Received: 14 August 2020 Revised: 11 December 2020 Accepted: 30 December 2020
DOI: 10.1111/dth.14775
LETTER
Amlodipine-induced generalized fixed drug eruption clinically
mimicking mycosis fungoides
Dear Editor,
Fixed drug eruption (FDE) is an adverse drug reaction characterized
by the development of well circumscribed, round, dusky erythematous
macules and plaques on cutaneous and mucosal surfaces.1 Drugs
which most commonly cause FDE include sulfonamides, tetracyclines,
dapsone, ampicillin, acetaminophen, aspirin, other NSAIDs, pseudo-
ephedrine, anticonvulsants and oral contraceptives.2
Amlodipine is a dihydropyridine-derived selective calcium-
channel blocker that inhibits the transmembrane influx of calcium ions
into cardiac and vascular smooth muscle. Its direct and selective
action on arteriolar smooth muscles leads to a reduction in peripheral
vascular resistance and reduction in blood pressure3. Both allergic and
non-allergic adverse drug reactions (ADRs) have been reported, such
as flushing, gingival hyperplasia, gynaecomastia and also cutaneous
ADRs.4,5 Serious adverse events such as anaphylaxis, Steven-Johnson
syndrome (SJS), and toxic epidermal necrolysis (TEN)
F I G U R E 1 Sharp limited, brown-erythematous plaques ranging in
diameter from 2 to 10 cm on trunk
Dermatologic Therapy. 2021;34:e14775. wileyonlinelibrary.com/journal/dth
https://doi.org/10.1111/dth.14775
occasionally been reported.6 Here in, we report a case of generalized
fixed drug eruption due to amlodipine clinically mimicking mycosis
fungoides.
A 73-year-old male patient presented with red-brown rash on
trunk and legs for 8 months. On dermatologic examination, there
were sharp limited, brown-erythematous plaques ranging in diameter
from 2 to 10 cm (Figure 1). He was taking amlodipine for 9 months
for hypertension. On physical examination, there was no cervical
lymphadenopathy or hepatomegaly. Laboratory test results revealed
no peripheral blood eosinophilia, normal renal and liver enzymes. He
had an aortic aneurysm operation. A punch biopsy was taken from the
plaque in the abdomen. In the differential diagnosis, mycosis
fungoides, parapsoriasis and drug eruption were considered.
Histopathologic examination revealed; orthokeratosis on surface,
focal parakeratosis on epidermis, diffuse basal cell vacuolization and
have rare single cell keratinization (Figures 2 and 3). Perivascular edema
and lymphohistiocytic infiltration were observed in dermis. Immuno-
histochemical staining was positive for CD3-CD4-CD8 and CD68.
Histopathological findings showed features of lichenoid dermatitis.
The patient was diagnosed with drug eruption with clinical and histo-
pathological findings. Amlodipine, which suspicious drug, was changed
to another antihypertensive drug by Cardiology Department. Topical
clobetasol propionate was started twice daily. The lesions were
completely regressed after 2 months.
F I G U R E 2 Focal parakeratosis, basal vacuolization in the
epidermis and lymphohistiocytic infiltrate in the superficial
dermis. (HE ×40)
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F I G U R E 3 Focal parakeratosis, basal vacuolization in the
epidermis and lymphohistiocytic infiltrate in the superficial dermis.
(HE ×100)
Drug eruptions can mimic many dermatological diseases. In such
cases, histopathology and drug history are helpful in differential diag-
nosis. The lichenoid tissue reaction is characterized by epidermal basal
cell damage that is associated with a band-like infiltrate of mononu-
clear cells in the papillar dermis.7 Cases of MF in which prior biopsy
specimens had been diagnosed as “lichenoid dermatitis” have been
reported. In the presence of a lichenoid pattern, histopathologic clues
helpful in identifying MF are basal epidermotropism, nuclear atypia,
and, frequently eosinophils and plasma cells in the dermal infiltrate.8
Previous studies of ADRs associated with antihypertensive drugs
have shown that CCBs were the most common cause of ADRs,
followed by diuretics and β-blockers. These reactions are generally
not serious and regress with discontinuation of the drug. It is impor-
tant to keep in mind that some patients may develop serious skin
reactions from CCBs.6
We present a case of generalized fixed drug eruption induced by
an anti-hypertensive drug amlodipine which is a selective calcium-
channel blocker. Although FDE usually occurs as a single lesion, it
should be kept in mind that in rare cases, it may occur as multiple
lesions in generalized form. The drug history should be questioned. To
the best of our knowledge, this is the first report of generalized fixed
drug eruption due to amlodipine in the literature. It should be consid-
ered that drug eruptions may mimic many dermatological diseases.
LETTER
CONFLIC T OF INT ER E ST
The authors declare no conflicts of interest.
DATA AVAILABILITY STAT EMEN T
The data that support the findings of this study are available from the
corresponding author upon reasonable request.
Tubanur Çetinarslan1
Aylin Türel Ermertcan2
Peyker Temiz3
1
Department of Dermatology, Manisa City Hospital, Manisa, Turkey
2
Department of Dermatology, Manisa Celal Bayar University, Faculty of
Medicine, Manisa, Turkey
3
Department of Pathology, Manisa, Turkey
Correspondence
Dr. Tubanur Çetinarslan, Department of Dermatology, Manisa City
Hospital, Uncubozkoy Mah. 5501 Sok. 29/5 Manisa, Turkey.
Email: t_sarmis@windowslive.com
OR CID
Tubanur Çetinarslan https://orcid.org/0000-0002-2847-9127
Aylin Türel Ermertcan https://orcid.org/0000-0001-7720-5491
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