Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 59, Num. 7, 2005, pp. 320-321

Indian Journal of Medical Sciences, Vol. 59, No. 7, July, 2005, pp. 320-321

Letter To Editor

Dermatological side effects of olanzapine

Varghese S.T., Balhara Y.P. S., Shyamsunder S., Mondal A.

Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi

Correspondence Address: Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi

Code Number: ms05049

Sir,

Olanzapine has been recently introduced to India and is currently one of the most commonly prescribed antipsychotic medicines. Although relatively safe as compared to other antipsychotic medications, few reports have suggested debilitating side effects of olanzapine. Although dermatological side effects are uncommon with antipsychotic medicines, two recent reports have described skin rashes and eruptions with olanzapine. [1] , [2] We describe a purpuric skin rash associated with olanzapine and a brief review of literature is also provided.

A 23-year-old man presented to us with history of recent heavy use of cannabis, which was followed by grandiose ideations, increased activity, decreased sleep, and increased self-esteem. A diagnosis of substance-induced mood disorder (DSM IV) was made and the patient was started on 15 mg of olanzapine. After 2 days of initiation of treatment, the patient was noted to have numerous purpuric spots over his face and trunk. These blanching nonpruritic purpura were not associated with any fever or any other signs of urticaria. The pupura extended to cover most of his trunk and face the following day, after which the dose of olanzapine was reduced to 5 mg/day and a mood stabilizer was planned. After the dose reduction, there was a mild reduction in the signs, but the purpura persisted. Because the manic symptoms were becoming difficult to control after a few days the olanzapine was increased to the previous dose. The purpuric rashes reappeared in a similar pattern over his trunk and face. The medicine was changed to Haloperidol 10 mg/day after which the rashes resolved spontaneously over the next few days. The patient was not on any other medication. There was no eosinophilia, or thrombocytopenia, and the liver function tests were within normal limits. Skin biopsy could not be done owing to the manic symptoms and uncooperative nature of the patient.

The adverse drug reaction probability score for the patient was ten, denoting a definite role of olanzapine in the occurrence of the rash. [3] Hypersensitive reaction with fever and hepatitis has been reported with olanzapine. [1] Other dermatological side effects that have been reported with olanzapine are eruptive xanthomas, [2] skin hyperpigmentation, [4] and purpura associated with thrombocytopenia. Congeners of olanzapine such as clozapine has been reported to have numerous dermatological side effects that are immune mediated. Very few reports are available about the dermatological side effects of olanzapine. Physicians should be aware of the various dermatological side effects of olanzapine.

REFERENCES

Copyright 2005 - Indian Journal of Medical Sciences