Calcium channel blockers were the only drug class significantly associated with eczematous rash.
Older patients sometimes develop chronic eczematous eruptions of unknown etiology. In a case-control study from France, researchers looked for associations between these rashes and long-term medication use.
The researchers identified 102 patients (age, >60; half inpatients and half outpatients) with chronic eczematous eruptions. Rashes had been present from 3 to 18 months before study entry, had no identified cause, and had histologic features of eczema. Cases were compared with 204 controls who were matched for age, sex, and inpatient or outpatient status. Calcium channel blockers (CCBs; used by 26% of cases and 12% of controls) were the only drug class significantly associated with eczematous rash. In multivariate analysis adjusting for other drug classes, the significant association between CCB use and rash persisted (odds ratio, 2.5).
In another series of 74 older patients with chronic eczematous eruptions, the authors found that rashes resolved in 10 of 12 CCB users (83%) who discontinued CCBs, compared with 14 of 42 patients (33%) who discontinued other drugs. Finally, the authors rechallenged three CCB users whose rash had resolved after CCB withdrawal; rashes recurred within several days in all cases.
Comment: This study suggests that calcium channel blockers are associated with chronic eczematous eruptions in older adults. The case-control methodology and the uncontrolled observations of response to withdrawal and rechallenge are obvious but understandable limitations. Nevertheless, the data are suggestive enough to justify withdrawal of CCBs in patients with unexplained eczematous eruptions.
Published in Journal Watch General Medicine January 10, 2008
Joly P et al. Chronic eczematous eruptions of the elderly are associated with chronic exposure to calcium channel blockers: Results from a case-control study. J Invest Dermatol 2007 Dec; 127:2766.