Olanzapine-Induced Eccrine Squamous Syringometaplasia

Abstract

Eccrine squamous syringometaplasia is a histopathologic pattern that has mainly been described in patients receiving chemotherapy. Its association to nonchemotherapeutic agents is rare, with very few cases reported in the literature. We present the case of a 55-year-old patient with schizophrenia, who developed a skin eruption 5 weeks after initiating treatment with olanzapine. The histopathologic study revealed squamous syringometaplasia of the dermal eccrine ducts.

Dysmorphic Delusion and Olanzapine-Induced Postpartum Dermatosis in a Case of Schizophrenia

“…Skin rash,[7] pustular eruptions,[8] hypersensitivity syndrome,[9] acneform eruptions,[7] and pellagroid skin eruptions have been reported with oral olanzapine preparation[10] in non-postpartum cases. Pathological findings have confirmed the nature of the skin eruption after olanzapine exposure[11] in non-postpartum cases. There is no previous case report describing postpartum acneiform dermatosis with olanzapine exposure in schizophrenia.…”

Eccrine squamous syringometaplasia associated with Natalizumab

“…Erosive lesions, ulcerations, or recent scars are commonly seen in ESS not related to chemotherapy. 1,9 The latency period was longer in this case, possibly because all the drugs that have been associated with squamous syringometaplasia up to now, that are not chemotherapy drugs, have a shorter latency period. This is due to the fact that they are drugs administered daily, unlike Natalizumab which is administered every 4 weeks.…”

“…Histologically, SEE not associated with chemotherapy is focal and SEE associated with chemotherapy is accompanied by vacuolar interface dermatitis in most cases. 1 From the therapeutic point of view, it is convenient to assess the severity and symptoms, as in some cases it is self-limiting 9 ; however, as in our case, the lesions worsened after treatment, so a more radical attitude should be adopted.…”

“…To our knowledge, only four cases of ESS in association with nonchemotherapeutic agents have been reported (Table S1). ESS has been reported in association with antipsychotic drugs (olanzapine), 9 nonsteroidal anti-inflammatory medications (NSAIDs) such as Benoxaprofen 10 and Pelubiprofen, 11 as well as Amineptine, a synthetic tricyclic antidepressant. 12 The clinical and histological differences represent a clinical diagnostic challenge as the clinical presentation of ESS is nonspecific.…”

Olanzapine-induced Skin Eruptions

“…There is scarce literature on olanzapine-induced skin eruptions, mostly in the form of case reports. Olanzapine-induced skin eruptions have been described previously, like pustules in a 56-year-old bipolar affective disorder patient,[ 1 ] vasculitis in an 82-year-old female diagnosed with delirium,[ 2 ] eccrine squamous syringometaplasia[ 3 ] in a 56-year-old patient of schizophrenia (a reaction that is commonly seen with chemotherapeutic agents). There have been reports on hypersensitive reactions with fever and hepatitis,[ 4 ] eruptive xanthomas,[ 5 ] and nonpruritic purpura.…”