BMJ 2000;320:283 ( 29 January )

Papers

Drug points

Lichenoid drug eruption with proton pump inhibitors

J L Bong,  T W Lucke,  W S Douglas. 

Department of Dermatology, Monklands Hospital, Airdrie ML6 OJS

We report a patient who developed a recurrent lichenoid eruption after treatment with omeprazole, lansoprazole, and pantoprazole.

An 81 year old man presented with a three month history of a widespread pruritic rash. He suffered from oesophagitis and had been taking omeprazole 20 mg/day for nine months. Examination revealed an annular scaly erythematous rash on the dorsal aspects of his forearms and, to a lesser extent, on his trunk and thighs (figure). A clinical diagnosis of adverse drug eruption was made and omeprazole stopped. The rash cleared in a month, but his dyspepsia recurred and he was prescribed lansoprazole 30 mg/day. Three weeks later, the eruption recurred, and a skin biopsy showed features of a lichenoid drug reaction. Lansoprazole was stopped, and the rash resolved. He suffered a second recurrence several months later after inadvertent challenge with pantoprazole 40 mg daily.



View larger version (95K):
[in this window]
[in a new window]
  		Lichenoid eruption in reaction to proton pump inhibitors

The most common adverse effects of omeprazole are diarrhoea, headache, and rashes, of which urticaria and toxic erythema are the most common. 1 2 Premarketing trials on lansoprazole showed a similar adverse reaction profile to omeprazole.3 The Committee on Safety of Medicines has received one report of lichen planus associated with omeprazole and two reports associated with lansoprazole but no reports associated with pantoprazole (personal communication). The identical lichenoid eruption induced by all three proton pump inhibitors suggests a "class effect, possibly" related to their similar substituted benzimidazole structure.

References
1. Committee on Safety of Medicines. Diarrhoea, skin rash and headache following omeprazole therapy. Curr Probl 1991;31.
2. GISED. Cutaneous reaction to alimentary tract medications. Dermatology 1996; 193: 11-16[Medline].
3. Colin-Jones DG. Safety of lanzoprazole. Aliment Pharmacol Ther 1993; 7(suppl 1): 56-60.

© BMJ 2000
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Severino, G., Chillotti, C., De Lisa, R., Del Zompo, M., Ardau, R. (2005). Adverse Reactions During Imatinib and Lansoprazole Treatment in Gastrointestinal Stromal Tumors. The Annals of Pharmacotherapy 39: 162-164 [Abstract] [Full text]  

Rapid Responses:

Read all Rapid Responses

Making the same mistake twice
Tom Oommen
bmj.com, 31 Jan 2000 [Full text]
Understated Dangers of Omeprazole
Cory Mermer
bmj.com, 25 Feb 2000 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ