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 Table of Contents  
LETTERS TO EDITOR
Year : 2016  |  Volume : 2  |  Issue : 1  |  Page : 40-41

Spironolactone-induced hypersensitivity in a patient with acne vulgaris


1 Department of Dermatology, NKPSIMS, Nagpur, Maharashtra, India
2 Department of Oral Medicine and Radiology, VSPM DCRC, Nagpur, Maharashtra, India
3 Department of Biochemistry, IGGMC, Nagpur, Maharashtra, India

Date of Web Publication15-Jun-2016

Correspondence Address:
Neha Iyer
Department of Oral Medicine and Radiology, VSPM DCRC, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-3972.184092

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How to cite this article:
Mehta B, Iyer N, Iyer C M. Spironolactone-induced hypersensitivity in a patient with acne vulgaris. Indian J Drugs Dermatol 2016;2:40-1

How to cite this URL:
Mehta B, Iyer N, Iyer C M. Spironolactone-induced hypersensitivity in a patient with acne vulgaris. Indian J Drugs Dermatol [serial online] 2016 [cited 2024 Mar 29];2:40-1. Available from: https://www.ijdd.in/text.asp?2016/2/1/40/184092



Sir,

Spironolactone has been used for the treatment of acne vulgaris (AV) in women above 25 years with hormonal-pattern AV, defined clinically as primarily inflammatory papules, many deep-seated and tender that are located predominantly on the lower half of the face and anterior-lateral neck region.[1] Spironolactone is an aldosterone antagonist that was used initially as a potassium-sparing diuretic in the treatment of hypertension and congestive heart failure. Structurally, its backbone is a basic steroidal nucleus with four rings. The rationale for using spironolactone in the treatment of AV is that is has been shown to inhibit sebaceous gland activity.[2] As increased size of sebaceous glands and increased sebum secretion are essential components in the development of AV lesions, inhibition of sebaceous gland functions leads to reduced formation of acne lesions.[1]

A 28-year-old female patient suffering from AV since 5 years presented with extensive inflammatory papules on the inferior border of the mandible and the anterolateral neck region bilaterally. This patient had multiple episodes of relapses and remissions in the past. The patient was initially treated with retinoids and topical application of clindamycin phosphate and benzoyl peroxide (5%) with little relief from the same. Later, a combination of ethinyl estradiol and cyproterone acetate was prescribed for 7 months with complete remission followed by relapse and exacerbation of the lesion after 7 months. The patient was prescribed with 100 mg spironolactone once daily for a month.

Within 30 min following the consumption of spironolactone, the patient developed intense pruritus, conjunctivitis, angioedema [Figure 1], skin rash, and nonspecific mechanical reflexes such as coughing and sneezing. Patient was prescribed with 10 mg of cetirizine hydrochloride and 20 mg of prednisolone stat and 10 mg of cetirizine hydrochloride was repeated 8 hourly. There was subsidence of the symptoms for 3 days following the hypersensitivity reaction.
Figure 1: Angioedema with puffiness in the eyelids and cheeks.

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Spironolactone is well-known drug to cause dose-dependent side effects such as hyperkalemia, orthostatic hypotension, breast enlargement and tenderness, menstrual irregularities, and reduced libido.[3] Hypersensitivity reaction reported after oral spironolactone are contact dermatitis, pruritus, and bullous pemphigoid induced by spironolactone.[4],[5] However, reports of spironolactone-induced acute hypersensitivity reactions have been rare. The purpose of reporting this case is to make the clinicians aware of the acute adverse drug reaction of spironolactone; a drug which has sufficient data of its overall safety.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Luderschmidt C, Bidlingmaier F, Plewig G. Inhibition of sebaceous gland activity by spironolactone in Syrian hamster. J Invest Dermatol 1982;78:253-5.  Back to cited text no. 1
[PUBMED]    
2.
Ober KP, Hennessy JF. Spironolactone therapy for hirsutism in a hyperandrogenic woman. Ann Intern Med 1978;89(5 Pt 1):643-4.  Back to cited text no. 2
    
3.
Katsambas AD, Dessinioti C. Hormonal therapy for acne: Why not as first line therapy? Facts and controversies. Clin Dermatol 2010;28:17-23.  Back to cited text no. 3
    
4.
Ghislain PD, Bodarwe AD, Vanderdonckt O, Tennstedt D, Marot L, Lachapelle JM. Drug-induced eosinophilia and multisystemic failure with positive patch-test reaction to spironolactone: DRESS syndrome. Acta Derm Venereol 2004;84:65-8.  Back to cited text no. 4
    
5.
Modeste AB, Cordel N, Courville P, Gilbert D, Lauret P, Joly P. Bullous pemphigoid induced by spironolactone. Ann Dermatol Venereol 2002;129(1 Pt 1):56-8.  Back to cited text no. 5
    


    Figures

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