Histologic Patterns of Melanocytic Nevi: A Proposal for a New Classification

May 2007 | Volume 6 | Issue 5 | Original Article | 487 | Copyright © May 2007


Robert M. Hurwitz MD, Larry J. Buckel MD, Thomas J. Eads MD

Dermatopathology Laboratory, PC, Inc, Indianapolis, IN

as SJS or TEN, have been reported in some publications.6,25-27 Our study also revealed that four cases who were treated with PPIs developed SJS or TEN. As in the previous reports, three out of the four cases had a reaction to omeprazole.6,25 Pantoprazole has not been reported to cause SJS or TEN, but one of our subjects experienced a reaction to pantoprazole. As previously described, lansoprazole has a potential to cause SJS or TEN. However, we did not find any association.
Despite previous reports of anaphylactic reaction to certain PPIs, including omeprazole, lansoprazole, pantoprazole, and rabeprazole, 9,21,22,29-31 none of our patients was reported to have anaphylaxis to PPIs.
Individuals with a history of any type of drug reaction had an increased risk of cutaneous reaction to PPIs. However, agents causing previous reactions and types of previous reaction did not differ between cases and controls. The cause of multiple drug reaction found in our study is unknown but might be explained by a deficiency of tolerance mechanism against small chemical compounds.24 In addition, Pichler et al found drug reactive CD4+T cells, in a preactivated state, in patients with a multiple drug allergy, which seemed to persist for years and was thought to enhance readiness to react to new medications.24

CONCLUSION

These data suggest that although PPIs are generally thought to be safe, cutaneous adverse reactions—ranging from minor drug rashes to a severe, life-threatening reaction such as SJS or TEN—have been reported. Individuals with a history of drug reaction have an increased risk of cutaneous reaction to PPIs.

ACKNOWLEDGMENTS

The authors are grateful to Dr. Chulaluk Komoltri for her kind support.

DISCLOSURES

The authors have no relevant conflicts of interest or financial support to disclose.

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ADDRESS FOR CORRESPONDENCE

Kanokvalai Kulthanan MDDepartment of DermatologyFaculty of Medicine, Siriraj Hospital, Mahidol University2 Prannok Road, Bangkoknoi, Bangkok 10700, ThailandPhone: (662) 419-4333Phone/Fax: (662) 411-5031sikkt@mahidol.ac.th
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