Development of morphoea in rheumatoid arthritis treated with penicillamine.

Drug-induced morphea: Report of a case induced by balicatib and review of the literature

“…In two cases bullous lesions were present. 14,15 Sclerotic lesions were usually preceded by erythematous lesions, variably itchy (5/15) 11,12,15,19,20 or associated with tingling or burning sensation (2/15). 9,14 Cases associated with L-5-hydroxytryptophane and carbidopa showed hypereosinophilia 14,15 ; some patients with bleomycin-associated scleroderma showed Raynaud's phenomenon, sclerodactyly, cutaneous calcinosis, lung involvement, and weakly positive reaction for antinuclear antibodies.…”

“…6 D-Penicillamine interferes with collagen maturation and synthesis as well, but also with elastin and, probably, with regulatory T cells. 12 An ischemic damage has been postulated for ergot derivatives and pentazocine. 3,16 Finally, vitamin K 1 and vitamin B 12 may induce morphea-like lesions locally, possibly in relation to a toxic effect of the vehicle (oilsoluble preparation) or the preservative (benzyl alcohol), or to a hypersensitivity reaction.…”

Paradoxes in dermatology

“…[120] Paradoxically, morphea-like cutaneous lesions (pseudoscleroderma) have been reported in patients receiving D-penicillamine for other indications. [121122]…”