Pityriasis rosea-like adverse reaction to atenolol

Abstract

A 56-year-old female patient was presented with diffuse, bright red to violet colour, scaly patches on trunk and extremities after using a hypertension drug, atenolol. The patient was diagnosed as pityriasis rosea-like adverse reaction to atenolol based on her history, dermatological examination and histopathological findings. To the best of our knowledge, this is the first reported case of pityriasis rosea-like adverse reaction to atenolol that is widely used in hypertension treatment.

Introduction

Atenolol is a synthetic β-1 selective adrenoreceptor blocking agent that is commonly used for treating hypertension. It can be induced by various kinds of adverse side effects, including psoriasiform skin eruption, skin necrosis, vasculitis and drug-induced connective tissue diseases. ^{1 –3} Pityriasis rosea is a distinct papulosquamous skin eruption that has typically clinical presentation including a bright red to violet colour, round or scaly plaques. ⁴ A rash very similar to pityriasis rosea is also attributed to several drugs such as angiotensin-converting enzyme (ACE) inhibitors, antirheumatic drugs and lithium. It also called as pityriasis rosea-like drug reaction. ⁵ Here, we report a case with pityriasis rosea-like eruption developed on whose trunk and extremities during atenolol treatment. To our knowledge, this is the first case report that described the association between pityriasis rosea-like eruption and atenolol administration.

Case report

We report a case of pityriasis rosea-like reaction in a 56 year-old female. She was admitted to our outpatient clinic with the appearance of flat, round or oval scaly patches bright red to violet in colour that were present for 1 week duration.They were present on the neck, abdomen, axilla regions and upper limbs. The localization of plaques was atypical and named as pityriasis rosea inversa (Figure 1). The patient also had severe itching. The patient did not have fever, systemic symptoms or positive laboratory tests. The result of potassium hydroxide preparation was negative. Complete blood count, routine biochemistry including hepatic and renal function tests, thyroid function tests and erythrocyte sedimentation rate were within normal limits. A skin biopsy showed a perivascular lymphocyctic infiltrate with eosinophils, mild spongiosis and oedema of upper dermis (Figure 2). The medication history revealed the introduction of a new antihypertensive drug, atenolol, about 3 weeks before the onset of the eruption. The patient had no other medication and had never suffered adverse drug reactions before. Atenolol was discontinued and substituted with a different antihypertensive agent belonging to the class of calcium channel blockers. The patient had been prescribed with topical corticosteroids and antihistaminic drugs. The above-mentioned drug-related clinical symptoms and itching healed rapidly in about a week. The problem was diagnosed as ‘pityriasis rosea-like eruption’ induced by atenolol based on the patient’s clinical and histopathological features and reaction to our treatment.

Figure 1.

Erythematous and scaly plaques on neck, antecubital, axillae and submamillar regions.

Figure 2.

Mild spongiosis in epidermis, perivascular lymphocytic infiltration and oedema in upper dermis.

Discussion

Atenolol is commonly used as a β-blocker that has current indications for its use including hypertension, angina pectoris, dysrhythmias, myocardial infarction and several non-cardiovascular uses. ^2,6 Adverse cutaneous reactions to atenolol include psoriasiform eruptions or exacerbations of psoriasis, skin necrosis, pseudolymphoma, cutaneous vasculitis and systemic lupus-like syndrome. ^1,2,3,7 Our patient used atenolol for hypertension treatment. Pityriasis rosea is a common, acute and scaly eruption of uncertain etiology. If the face, axillae and groin are predominantly affected, it is named as pityriasis rosea inversus. ⁸ Our patient’s plaques localized on axillae, abdomen and neck. Because of this reason, this case could be called pityasis rosea inversus. It has been attributed to infections like viral and bacterial causes, vaccination and certain drugs. Drugs responsible for pityriasis rosea-like eruptions have been reported with ACE inhibitors, non-steroidal anti-inflammatory drugs, lithium, barbiturates and antipsychotic drugs. ^5,9 To the best of our knowledge, before the above-mentioned case, there was no report in literature that showed atenolol-induced pityriasis rosea-like eruption. Histopathological features of pityriasis rosea revealed perivascular lymphocyctic infiltration with eosinophils, spongiosis and oedema of papillary dermis, focal parakeratosis and mild acanthosis. ¹⁰ The pathological picture of our patient was consistent with pityriasis rosea.

In conclusion, we presented the first case of atenolol-induced pityriasis rosea-like adverse reaction to highlight the possibility of its existence.