Blue-Gray Mucocutaneous Discoloration A New Adverse Effect of Ezogabine
Blue-Gray Mucocutaneous Discoloration A New Adverse Effect of Ezogabine
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DOI：
10.1001/jamadermatol.2013.8895
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发表时间：
2014-09-01
期刊：
影响因子：
10.9
通讯作者：
Hodak, Emmilia
中科院分区：
文献类型：
--
作者：
Shkolnik, Tali Garin;Feuerman, Hana;Hodak, Emmilia
重要性据报道，许多药物可诱导皮肤和/或粘膜变色。Ezogabine（瑞替加滨）最近被批准作为治疗成人癫痫部分发作的添加药物。粘膜皮肤变色引起的抗癫痫药物一般和ezogabine特别是以前没有reported.Observations两名患者谁收到了多种抗癫痫药物几年提出了一个蓝灰色的皮肤色素异常，这是最明显的脸和嘴唇，并与指甲色素沉着，硬腭上的蓝色色素沉着，和黑色色素沉着的conjuctivae。两例患者治疗方案的唯一共同药物是依佐加滨。组织学上，主要发现是血管周围和附件周围的真皮细胞大量负载粗黑色素颗粒，其在超微结构上表现为细胞内的电子致密颗粒。四个月后，停止ezogabine，我们的第一个病人表现出显着改善mucocutaneous和指甲dysigmentation.CONCLUSIONS和RELEVANCE的时间关系，临床特点，组织学和超微结构的研究结果，并改善后撤回ezogabine表明，色素异常是药物引起的。应将Ezogabine添加到可诱导粘膜皮肤变色的药物列表中。这种显著不良反应的发生率需要进一步研究。
IMPORTANCE Many drugs have been reported to induce skin and/or mucous membrane discoloration. Ezogabine (retigabine) was recently approved as an add-on drug for the treatment of partial seizures in adults with epilepsy. Mucocutaneous discoloration induced by antiepileptic drugs in general and ezogabine in particular has not been previously reported.OBSERVATIONS Two patients who had received multiple antiepileptic drugs for several years presented with a blue-gray skin dyspigmentation that was most pronounced on the face and lips and was associated with nail pigmentation, blue pigmentation on the hard palate, and black pigment deposits on the conjuctivae. The sole drug common to the therapeutic regimens of both patients was ezogabine. Histopathologically, the main finding was perivascular and periadnexal dermal cells heavily laden with coarse melanin granules, which appeared ultrastructurally as intracellular electron-dense granules. Four months after discontinuing ezogabine, our first patient showed a significant improvement in the mucocutaneous and nail dyspigmentation.CONCLUSIONS AND RELEVANCE The temporal relationship, clinical features, histologic and ultrastructure findings, and improvement following withdrawal of ezogabine indicate that the dyspigmentation was drug induced. Ezogabine should be added to the list of drugs that can induce mucocutaneous discoloration. The incidence of this significant adverse effect requires further investigation.