Concurrence of Palmoplantar Psoriasiform Eruptions and Hair Loss during Carbamazepine Treatment

Abstract

The anti-convulsant drug carbamazepine may induce ge-neralized exanthema or, less frequently, severe cutaneous eruptions, such as hypersensitivity syndrome or toxic epidermal necrolysis. The development of psoriasiform eruptions and the exacerbation of pre-existing psoriasis have been recognized as common adverse reactions to beta-blockers, lithium and antimalarials (1). Additional causative drugs include angiotensin converting enzyme inhibitor, indomethacin, progesterone, and lipid-lowering drugs, such as gemfibrozil (2). Drug-induced alopecia presents as a diffuse, non-scarring loss of hair that is often reversible upon discontinuation of the drug. The drugs as-sociated with telogen effluvium include beta-blockers (3), angiotensin converting enzyme, oral contraceptives, anti-thyroid medications, anticoagulants and anticonvulsant (4). We report here a case of a 52-year-old woman who experienced diffuse hair loss and a palmoplantar psoria-siform eruption apparently due to carbamazepine.CASE REPORTA 52-year-old woman was referred to our dermatology clinic because of diffuse hair loss and psoriasiform er-uptions on her hands and feet. She had no past or family history of psoriasis, alopecia, or other skin disorders. There was no evidence of dermatitis, allergic reaction, or other causes for hair loss and psoriasiform eruption. She was diagnosed with an acoustic schwannoma 2 months previously and had been taking carbamaze-pine (200 mg, 3 times/day) for 3 months due to severe facial pain. The psoriasiform eruptions on her palms and soles started one month after administration of carbamazepine, and remarkable hair loss occurred one month after the appearance of the eruptions. Physical examination showed thick hyperkeratotic plaques on the palmoplantar areas and diffuse hair loss on the scalp (Fig. 1). A hair-pull test demonstrated that hairs could be extracted easily. Since carbamazepine was suspected as one of the inciting agents, the dosage of carbamazepine was reduced to 200 mg once/day. The psoriasiform eruptions began to improve one week after tapering the drug without any treatment. The pal-moplantar lesions also improved (Fig. 2) and the hair loss began to stop 4 weeks after decreasing the dose. Two months later, she underwent surgical operation for the acoustic schwannoma. The eruptions cleared completely and spontaneous hair regrowth was shown after discontinuing medication.DISCUSSIONA causative relationship between a drug and associated adverse reactions is based primarily on experience and observation. The following three factors are important in supporting the diagnosis of a drug reaction: first, the adverse reaction occurs after drug administration; secondly, as long as the patient continues to take the drug, the adverse reaction resists conventional treat-