Differentiation of hydrochlorothiazide-induced dermatitis from stasis dermatitis

Abstract

A woman in her 60s with a history of hypertension and stasis dermatitis presented to a primary care clinic with a bilateral, erythematous rash on the legs, stomach, and chest. Photosensitive rash and dermatitis may be caused by many conditions. Hydrochlorothiazide-induced dermatitis is a rare side effect of thiazide diuretics. Early identification of sulfa-sensitivity and photoallergic or phototoxic reaction is essential to accurate diagnosis and treatment of photosensitive dermatitis. Soliciting a targeted history is essential to delineating drug-induced dermatitis from stasis dermatitis. A thorough skin examination can elucidate the focal or extensive nature of the rash and is essential to making an accurate diagnosis. Immediate cessation of hydrochlorothiazide and switching drugs classes for hypertension management typically leads to resolution of symptoms.

Brodalumab-Induced Eczematous Reactions in Psoriasis Patients: Management With Switching to Risankizumab

“…14 It is important to differentiate drug induced dermatitis with lower extremities predominance from stasis dermatitis, especially in elderly patients. 15 Skin stretch and chronic barrier dysfunction in chronic stasis dermatitis are suggested to result in altered epidermal microenvironment that is primed for induction of a Th2-immune response. 16 Together with the immune imbalance and shift to a Th2 dominant immune response induced by brodalumab treatment, could explain the eczematous reaction with a predominance of lower extremities in our cases.…”

Hydrochlorothiazide-Induced Exfoliative Rash and Sepsis

“…Clinical presentations are similar to classic allergic responses such as rash, anaphylaxis, and eosinophilia. Hydrochlorothiazide-induced drug rash is a very rare side effect of thiazide diuretics [ 4 ].…”