Poppers-Makulopathie

Abstract

Although poppers have been in use for several decades, in 2007 in England, the popper composition was changed by law from isobutyl nitrite to isopropyl nitrite. It is hard to distinguish whether a specific nitrite group triggers the maculopathy or whether it is the dose level, thus suggesting the existence of a cumulative dose-response relationship. We postulate that a major factor of the manifestation of maculopathy is the individual limit of vulnerability. Despite decades of use, the majority of our series does not present any pathology. Limits of our patient population represents the HIV disease: three maculopathies of our series are HIV-associated and controlled by antiretroviral therapy, so that a clear distinction to the disease is absent. Poppers were earlier regarded to cause an AIDS-defining disease of viral aetiology: Kaposi sarcoma. We are well aware of that association and postulate that the observed maculopathies are not causally related to HIV disease and antiretroviral therapy. Considering the cultural background of our patients (multiple partners, frequent sex) and the disinhibiting effect of poppers, an increased risk of HIV disease is found. Since this disease is a rare disorder, patients should be asked specifically about poppers abuse. Further study of the effect of poppers on maculopathy is needed.