Bullous Dermatosis among Patients with Chronic Renal Failure on High Dose Frusemide

Abstract

Twelve of 56 patients with chronic renal failure, all treated with frusemide (Lasix®) in daily doses of 0.5–2 g, developed bullae in areas exposed to light. In most cases the bullae developed during summer months and disappeared later in the year whether the frusemide treatment was continued or not. In two patients the eruption reappeared when treatment was resumed. Disturbance of the porphyrin metabolism was not found, neither could a change in the frusemide metabolism be demonstrated. Tissue typing and blood groups showed no difference from the average population. It is concluded that the condition presumably is a photo reaction due to the frusemide treatment but it cannot be said whether it is allergic or toxic.

Frusemide‐induced Bullous Pemphigoid

“…In these two patients the repeated appearance of bullous lesions while on regular frusemide therapy, and resolution of all the lesions soon after cessation of the drug, strongly suggest a causative association. Frusemide‐induced bullous pemphigoid was first described 25 years ago 2 and a few similar cases have been reported since 3–6 . This adverse event bears no relation to the dose of frusemide used, and may appear on entirely normal skin or be preceded by pruritus or a maculopapular rash.…”

Diuretic Use in End‐Stage Renal Disease

“…Such eruptions usually occur in sun-exposed areas of the skin although occasionally in non-sun-exposed areas. In the series reported by Heydenreich et al, 12 of 56 patients treated with furosemide (dose range 0.5-2.0 g/day) developed bullae in sun-exposed areas (58). Similarly, three of the thirteen patients in the studies of van Olden et al developed bullous dermatosis (4!3-50).…”

“…Bullous skin eruptions have been reported in ESRD patients given high doses of either furosemide or chlorthiazide (49-50, [58][59][60]. Such eruptions usually occur in sun-exposed areas of the skin although occasionally in non-sun-exposed areas.…”