Metoprolol rash
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Metoprolol-Induced Rash: A Review of Dermatological Reactions
Introduction to Metoprolol and Dermatological Reactions
Metoprolol, a commonly prescribed beta-blocker, is used to manage various cardiovascular conditions such as hypertension, angina, and arrhythmias. However, like many medications, it can cause adverse effects, including dermatological reactions. This article synthesizes research findings on metoprolol-induced rashes, focusing on lichenoid dermatitis and psoriasiform eruptions.
Metoprolol-Induced Lichenoid Dermatitis
Clinical Presentation and Diagnosis
Lichenoid dermatitis is a rare but documented side effect of metoprolol. A case study described a 74-year-old man who developed multiple pruritic, hyperpigmented, lichenoid plaques on his legs, thighs, and arms eight weeks after starting metoprolol. A skin biopsy confirmed lichenoid interface dermatitis, characterized by scattered eosinophils and incontinence of the dermis, leading to a diagnosis of lichenoid drug eruption (LDE).
Pathophysiology and Management
The pathophysiology of LDE involves the activation of cytotoxic CD8+ T cells by exogenous stimuli, resulting in epidermal damage. Upon discontinuation of metoprolol and initiation of topical steroids, the patient's rash resolved within four weeks. This case highlights the importance of recognizing the temporal relationship between drug initiation and rash appearance, as well as the effectiveness of discontinuing the offending agent and using topical treatments.
Metoprolol-Induced Psoriasiform Eruptions
Case Report and Symptoms
Another documented dermatological reaction to metoprolol is psoriasiform drug eruption. A 58-year-old hypertensive and diabetic woman developed itchy, thick, and scaly erythematous papules between her breasts one day after switching from propranolol to metoprolol succinate. The lesions resolved after discontinuing metoprolol and applying topical corticosteroids, indicating a drug-induced psoriasis.
Cross-Reactivity and Treatment
Interestingly, this patient did not experience cross-reactivity when other beta-blockers were prescribed, suggesting that while metoprolol can induce psoriasiform eruptions, not all beta-blockers will necessarily cause the same reaction in every patient. This underscores the need for individualized patient management and careful monitoring when switching medications within the same class.
Conclusion
Metoprolol, while effective for cardiovascular conditions, can cause rare but significant dermatological reactions such as lichenoid dermatitis and psoriasiform eruptions. These reactions typically resolve upon discontinuation of the drug and appropriate topical treatment. Clinicians should be vigilant in monitoring for these adverse effects and consider alternative beta-blockers if necessary. Understanding the potential for such reactions can lead to better patient outcomes and more informed therapeutic decisions.
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