis, lichen planus, oral ulcers, injections site reactions, cutaneous vasculitis, and superficial gyrate erythema in the literature 16‐20 . To our knowledge aggravation of cutaneous lupus erythematosus has not been reported previously.…”

“…16 The most common cutaneous reactions with alendronate were pruritus, urticaria, contact dermatitis, photosensitivity, toxic epidermal necrolysis, lichen planus, oral ulcers, injections site reactions, cutaneous vasculitis, and superficial gyrate erythema in the literature. [16][17][18][19][20] To our knowledge aggravation of cutaneous lupus erythematosus has not been reported previously.…”