Severe Psoriasis Palmaris et Plantaris Associated with Topical Use of Dorzolamide

Abstract

Dorzolamide is a carbonic anhydrase inhibitor. 1. Case Report Carbonic anhydrase is an enzyme found in many tissues of the body, including the eye. It catalyses An 80-year-old male, generally healthy except the reversible reaction involving the hydration of for glaucoma, was admitted to the dermatology decarbon dioxide and the dehydration of carbonic acid. partment of the Staten Island University Hospital as In humans, carbonic anhydrase exists as a number of a result of developing severe psoriasis palmaris et isoenzymes, the most active of which is carbonic plantaris for the first time in his life. The psoriatic anhydrase II. Dorzolamide, used as an antiglaucoma plaques started to appear about 2 months after the agent, inhibits human carbonic anhydrase II.[1,2] patient was started on dorzolamide drops Inhibition of carbonic anhydrase in the ciliary (Trusopt®,1 Merck & Co. Westpoint, PA, USA) for processes of the eye decreases aqueous humour sehis glaucoma. He said he did not have hypertension, cretion,[1,3] presumably by slowing the formation of ischaemic heart disease, diabetes mellitus or any bicarbonate ions, with subsequent reduction in sodiother chronic illness, including any drug allergy. He um and fluid transport. The result is a reduction in was not taking any medication except dorzolamide intraocular pressure. drops, and did not smoke. Dorzolamide is a more potent drug from the same His physical examination revealed diffuse group as acetazolamide, a well known carbonic ansubungual hyperkeratosis with pitting and erythemhydrase inhibitor given per os. Dorzolamide is abatous psoriatic plaques scattered over both his sorbed systemically when applied to the eye. In a palms, his soles and both feet with bilateral calcanestudy designed to simulate systemic absorption al hyperkeratosis. The psoriatic plaques are illustratduring long-term ophthalmic administration, steady ed in figure 1 and figure 2. state was reached within 8 weeks.[1] Vital signs were: systolic/diastolic blood presAcetazolamide, an older generation carbonic ansure 150/75mm Hg, respiratory rate 16 breaths/min, hydrase inhibitor given systemically, is known to heart rate 74 beats/min; regular heart sounds without precipitate psoriasis, as has been confirmed by murmurs; vesicular breathing sounds, good air enrechallenge tests.[4] trance over both lungs without wheezes or crackles;