Dermatologic adverse reactions to proton‐pump inhibitors: A synthetized review

Abstract

Background Proton‐pump inhibitors (PPIs) are one of the most prescribed drugs. Their dermatological adverse reactions are multiple and vary in severity. Aims This review discusses all reported cutaneous side effects of PPIs in order to help physicians understand them and provide appropriate management. Methods A thorough search of PubMed, Embase, and FDAAQ8 drugs websites was conducted. 56 articles including case reports, case series, and review articles of PPI‐induced cutaneous adverse reactions were selected. Data were recorded regarding patient age, gender, history, clinical manifestations, diagnostic tests, management, and clinical outcomes. Results PPI‐induced adverse skin reactions are mostly immunological and include both immediate and delayed‐type hypersensitivity reactions. These reactions are sometimes life‐threatening. All PPIs can induce immediate IgE‐mediated reactions. Most of previously published cases of delayed‐type hypersensitivity reactions have involved esomeprazole, omeprazole, and lansoprazole. Skin tests are helpful in confirming PPI‐induced hypersensitivity reactions and diagnosing potential cross‐reactivities. PPIs should also be added to our list of usual suspects when considering possible culprits for a new presentation of drug‐induced subacute lupus erythematosus. PPI‐related occupational contact dermatitis has also been numerously reported. Conclusion PPIs should be considered in our list of culprits when considering a patient with a cutaneous drug reaction, taking into account that these drugs can cause severe immunological manifestations.

Persistent cutaneous lesion in a child with tyrosinemia: Esomeprazole‐induced lichenoid drug eruptions

“…Changes in Benzoimidazole ring on PPIs are believed to be the mechanism for hypersensitivity reactions associated with PPIs. 2 , 6 …”

“…Changes in Benzoimidazole ring on PPIs are believed to be the mechanism for hypersensitivity reactions associated with PPIs. 2,6 LDEs mostly affect elderly population and can have a latent period of weeks to a year depending on the previous exposure to the offending medication, its type and dosage. 7 There are limited reports of PPI-induced LDEs in literature.…”

“…Although omeprazole and esomeprazole are different drugs, they share similarities in their clinical effects and subsequently adverse effects so there is a potential of cross reactivity between different components of family of PPIs. 2 It is important that clinicians be aware of adverse cutaneous manifestations of esomeprazole to provide proper diagnosis and treatment.…”

Proton pump inhibitor–induced vitiligo following airborne occupational sensitization

“…Chemical‐induced depigmentation is referred to as “chemical‐induced vitiligo” as a major subset of the vitiligo spectrum rather than “chemical leukoderma.” 3 Depigmentation from chemicals may be associated with an initial instance of allergic contact dermatitis and appears to be due to the activation of melanocyte‐specific autoimmunity, as also seen in non–chemically‐induced vitiligo 3 . Pantoprazole and rabeprazole, which are members of a highly sensitizing group of chemicals, may cause an airborne pattern of contact dermatitis 1,4 . This inflammation can subsequently lead to the Koebner phenomenon, which can result in the occurrence of vitiligo in people with genetic susceptibility.…”

“…The literature reports that proton‐pump‐inhibitor (PPI)–induced adverse skin reactions are mostly instances of immunological and PPI‐related occupational contact dermatitis after direct contact or airborne exposure 1 . Although there are few cases of vitiligo after the ingestion of oral PPIs, 2 vitiligo after airborne PPI exposure has yet to be reported.…”