Carbamazepine/risperidone
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Reactions 1276 - 31 Oct 2009 Carbamazepine/risperidone Lichenoid drug eruptions: case report A 15-year-old boy developed oral lichenoid drug eruption [OLDE] during treatment with carbamazepine and risperidone [dosages not stated]. The boy, who had been receiving carbamazepine [Tegretol] and risperidone [Risperdal] for 2 years for insomnia and mood swings, was referred with bilateral buccal mucosal and tongue lesion, which had lasted for > 1 year. He reported that these lesions were painful, especially after exposure to certain foods and liquids. Intraoral examination revealed erosive lesions and white striated peripheral borders affecting the right and left buccal mucosa and lateral tongue borders. The ulcers corresponded with the occlusal planes, suggesting a Koebner phenomenon. There was also a predominantly reticular lesion on his lower labia mucosa. Differential diagnoses included oral lichen planus or an oral mucosal lichenoid reaction. Biopsy showed hyperparakeratosis and an underlying lichenoid infiltrate, which contained scattered neutrophils. There was also interface mucositis with intraepithelial lymphocytic exocytosis and colloid bodies. Biopsy findings indicated hyperkeratosis and lichenoid mucositis. The boy received topical dexamethasone, but at follow- up 2 weeks later, his lesions were unchanged. A drug- induced OLDE was suspected and risperidone and carbamazepine were discontinued. One month later at follow-up, he reported 100% improvement in his lesions. Examination showed almost complete improvement of his ulcers, but there was residual white striations affecting the right and left posterior buccal mucosa. His tongue borders were normal. A drug rechallenge was refused. At follow-up after 1 year, there were persistent reticular lesions on the bilateral buccal mucosa without evidence of ulceration. Author comment: "Although it cannot be stated with certainty which agent caused the OLDE in our patient, carbamazepine is favored due to its more extensive history of drug reactions." Woo V, et al. Oral lichenoid drug eruption: a report of a pediatric case and review of the literature. Pediatric Dermatology 26: 458-464, No. 4, Jul-Aug 2009 - USA 801154297 1 Reactions 31 Oct 2009 No. 1276 0114-9954/10/1276-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Carbamazepine/risperidone
Reactions 1276 - 31 Oct 2009
Carbamazepine/risperidone
Lichenoid drug eruptions: case reportA 15-year-old boy developed oral lichenoid drug
eruption [OLDE] during treatment with carbamazepine andrisperidone [dosages not stated].
The boy, who had been receiving carbamazepine[Tegretol] and risperidone [Risperdal] for 2 years forinsomnia and mood swings, was referred with bilateralbuccal mucosal and tongue lesion, which had lasted for> 1 year. He reported that these lesions were painful,especially after exposure to certain foods and liquids.Intraoral examination revealed erosive lesions and whitestriated peripheral borders affecting the right and leftbuccal mucosa and lateral tongue borders. The ulcerscorresponded with the occlusal planes, suggesting aKoebner phenomenon. There was also a predominantlyreticular lesion on his lower labia mucosa. Differentialdiagnoses included oral lichen planus or an oral mucosallichenoid reaction. Biopsy showed hyperparakeratosis andan underlying lichenoid infiltrate, which containedscattered neutrophils. There was also interface mucositiswith intraepithelial lymphocytic exocytosis and colloidbodies. Biopsy findings indicated hyperkeratosis andlichenoid mucositis.
The boy received topical dexamethasone, but at follow-up 2 weeks later, his lesions were unchanged. A drug-induced OLDE was suspected and risperidone andcarbamazepine were discontinued. One month later atfollow-up, he reported 100% improvement in his lesions.Examination showed almost complete improvement of hisulcers, but there was residual white striations affecting theright and left posterior buccal mucosa. His tongue borderswere normal. A drug rechallenge was refused. At follow-upafter 1 year, there were persistent reticular lesions on thebilateral buccal mucosa without evidence of ulceration.
Author comment: "Although it cannot be stated withcertainty which agent caused the OLDE in our patient,carbamazepine is favored due to its more extensive history ofdrug reactions."Woo V, et al. Oral lichenoid drug eruption: a report of a pediatric case and reviewof the literature. Pediatric Dermatology 26: 458-464, No. 4, Jul-Aug 2009 -USA 801154297
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Reactions 31 Oct 2009 No. 12760114-9954/10/1276-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
