Macronodular iatrogenic acne due to amineptine

ARTICLE

A 42-year-old Caucasian woman came to our Department because of the rapid onset of multiple nodules on her face. The patient stated that the lesions started one year previously and rapidly grew to their present size. Her past medical history was significant for several episodes of renal calculi, hypertension, type II diabetes mellitus, arthrosis and depression. She was following a medical treatment quite anarchically based on: diclofenac, atenolol, hydrochlorothiazide, melitracen hydrochloride-flupenthixol dihydrochloride (Deanxit^®), amineptine, lorazepam, glibenclamide and metformin.

Clinical examination revealed the presence of multiple nodular lesions on her face (Fig. 1) that deformed her anatomy in some areas (Fig. 2). A closer examination revealed also the presence of comedones, non-inflammatory papules, cystic lesions and confluent masses.

Macronodular iatrogenic acne due to amineptine

In this case, a biopsy was unnecessary since the clinical examination and a detailed history lead us to a diagnosis. The patient admitted that she was taking amineptine at will, varying from 2 to 5 pills a day. We wrote a letter to her psychiatrist suggesting that amineptine be stopped, and started the patient on oral isotretinoin (1 mg/kg).

Discussion

The first acneiform reaction to amineptine (Survector^®) was seen in our department in 1989 [1]. Several other cases have been published [2-11].

Cutaneous adverse reactions to antidepressant drugs are rare and include: phototoxicity (imipramine and proptriptyline), urticaria-like rashes, hyperhidrosis, and Lyell syndrome (amoxapine). One case of acne due to maprotiline has been also described [12].

The acneic reaction to amineptine can appear in depressed patients who take therapeutic doses ranging from 2 to 4 pills a day. This tricyclic antidepressant drug is extremely effective because of its rapid euphoric (amphetamine-like) effect, leading in some cases to addiction. The intensity of the disease seems to correlate with the dose. Most patients develop acne 6 to 18 months after starting amineptine.

As in other cases of iatrogenic acne, amineptine acne typically appears late in life and may regress when the treatment is discontinued. The main characteristics of the lesions are that they are exclusively comedonic and cystic with a total absence of inflammation. The treatment suggested in the literature is oral isotretinoin but surgical excision of larger lesions may be the treatment of choice.

REFERENCES

1. Martin-Ortega E, Zamora E, Herrero C, Palou J. Acneiform eruption induced by amineptine. Med Cutan Ibero Lat Am 1989; 17: 414-6.

2. Thioly-Bensoussan D, Edelson Y, Cardinne A, Grupper Ch. Acné monstrueuse provoquée par le Survector. Nouv Dermatol 1987; 6: 536-7.

3. Thioly-Bensoussan D, Charpentier A, Triller R, et al. Acné iatrogène à l'amineptine. A propos de 8 cas. Ann Dermatol Venereol 1988; 115: 1177-80.

4. Grupper CH. Une nouvelle acné iatrogène: l'acné à l'amineptine. Ann Dermatol Venereol 1988; 115: 1174-6.

5. Vexiau P, Gourmel B, Husson C, et al. Lésions sévères de type acnéique indutes par une intoxication chronique à l'amineptine. A propos de 6 cas. Ann Dermatol Venereol 1988; 115: 1180-2.

6. Teilla D, Weber MJ, Lowenstein W, de Prost Y. Acné au Survector. Ann Dermatol Venereol 1988; 115: 1183-4.

7. Lévigne V, Faixant M, Mourier C, et al. Acné monstrueuse de l'adulte rôle inducteur du survector? Ann Dermatol Venereol 1988; 115: 1184-5.

8. Jeanmougin M, Civatte J, Cavelier-Balloy B. Toxicodermie rosacéiforme à l'amineptine. Ann Dermatol Venereol 1988; 115: 1185-6.

9. Vexiau P, Gourmel B, Castot A, et al. Severe acne due to chronic amineptine overdose. Arch Dermatol Res 1990; 282: 103-7.

10. Vexiau P, Gourmel B, Julien R, et al. Severe acne-like lesions caused by amineptine overdose. Lancet 1988; 12: 1: 585.

11. Farella V, Sberna F, Knopfel B, Urso C, Difonzo EM. Acne-like eruption caused by amineptine. Int J Dermatol 1996; 35: 892-3.

12. Ponte CD. Maproptiline-induced acne. Am J Psychiatry 1982; 139: 141.