Skin Reactions Due to Antiepileptic Drugs: Several Case-Reports with Long-Term Follow-up

Abstract

In this study, the clinical findings and management of allergic skin reactions induced by the most used antiepileptic drugs, Lamotrigine (LMT) and Carbamazepine (CBZ), were evaluated. Lamotrigine is an antiepileptic drug recently released in several countries; it is effective for a variety of seizure types in adults and children, both as an add-on agent and in monotherapy, and it is generally well tolerated. Clinical and epidemiologic evidence suggest serious cutaneous reactions to antiepileptic drugs are more likely to occur during the first 8 weeks and they appear to increase when drugs are administered with other anticonvulsants, such as Valproate (VPA). We selected 10 patients who presented an idiosyncratic skin rash when treated with carbamazepine (8 patients) and lamotrigine (2 patients) administered as monotherapy, and we followed up on these patients for several years. Seven reactions were mild/severe cutaneous eruptions; one Toxic Epidermal Necrolysis, a case of Stevens-Johnson and a case of Hypersensitivity Syndrome. All severe skin drug reactions were induced by Carbamazepine. In five patients the AEDs were ceased abruptly (sometimes with the administration of a different molecule), tapered in four and continued unchanged in one. We conclude that the discontinuation of the drug with substitution with another is the most effective treatment and that corticosteroids are helpful in mild cutaneous reactions, while in severe skin reactions, such as Toxic Epidermal Necrolysis, corticosteroids are only a complementary therapy since intravenous immunoglobulins are the first choice treatment.

Expression of the High-Affinity Laminin Receptor (67 kDa) in Normal Human Skin and Appendages

“…In the cardiovascular system this receptor is present on both adherent cardiovascular system cells and on circulating inflammatory cells (39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53) . It is involved in balancing degradation processes initiated by inflammatory cells and in the response of adherent cells to alterations in surrounding extra cellular matrix.…”

Toxic epidermal necrolysis due to lamotrigine in a pediatric patient

“…[11] They appear to increase when it is co-administered with valproate. [12] The patient was taking sodium valproate along with lamotrigine. Lamotrigine is metabolized by uridine glucuronyl transferase (UGT).…”

Carbamazepine-Induced Stevens-Johnson Syndrome Sparing the Skin Previously Affected by Herpes Zoster Infection in a Patient with Systemic Lupus Erythematosus: A Reverse Isotopic Phenomenon

“…CBZ is widely used in the treatment of postherpetic neuralgia along with NSAID, opioid analgesics, local anesthetics and antiviral therapy [8]. Skin reactions induced by CBZ are usually mild, reversible and dose related [8, 9]. Severe idiosyncratic drug reactions can also occur [9].…”

“…Skin reactions induced by CBZ are usually mild, reversible and dose related [8, 9]. Severe idiosyncratic drug reactions can also occur [9]. They are more likely to occur during the first 8 weeks of the treatment, when the starting dose is high or when CBZ is administered with other anticonvulsants [9].…”

“…Severe idiosyncratic drug reactions can also occur [9]. They are more likely to occur during the first 8 weeks of the treatment, when the starting dose is high or when CBZ is administered with other anticonvulsants [9]. In the case presented herein, SJS developed after 11 days of taking CBZ.…”