Pustular Psoriasis Precipitated by Acetazolamide

Abstract

We report a case of pustular psoriasis precipitated by acetazolamide, a carbonic anhydrase inhibitor. A 28-year-old man suffering from 20 years-standing generalized pustular psoriasis developed psoriatic arthritis and glaucoma and experienced a precipitation of pustular lesions and widespread erythema after initiation of oral acetazolamide for glaucoma. The cutaneous lesions and systemic symptoms improved after restriction of acetazolamide and administration of oral etretinate. Readministration of acetazolamide confirmed that generalized pustules arose within 24 hours.

Dermatological adverse effects of anti‐glaucoma eye drops: a review

“…Regarding carbonic anhydrase inhibitor eye drops, the reported psoriasis and lichenoid eruption cases appear chronologically relevant, with positive rechallenge, but the mechanism is unknown, and only one case involving systemic acetazolamide has been reported in the literature. 134 However, it is worth noting that among the few generalized eruptions reported in association with anti-glaucoma eye drops, two cases of erythema multiforme 122,123 and two cases of toxic epidermal necrolysis 120,121 had dorzolamide eye drops in common. Although scarce, these data invite us to consider nonsystemic drugs in severe cutaneous adverse reactions.…”

Study of serum carbonic anhydrase activity, uric acid, C-reactive protein levels and lipid parameters in patients with Psoriasis

“…24 It is also seen that pustular psoriasis has been precipitated by acetazolamide, a CA inhibitor, when used for glaucoma in some psoriatics. 25 Recently it has been suggested that increased reactive oxygen species (ROS) production and deficient function of antioxidant systems activities may be involved in the pathogenesis of the disease. 26 The carbonic anhydrase enzyme has recently been reported to have an anti-oxidant activity, which is glutathione- Original Article NJDVL -21 mediated.…”