Ann Dermatol.  2008 Dec;20(4):260-262. 10.5021/ad.2008.20.4.260.

Toxic Epidermal Necrolysis Induced by the Topical Carbonic Anhydrase Inhibitors Brinzolamide and Dorzolamide

• Chun JS
• Yun SJ
• Lee JB
• Kim SJ
• Won YH
• Lee SC

• KMID: 2156410
• DOI: http://doi.org/10.5021/ad.2008.20.4.260

Abstract

Brinzolamide and dorzolamide are highly specific topical carbonic anhydrase inhibitors (CAIs). They lower intraocular pressure (IOP) by reducing the rate of aqueous humour formation without serious side effects. Although systemic CAIs are the most potent medications for lowering intraocular pressure for conditions with ocular hypertension, many cases with adverse systemic reactions have been reported, including Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN). Here, we report 2 cases of TEN that were associated with topical CAIs rather than systemic CAIs.

Keyword

Brinzolamide; Dorzolamide; Toxic epidermal necrolysis

MeSH Terms

Carbon
Carbonic Anhydrase Inhibitors
Carbonic Anhydrases
Epidermal Necrolysis, Toxic
Intraocular Pressure
Ocular Hypertension
Stevens-Johnson Syndrome
Sulfonamides
Thiazines
Thiophenes
Carbon
Carbonic Anhydrase Inhibitors
Carbonic Anhydrases
Sulfonamides
Thiazines
Thiophenes

Figure

• 

  Fig. 1 (A) Variable sized scattered vesicles on erythematous patches seen over the entire body of patient 1. (B) Vesicles and erythematous patches became dusky, red-colored confluent patches with Nikolsky sign. Widespread necrolytic skin detachment finally developed after 7 days of disease progression. (C) Dusky, red-colored confluent patches on the face and neck. Note the flaccid bullae caused by necrolytic epidermis on the auricle of patient 2.

Reference

1. Cvetkovic RS, Perry CM. Brinzolamide: a review of its use in the management of primary open-angle glaucoma and ocular hypertension. Drugs Aging. 2003; 20:919–947.

2. Herkel U, Pfeiffer N. Update on topical carbonic anhydrase inhibitors. Curr Opin Ophthalmol. 2001; 12:88–93.

3. Sulfonamide cross reactions explained. SDIS Drug News. 2003; 20(2):April-May.

4. DeSantis L. Preclinical overview of brinzolamide. Surv Ophthalmol. 2000; 44:S119–S129.

5. Mincione F, Scozzafava A, Supuran CT. The development of topically acting carbonic anhydrase inhibitors as anti-glaucoma agents. Curr Top Med Chem. 2007; 7:849–854.

6. Alcon (USA) Inc. Azopt® (brinzolamide ophthalmic suspension) 1%. Prescribing information [Internet]. http://ecatalog.alcon.com/pi/Azopt_us_en.pdf.

7. Alcon Laboratories (UK) Ltd. Azopt (brinzolamide eye drops suspension) 1%. Summary of product characteristics. eMC [Internet]. http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=2808.

8. Florez A, Roson E, Conde A, Gonzalez B, GarciaDoval I, de la Torre C, et al. Toxic epidermal necrolysis secondary to timolol, dorzolamide, and latanoprost eyedrops. J Am Acad Dermatol . 2005; 53:909–911.

9. Radimer GF, Davis JH, Ackerman AB. Fumigantinduced toxic epidermal necrolysis. Arch Dermatol. 1974; 110:103–104.

10. Thompson JA Jr, Wansker BA. A case of contact dermatitis, erythema multiforme, and toxic epidermal necrolysis. J Am Acad Dermatol. 1981; 5:666–669.