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• W1888794770 abstract "Pigmented purpuric dermatoses (PPD) are described as a group of skin diseases of various aetiology. They share similar clinical patterns manifested by skin changes, but there are some differences in their appearance. The skin lesions tend to be chronic and more persistent in persons with Schamberg’s disease. Schamberg’s disease is a rare dermatosis characterized by progressive, non-palpable pigmentary changes. Typically the lesions occurs as patches and ‘cayenne pepper puncta’ with pigmentation as a prominent feature. The lesions do not exceed 3 cm in diameter and manifest themselves as reddish-brown macules. They are located especially on the lower extremities and have a vasculitic appearance, although this skin disorder is not associated with haematologic disease. Schamberg’s disease is asymptomatic, may occur at any age and males are more often affected. These skin symptoms are caused by erythrocytes breaking down outside the capillary with haemosiderin deposits 1-4. Although drug-induced Schamberg's disease has been reported on a few occasions until now 4, to the best of our knowledge there are no reports about such a reaction caused by amlodipine administration. We present a case of a 31 year-old male, who required pharmacological treatment for stage 1 hypertension. The patient was initially treated with lisinopril 20 mg once daily for 5 weeks but his blood pressure was still elevated (greater than or equal to 140/78 mmHg). He received amlodipine 10 mg once daily in combination therapy with lisinopril 20 mg daily. After 3 months of treatment with antihypertensive drugs his blood pressure was lowered (131/66 mmHg). Although the treatment was effective, purpuric skin eruptions around the ankle region accompanied by ankle oedema were observed. The oedema subsided after a few days. The skin lesions progressively worsened and after the next 2 months asymptomatic, Schamberg's like irregularly distributed rust-coloured spots were located on the outer side of the tibia from the ankles to the knees (Figure 1). There were no significant changes in complete blood count, ESR, prothrombin and partial prothrombin time and there were no systemic symptoms. The amlodipine treatment was discontinued. The patient received lisinopril 20 mg daily for the next 3 months and the changes in the skin were still visible, but became brown and the intensity was slightly reduced. After the next 4 months of observation his lesions completely disappeared. As there were no reports in the medical literature about amlodipine induced Schamberg's disease, 6 months after withdrawal of lisinopril the patient started taking amlodipine again. Subsequently symptoms of the adverse skin reaction re-appeared after 1 month. To confirm our diagnosis, a biopsy of the skin was performed by a specialist in dermatology and pathomorphology. The investigation showed a perivascular inflammatory T-cell lymphocytic infiltrate and extravasation of blood cells. As previously, there were no significant changes in: complete blood count, ESR, prothrombin, partial prothrombin time or any systemic symptoms. Taking into account clinical symptoms and biopsy findings Schamberg's disease induced by amlodipine was diagnosed. Base on causality assessment performed using the Naranjo Adverse Drug Reaction Probability Scale it was concluded that the adverse event was related to amlodipine administration (the total score was 8). In our opinion the skin condition described in this paper was associated with amlodipine administration. The first symptoms were already visible 3 months after the beginning of the treatment with amlodipine and subsided within a period of 3–7 months after the drug was discontinued. Based on clinical symptoms (e.g. characteristic appearance of the lesions, ‘cayenne pepper spots’, the changes that most often affect the lower extremities) and histological findings, in our patient Schamberg's disease seems to be the most probable diagnosis among other PPD. According to the literature Schamberg's disease is characterized by a normal haematological profile and coagulation tests and a skin biopsy showing a perivascular T-cell lymphocytic infiltrate centred on the small superficial blood vessels of the skin 3. Such changes were seen in our case and were consistent with Schamberg's disease. The pathological mechanisms of this condition remain unknown but in our patient it was probably caused by drug induced erythrocytes breaking down outside the capillary with haemosiderin deposits, which has also been reported in the literature for other drugs on a number of occasions 2. As our report has shown, this disorder is asymptomatic. After a considerable period the lesions may become confluent and have darker brown colour 2, 5. Despite the fact that in this case there were no systemic symptoms, drug discontinuation was necessary in order to prevent progression of these lesions. In conclusion, Schamberg's disease can be caused by amlodipine administration and early drug discontinuation is necessary in order to prevent progression of the skin lesions. We received the consent of the patient to participate in the study as well as written consent form for invasive procedure which was necessary to perform diagnostic biopsy of the skin. All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work." @default.
• W1888794770 created "2016-06-24" @default.
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• W1888794770 date "2015-10-27" @default.
• W1888794770 modified "2023-09-26" @default.
• W1888794770 title "A new adverse drug reaction - Schamberg's disease caused by amlodipine administration - a case report" @default.
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• W1888794770 doi "https://doi.org/10.1111/bcp.12742" @default.
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