|
|
|
Indian Pediatr 2009;46: 432-433 |
 |
Naproxen Induced Pustular Eruption |
|
Tapomay Banerjee and Mithun Chandra Konar
Department of Pediatrics, R G Kar Medical College and
Hospital, 1, Khudiram Bose Sarani, Kolkata 700 004, India.
E-mail: [email protected]
|
|
A
10-year old girl diagnosed as
polyarticular JIA (Juvenile Idiopathic Arthritis) was treated with
Naproxen (15 mg/kg/day). Three days later, she developed multiple well
circumscribed, painless, mildly pruritic, pustular eruptions all over the
body (Fig. 1). They appeared in crops, involving all parts
of the body within a span of 6-8 hours, each pustule having diameter of
3-4 mm with few bigger ones. None of them had any sign of surrounding
erythema or inflammation. Review of history revealed that similar type of
eruptions had occurred twice in the past, each time after starting
Naproxen, and resolved after stoppage of the drug. Aspirated materials
from lesions revealed large numbers of pus cells without any organism and
culture was sterile. The offending drug was withdrawn and oral Cetrizine
(antihistamine) started. The lesions subsided within next 5-7 days without
leaving any scar or pigmentation.
Naproxen can induce adverse skin lesions such as
pseudoporphyria, which is characterized by skin fragility and vesiculation
resulting in shallow scarring in sun exposed areas. These are identical to
porphyria cutanea tarda but without any disturbance in heme metabolism.
Usually they disappear within 3-5 wks of discontinuation of the drug but
leave scars and pigmentations. Other adverse skin lesions to naproxen
include exfoliative dermatitis, TEN, and Steven Johnson’s Syndrome.
Acute generalized exanthematous pustulosis (infective,
drug induced, toxins), erythema multi-forme, and infective lesions like
bullous impetigo were the differential diagnosis of this case.
|
|
|
 |
|
