A Case Report of Photosensitivity to Amisulpride

Abstract

Sir: Amisulpride is a second-generation antipsychotic approved as monotherapy for treatment of refractory schizophrenia.1 It acts with a unique pharmacologic profile that has preferential affinity for D2/D3 receptors and specificity for limbic rather than striatal structures. Very few side effects of amisulpride therapy, and none with a dermatologic nature, have been reported.2 We hereby report the following case of photosensitivity to amisulpride in a patient with chronic schizophrenia. Case report. Ms. A is a 38-year-old white woman with a 15-year history of paranoid schizophrenia (DSM-IV3). During her previous hospitalization for an acute exacerbation of her mental disorder with bizarre paranoid delusions and auditory hallucinations, she was treated with clozapine 300 mg/day for 2 months, but this medication was discontinued in June 2005 because of a weight gain, strong sedation, and persistence of auditory hallucinations. After clozapine treatment was stopped, Ms. A was treated with amisulpride. Six days after the initiation of this therapy at a dose of 400 mg/day, she experienced a photosensitivity dermatitis, as evidenced by erythema over exposed areas of the body (face, hands, posterior aspect of the neck); covered skin was spared. Ms. A denied the recent use of new soaps, new creams, or different foods and also denied more exposure to sunlight than usual. With the exception of this dermatitis, the patient tolerated amisulpride well and had a good clinical response, i.e., decrease in auditory hallucinations. A dermatologic consultation confirmed the diagnosis of a photoallergic reaction. A medical history and physical examination revealed no somatic disorder. Results of a blood test were normal (no inflammatory or auto-immune factors were detected), and there was no remaining clozapine in the patient's system. No other prescribed medications were changed during the 2 weeks of amisulpride treatment. Amisulpride treatment was interrupted, and Ms. A was instructed to apply sunscreen to the affected areas 3 times daily. The degree of erythema diminished over the next 10 days. Dermatitis continued to remain quiescent with the daily application of sunscreen. The patient reported that she was prescribed amisulpride 4 years ago, during a previous hospitalization, with the same side effect, and the treatment was stopped 2 weeks after introduction. This is the first reported case of photosensitivity to amisul-pride. While other neuroleptics are well known to cause photosensitivity,4 there is no report of a dermatologic side effect with amisulpride. Those individuals who are known to be photosensitive and are started on a regimen of amisulpride should be monitored carefully to minimize their unprotected exposure to the sun. Further studies are needed to understand the precise mechanisms involved. This research is particularly important because atypical antipsychotics are now commonly prescribed over conventional neuroleptics.