Carbamazepine induced exfoliative dermatitis

Samir V Shah, JN Dava, Vikas Aggrawal

 Department of Skin & VD, Bapunagar General Hospital, (ESI Scheme), C/o BJ Medical College, Ahmedabad, India

Correspondence Address:
Samir V Shah
Department of Skin & VD, Bapunagar General Hospital, (ESI Scheme), C/o BJ Medical College, Ahmedabad
India

To the editor,

Drug sensitivity is very known presentation in any skin OPD. One of these is generalised exfoliation of skin which is not so rare.[1] Some common drugs which can cause generalised exfoliation of skin are antiepileptics, antimalarials, heavy metals and certain antibacterials. In antiepileptic drugs, phenytoin, barbiturates and carbamazepine[2] are common. Carbamazepine can also cause erythematous, morbilliform, urlticarial or purpuric rashes, toxic epidermal necrolysis and photosensitivity commonly, while LE-like syndrome, dermatomyositis, and erythema multiforme are very rare[3].

A middle aged male patient attended the skin department, Bapunagar General Hospital, Ahmedabad. Before 2 months he had involuntary movements for which he was diagnosed as suffering from Idiopathic grand mal seizures. Since then he was given tab. carbamazepine 200mg. 3 times a day. At real time he was having chief complaints of severe and generalised itching, burning sensation with peeling of skin acute in origin since 20 days. Anorexia, nausea and loss of weight were other associated symptoms. No past history of any skin lesion was noted.

On examination, patient was having generalised peeling of skin with loosely attached scales, with erythema and dryness. Eczematization was also seen at some lesions. Hair, nails and mucosa were normal.

Patient was investigated thoroughly, Hb was 9.5 gm %, polymorphonuclear leucocytosis with raised ESR was there. Urine, LIFT, RFT, X-ray chest reporting were within normal limits. Histopathological examination findings were suggestive of erythroderma.

With the help of physician patient was switched over from carbamazepine to sodium valproate. As a part of skin treatment, patient was given only antihistaminic orally and emollient locally with other supportive therapy. Patient responded remarkably within 7 days after switching over from carbamazepine and supportive skin treatment. Challenge test with carbamazepine was performed later on to confirm cause.

Carbamazepine induced exfoliative dermatitis seems not that much common. It will be worthwhile if those who have come across a similar situation share their experiences.

1.	Vigtus Sigurdsson, et al. Erythroderma. J Am Acad Dermatol 1996;35:53-57. [Google Scholar]
2.	Chaudhary SD, et al. Carbamazepine induced exfoliative dermatitis. Indian J Dermatol Venereal Leprol 1990;56:326-327. [Google Scholar]
3.	Marfatia, et al. Letter to editor: Can carbamazepine (CAP) precipitate 'psoriatic erythroderma' (PE): Indian J Dermatol Venereal Leprol 1994;60:247. [Google Scholar]