Linear drug eruption

European Journal of Dermatology. Volume 11, Number 2, 122-3, March - April 2001, Cas cliniques

Author(s) : Remedios ALFONSO, Isabel BELINCHON, Department of Dermatology, Hospital G. Elda, Ctra, Elda-Sax s/n, 03600 Elda, Alicante, Spain..

Summary : Linear eruptions are sometimes associated with systemic diseases and they may also be induced by various drugs. Paradoxically, such acquired inflammatory skin diseases tend to follow the system of Blaschko's lines. We describe a case of unilateral linear drug eruption caused by ibuprofen, which later became bilateral and generalized.

Keywords : Blaschko lines, drug reactions, ibuprofen, linear eruption.

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ARTICLE

Several cutaneous disorders can have a linear distribution corresponding to Blaschko's lines. We describe here a case of linear drug eruption induced by ibuprofen, following the Blaschko embryological lines, with an unusual course.

Case report

A 19-year-old Caucasian woman was referred with a pruriginous linear eruption on her right arm and trunk of 5 days duration. The first physical examination disclosed a pruritic, linear, whorled, erythematosus, papular eruption on the right side of her trunk, back and arm, from the shoulder downward along the inner aspect of the flexural surface of the arm to the hand, affecting the second and fifth fingers (Figs. 1 and 2). After five days the lesions became generalized (Fig. 3). Histopathological examination was not performed, because the patient did not give permission. No systemic abnormalities were found on physical and routine laboratory examination. She had received oral ibuprofen (400 mg every 12 hrs) during the previous four days, for dismenorrhea. She had a history of ibuprofen intake every month during the last year.

After withdrawal of ibuprofen and treatment with dexametasone (0.2 mg every 8 hrs) and clemastine (1 mg every 12 hrs) for fifteen days in tapering dosages, the lesions cleared without residual hyperpigmentation.

Six weeks later, topical provocation tests were performed. Tape-stripping occlusive patch testing with ibuprofen without dilution in white petrolatum, with pure petrolatum as negative control, gave no reaction on previously affected skin.

Discussion

Several cutaneous disorders can have a linear distribution, such as lichen planus, lichen striatus, epidermal nevi including inflammatory linear verrucous epidermal nevus, and incontinentia pigmenti [1]. In these disorders the distribution of the lesions corresponds to Blaschko's lines, suggesting that a postzygotic mutation is related to this phenomenon [1, 2]. However, on the extremities, linear inflammatory skin diseases run in a perpendicular pattern. Reviewing the literature, we found some reports of linear dermatosis related to drugs as linear fixed drug eruption caused by trimethoprim [3] and cephazolin [4], or related with chronic cutaneous graft-versus-host disease [5] and a case of lichen planus induced by nicergoline [6], but without generalization of the eruption. Our patient initially disclosed a linear eruption following Blaschko's lines but, after several days, the lesions became generalized, related to the ibuprofen treatment. The linearity seen in our patient did not occur in dermatomes previously affected by herpes zoster or other dermatosis. Grosshans et al. [7] proposed the term blaschkitis for those acquired lesions that follow Blaschko's lines and suggested that the linear distribution might be explained by cellular mosaicism. During fetal life, a mutation may have caused a clone of cells with a different histocompatibility antigen to populate a specific area of skin. An immunological tolerance to aberrant cellular clones may exist, but several factors may induce a specific cellular clone to acquire different features, such as a membrane antigen that would induce the immune response causing the dermatosis [7, 8]. To the best of our knowledge, this report represents the first case of linear drug eruption that later evolved in a disseminated rash.

REFERENCES

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