Lisinopril rash pictures
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Lisinopril-Induced Rash: Clinical Presentation and Insights
Introduction to Lisinopril and Rash
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is commonly prescribed for hypertension and heart failure. However, it has been associated with various dermatological side effects, including rashes and angioedema. Understanding the clinical presentation and underlying mechanisms of these reactions is crucial for effective management.
Clinical Presentation of Lisinopril-Induced Rash
Case Study: Annular and Follicular Lesions
A notable case involved a 38-year-old male who developed skin eruptions on his face and upper chest while on lisinopril therapy. The facial rash appeared as "juicy" annular or targetoid lesions with darker centers, while the upper trunk exhibited pinpoint follicular and slightly erythematous papules. These lesions were moderately itchy and persisted for eight days without systemic symptoms or mucosal involvement.
Histopathological Findings
Biopsies from the affected areas revealed neutrophilic infiltrates in the sebaceous glands, a condition known as neutrophilic sebaceous adenitis (NSA). This rare condition has been reported in a limited number of cases, predominantly affecting Caucasian males. The histopathology of NSA is distinct, characterized by neutrophilic collections in the sebaceous glands, differentiating it from other conditions like lupus erythematosus tumidus and rosacea.
Mechanisms of Inflammatory Reactions
Experimental Insights from Animal Studies
In a study involving guinea pigs, continuous infusion of lisinopril into the peritoneal cavity of ovalbumin-sensitized animals induced significant intradermal inflammation. The inflammatory responses were measured by the area of rash, providing an index of the inflammatory reaction triggered by lisinopril. This suggests that lisinopril can provoke inflammatory skin reactions, potentially through immune-mediated mechanisms.
Conclusion
Lisinopril-induced rashes can present in various forms, including annular and follicular lesions, and may involve neutrophilic infiltrates in the sebaceous glands. While the exact etiology remains unclear, both clinical observations and experimental studies indicate a significant inflammatory component. Clinicians should be aware of these potential side effects and consider alternative treatments if patients develop such reactions.
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