Amlodipine-induced skin reactions
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Overview of Amlodipine-Induced Skin Reactions
Amlodipine, a commonly prescribed calcium channel blocker for hypertension, is generally well-tolerated but can rarely cause a range of skin reactions. These reactions vary in severity from mild rashes to life-threatening conditions. Although such adverse effects are uncommon, awareness is important for timely diagnosis and management 345678910.
Common and Mild Skin Reactions: Petechial Rash and Hyperpigmentation
Several cases have reported the development of a petechial, non-blanching macular rash on the lower limbs and feet after starting amlodipine. These rashes typically appear several months after initiation, are not associated with systemic symptoms, and resolve completely after discontinuing the drug. The Naranjo score in these cases indicated a probable adverse drug reaction. Early recognition and stopping amlodipine can prevent permanent skin staining 12.
Amlodipine has also been linked to cutaneous and oral hyperpigmentation, especially in photoexposed areas, developing gradually over time. This reaction is rare and not associated with other symptoms like pruritus or flushing .
Severe and Rare Skin Reactions: DRESS, Toxic Epidermal Necrolysis, and Linear IgA Disease
Though extremely rare, amlodipine can trigger severe skin reactions:
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DRESS Syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms): This is a serious hypersensitivity reaction characterized by a widespread rash, facial edema, fever, hypereosinophilia, and organ involvement. Discontinuation of amlodipine and corticosteroid therapy led to resolution in reported cases. DRESS is very rare with amlodipine but should be recognized due to its severity .
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Toxic Epidermal Necrolysis (TEN): Amlodipine has been implicated in a case of TEN, a life-threatening condition with widespread skin blistering and sloughing. The reaction developed within two weeks of starting amlodipine and required hospitalization. TEN is more commonly caused by antibiotics and antiepileptics, but calcium channel blockers like amlodipine can also be responsible .
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Linear IgA Disease: Amlodipine has been reported to induce linear IgA dermatosis, presenting as pruritic plaques and vesicles. Diagnosis is confirmed by skin biopsy and immunofluorescence. Discontinuation of amlodipine and treatment with steroids and dapsone resulted in prompt resolution .
Allergic and Delayed Hypersensitivity Reactions
Amlodipine can cause delayed allergic reactions, such as pruritic, erythematous maculopapular exanthema. In some cases, a positive lymphocyte transformation test (LTT) confirmed amlodipine as the cause and also showed cross-reactivity with another calcium channel blocker, nifedipine. LTT may be a useful diagnostic tool for such reactions 67.
Angioedema
Amlodipine-induced angioedema, characterized by rapid swelling of the skin and mucous membranes, has also been reported. This reaction can be severe, especially if it affects the airway, and requires prompt recognition and management to prevent complications .
Other Rare Skin Manifestations
Amlodipine has been associated with Schamberg’s disease, a rare pigmented purpuric dermatosis presenting as reddish-brown macules, especially on the lower extremities. This is a newly reported adverse reaction to amlodipine .
Conclusion
Amlodipine-induced skin reactions are rare but can range from mild rashes and hyperpigmentation to severe, potentially life-threatening conditions like DRESS syndrome and toxic epidermal necrolysis. Prompt recognition, discontinuation of the drug, and appropriate management are essential for patient safety. Clinicians should be aware of these possible adverse effects, especially in patients presenting with new or unexplained skin symptoms while on amlodipine therapy 12345678+2 MORE.
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