Proton pump inhibitor-induced exfoliative dermatitis: A case report

Abstract

Abstract.A 74-year-old female patient was admitted to hospital following a road accident with pains in the chest, abdomen, waist, back, nose, left wrist and lower limbs. After 1 week, the patient presented with gastrointestinal bleeding, and thus was treated with protein pump inhibitors (PPIs), including lansoprazole, esomeprazole and omeprazole enteric-coated tablets, in order to inhibit acid secretion and attenuate bleeding. However, the patient developed skin rashes on the chest and right lower limb and foot 28 days following treatment initiation. The skin rashes spread and ulcerated after 3 days, and were associated with tracheal mucosal injury and hemoptysis. Subsequently, treatment of the patient with PPIs was terminated, after which the tracheal hemoptysis and skin rashes markedly improved. In addition, no new skin rashes appeared following termination of the PPI treatment. In the present case, long-term treatment of an elderly patient with PPIs may have induced exfoliative dermatitis, due to hepatic ischemia, hypoxia and acute renal failure, which may have decreased the metabolism of PPIs, resulting in the accumulation of PPI metabolites. IntroductionExfoliative dermatitis, also known as erythroderma, is an uncommon but serious skin disorder which results in generalized eruption of the skin. It is usually caused by a variety of underlying dermatoses, drug reactions and malignancies, including lymphoma, leukemia and solid tumors (1-8). Previous studies have demonstrated that therapeutic agents including sulfonamides, captopril, phenobarbital, all-transretinoic acid and anti-tubercular drugs, such as rifampicin, isoniazid, ethambutol and pyrazinamide, may induce exfoliative dermatitis (3-8).Protein pump inhibitors (PPIs) are commonly-used prescription drugs, which can inhibit gastric acid secretion by blocking the gastric H + /K + -ATPase that is necessary for the final step of this process. PPIs are widely administered for the treatment of numerous acid-associated diseases, including peptic ulcer, gastroesophageal reflux disease and Zollinger-Ellison syndrome (9,10). In addition, PPIs have an important role in eradicating infections caused by Helicobacter pylori, controlling gastrointestinal bleeding and preventing nonsteroidal anti-inflammatory drug-induced gastric mucosal injuries. Furthermore, Ramirez et al (11) suggested that the long-term use of PPIs may be considered a major risk factor in the occurence of anaphylaxis with common PPI-induced anaphylactic symptoms including skin rashes, erythema and systemic pruritus, and rare symptoms including urticaria, herpes and skin allergic edema. In severe cases, acute diffuse epidermal necrolysis and anaphylactic shock have also been reported (12). Case reportOn September 29 th 2014, a 74-year-old female patient was admitted to Hubei General Hospital (Hubei, China) following a road accident with pains in the chest, abdomen, waist, back, nose, left wrist and lower limbs. A cranial computed tomography (CT) scan did not detect any abnormalities, whereas a nasal...

Severe adverse reactions caused by omeprazole: A case report

“…In the clinic previously, a patient presented with dermatitis exfoliativa ~1 month after being administered lansoprazole and esomeprazole on an alternate basis (23). All of these other rare and severe adverse reactions mentioned in the present study following administration of PPIs highlight that clinicians, in particular clinical pharmacists, must carefully regulate pharmaceutical treatment with PPIs.…”

“…All of these other rare and severe adverse reactions mentioned in the present study following administration of PPIs highlight that clinicians, in particular clinical pharmacists, must carefully regulate pharmaceutical treatment with PPIs. In recent years, with the increasing use of PPIs, a number of novel severe adverse reactions are being gradually discovered (15)(16)(17)(18)23). In particular, the overuse of PPIs in the clinic has become problematic (24)(25)(26).…”

Nitrofurantoin-Induced Exfoliative Dermatitis: A Case Report

“…Its classical finding is bright red patches that coalesce to cover the skin surface, and patients may complain of tight skin due to progressive edema and lichenification. Pruritus occurs in nearly all patients, and it could be associated with systemic symptoms like fever, shivering, and nausea [2,3,6]. Lymphadenopathy, splenomegaly, and hepatomegaly may be present in 50% of patients [2,7].…”

“…Triggers can be grouped into several general categories, including preexisting inflammatory dermatosis, adverse drug reactions (Table 2), and malignancies (lymphoma, leukemia, and solid tumors). Few cases are idiopathic [2,6,8].…”

“…Being a potentially life-threatening state of "skin failure", initial management includes monitoring and ensuring metabolic and hemodynamic stability since patients are at risk of hypothermia, fluid and electrolyte imbalance, and secondary infections [2,3,6].…”