Sulfhydryl Drug‐induced Eruption: A Clinical and Histological Study

Abstract

Sulfhydryl drug-induced skin eruptions were studied clinically and histologically in 23 patients. In this study, tiopronin, D-penicillamine, captopril and gold sodium thiomalate were considered to be sulfhydryl drugs, because they have a thiol group or release sulfhydryl compounds. The clinical features included skin eruptions that were maculopapular, erythema multiforme-like, eczematous, psoriasis-like, seborrheic dermatitis-like, Gibert-like, lichen planus-like, and pemphigus-like. These clinical findings were reminiscent of the wide variety of eruptions seen in cutaneous graft-versus-host reactions (GVHR). Histologically, areas of vacuolation and eosinophilic necrosis with a satellite infiltrate of lymphoid cells were seen in the epidermis, and perivascular infiltrates were noted in the dermis. These findings were similar to the histological picture of cutaneous GVHR. In skin tests with sulfhydryl compounds, 19 out of 20 subjects showed positive reactions, and autoantibodies were found in 8 out of 12 subjects tested. Sulfhydryl drugs seem likely to induce immunologic changes in the host and to produce a distinctive reaction similar to that of cutaneous GVHR.

Preparation and Characterization of Cerium (III) Doped Captopril Nanoparticles and Study of their Photoluminescence Properties

“…Captopril is also the only drug that includes sulfhydryl group. Its chemical formula is following: 1-[(2S)-3-mercapto-2-methylpropionyl]-L proline [6,7].…”

Erythema multiforme-like Eruption in Association with Severe Headache following Pyritinol

“…44 Nachbar/Korting/Vogl Erythema multiforme following Pyritinol As pointed out by Kitamura et al [5], numerous cuta neous eruptions may be caused by thiol drugs such as eczematous, psoriasis-like, lichen planus-like, erythema multiforme-like and pemphigus-like lesions. Two cases of erythema multiforme-like eruption after use of thiopronine and 1 case after application of captopril arc reported in the study of Kitamura et al [5]. To our knowledge, pyritinol has been mentioned as cause of erythema multiforme-like eruptions only in 2 cases so far.…”

“…However, neither histologic nor immunologic findings nor the clinical feature following the initial phase of the disease could confirm this differential diagnosis. The case pre sented here corresponds to erythema multiforme-like skin eruptions induced by other sulfhydryl-containing drugs [5] and possibly also to other well documented pyritinolinduced b u llo u s dermatoses [6][7][8]. 44 Nachbar/Korting/Vogl Erythema multiforme following Pyritinol As pointed out by Kitamura et al [5], numerous cuta neous eruptions may be caused by thiol drugs such as eczematous, psoriasis-like, lichen planus-like, erythema multiforme-like and pemphigus-like lesions.…”

“…The case pre sented here corresponds to erythema multiforme-like skin eruptions induced by other sulfhydryl-containing drugs [5] and possibly also to other well documented pyritinolinduced b u llo u s dermatoses [6][7][8]. 44 Nachbar/Korting/Vogl Erythema multiforme following Pyritinol As pointed out by Kitamura et al [5], numerous cuta neous eruptions may be caused by thiol drugs such as eczematous, psoriasis-like, lichen planus-like, erythema multiforme-like and pemphigus-like lesions. Two cases of erythema multiforme-like eruption after use of thiopronine and 1 case after application of captopril arc reported in the study of Kitamura et al [5].…”

“…Several hypotheses are under discus sion. Most investigators propose that the free sulfhydryl (SH-) group in thiol drugs contributes to the induction of skin lesions [4,5,[7][8][9][10][11]. Sulfur-containing groups may be responsible for drug attachment in the epidermis where many free sulfhydryl and cross-linked sulfur groups can be found [12,13].…”