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Lichenoid Eruption Associated with the Use of Nebivolol

Resident Physician, Clinical Pharmacology & Toxicology, University Hospital, Basel, Switzerland

Sabin S Egger

MS PhD Candidate, Clinical Pharmacology & Toxicology, Department of Internal Medicine, University Hospital, Basel

Elisabeth Hohenstein, MD

Resident Physician, Department of Dermatology, University Hospital, Basel

Helmut Beltraminelli, MD

Chief Resident Physician, Department of Dermatology, University Hospital, Basel

Stephan Krähenbühl, MD PhD

Head, Clinical Pharmacology & Toxicology, Department of Internal Medicine, University Hospital, Basel

Reprints: Dr. Bodmer, Clinical Pharmacology & Toxicology, University Hospital of Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland, fax 41 61 265 88 64, BodmerM{at}uhbs.ch

OBJECTIVE: To report a case of lichenoid drug eruption (LDE) after starting antihypertensive treatment with nebivolol, a cardioselective ß-blocker.

CASE SUMMARY: Five weeks after starting treatment with nebivolol, a 62-year-old woman presented with erythematous papules on both extremities and skin lesions spreading over the back. She was not being treated with any other drugs. Because the administration of levocetirizine, topical methylprednisolone, and systemic prednisone was unsuccessful, the treatment was stopped and the lesions were biopsied. The histopathological features of the lesions were consistent with LDE. After withdrawal of nebivolol and subsequent readministration of topical methylprednisolone and systemic prednisone, the skin lesions resolved within 12 days. Assessment of the causality revealed a probable relationship between nebivolol and the lichenoid eruptions.

DISCUSSION: Although ß-blockers can be associated with LDE, as of July 7, 2006, this has not been previously reported with nebivolol. T cells invading the dermis are considered to be responsible for epidermal destruction associated with LDE, as has been described for lichenoid forms of chronic graft versus host disease and idiopathic lichen ruber planus.

CONCLUSIONS: Nebivolol can cause LDE, as has been reported with other ß-blockers. The underlying mechanism appears to be T cell-mediated. Cross-reactivity with other ß-blockers cannot be excluded; therefore, the risk of recurrent LDE should be weighed carefully against the clinical benefit before switching to another ß-blocker.

Key Words: lichenoid drug eruption, nebivolol

Published Online, August 8, 2006. www.theannals.com, DOI 10.1345/aph.1H094