Psychoactive drugs and skin

In this issue you will find a paper written by Baba et al. (pp. 399–401) about anticonvulsant hypersensitivity syndrome. This is a rare, potentially life-threatening complication of antiepileptic medications. It is most often caused by aromatic anticonvulsants such as phenytoin, phenobarbital and carbamazepine, 1 but can also occur with non-aromatic anticonvulsants such as lamo-trigine, or other drugs, including sulphonamides, dapsone, minocycline, azathioprine, allopurinol, terbinafine and more. 2 The rate of occurrence is from 1 in 1000 to 1 in 10 000 in cases of exposure to the abovementioned drugs. 1 It is most likely to occur 2–6 weeks after the antiepileptic drug therapy is initiated, but can occur at any time. The tendency to develop the syndrome is familial 3 but a single genetic defect has not been identified. 4 It is recognized by the following triad of symptoms: fever, rash and lymhadenopathy, usually accompanied by internal organ involvement, 2 as you can read in the paper by Baba et al. Adverse cutaneous reactions (ACRs) to psychotropic medications occur regularly, are often easily noticeable and are potentially serious, so both dermatologists and psychiatrists should be familiar with the most common and life-threatening ones. Moreover, because ACRs may cause distress to patients and lead to non-compliance, physicians should also be aware of the benign and less common ones. Although the exact incidence of ACRs to particular medications is unknown and difficult to establish, it has been estimated that approximately 2–5% of patients taking psychotropic medications will develop an ACR, and that ACRs remain the most common allergic reaction to these medications. 5,6 This compares with an overall ACR rate of 2% among inpatients taking a variety of medications. 7 Among psychotropic medications, carbamazepine is associated with a uniquely high rate of ACRs (10–11%). 8,9