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RECURRENT AND CHRONIC LEG ULCERS SECONDARY TO FUROSEMIDE‐INDUCED BULLOUS PEMPHIGOID

1995; Wiley; Volume: 43; Issue: 10 Linguagem: Inglês

10.1111/j.1532-5415.1995.tb07038.x

1532-5415

Mumtaz A. Siddiqui, Muhammad N. Zaman,

Eosinophilic Disorders and Syndromes

To the Editor: Furosemide is prescribed commonly in congestive cardiac failure, hypertension, and chronic renal failure. Furosemide is a sulfonamide derivative, and skin eruptions with sulfonamides are well recognized. Adverse dermatological reactions to furosemide include epidermolysis bullosa,1 hemorrhagic bullous eruptions,2 erythema multiforme,3 vasculitis,4 photoreaction,5 and bullous pemphigoid.5 We report three cases with recurrent and chronic leg ulcers, secondary to possible furosemide-inducing bullous pemphigoid. In all cases, histopathological confirmation was obtained and furosemide changed to bumetanide or ethacrynic acid. The patient details are tabulated in Table 1. Furosemide may cause bullous lesions with low-dose7 or high-dose therapy as seen in patients with chronic renal failure.1, 5 They may appear on normal skin or on a maculopapular rash preceding the bullous lesions3, 7 or with preceding generalized pruritus.6 These blisters usually appear on the extremities but may appear on trunk, face, or ears (Table 2). The duration of furosemide with bullous lesions may be long-term5, 6, 4 to 8 weeks2, 5; the least time reported has been 6 days.3 The blistering lesions may be clear,3 with erythematous base,7 or frankly hemorrhagic.2, 6 They may be seasonal, seen during the summer,5 or unrelated to any season.6 Heydenreich et al.5 reported the highest frequency of bullous lesions in 12 of 56 patients prescribed high dose furosemide therapy. The cases with bullous disease had comparable serum furosemide levels, tissue-type antigen, and blood group, and similar responses to furosemide patch or scratch test with normal porphyrin levels. The lesions were treated either symptomatically or with high dose corticosteroids.7 There is controversy about the pathogenesis of the bullous eruptions, and some workers believe that these eruptions will subside whether or not furosemide therapy is discontinued. Other factors in the pathogenesis include necrotizing vasculitides or bullous pemphigoid-like antibodies.4, 7 Chronic and recurrent leg ulcers from unrecognized furosemide-induced bullous disease may add to the morbidity in patients with heart failure. Leg ulcers in patients prescribed furosemide therapy should be examined for possible bullous skin lesions because these may be treatable.