Case and Research Letters
Granuloma Annulare Possibly Secondary to Oral Treatment With Topiramate
Granuloma anular posiblemente secundario a la ingesta de topiramato
S. Heras-González
, T. Piqueres-Zubiaurre, A. Martínez de Salinas-Quintana, R. González-Pérez
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Servicio de Dermatología, Hospital Universitario Araba, Vitoria-Gasteiz, España
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Heras-González, T. Piqueres-Zubiaurre, A. Martínez de Salinas-Quintana, R. González-Pérez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Heras-González" "email" => array:1 [ 0 => "soniaherasgonzalez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Piqueres-Zubiaurre" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Martínez de Salinas-Quintana" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "González-Pérez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Araba, Vitoria-Gasteiz, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granuloma anular posiblemente secundario a la ingesta de topiramato" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 794 "Ancho" => 750 "Tamanyo" => 109043 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Granuloma annulare over the metacarpophalangeal joint of the left hand.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Granuloma annulare (GA) is a benign and typically self-limiting granulomatous disease of unknown etiology; it tends to resolve spontaneously over a period of months or years. It usually presents with annular lesions on the hands, upper limbs, trunk, or lower limbs; facial involvement is rare. It is associated with diabetes mellitus, paraneoplastic disorders, thyroid disturbances, and some drugs.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A woman aged 38 years, with a personal history of an eating disorder for which she had been on treatment with topiramate for several months, was seen in dermatology outpatients for slightly pruritic lesions that had arisen on the dorsum of both her hands some months earlier. On physical examination, confluent papules with an annular morphology were observed on the dorsum of the fingers of both hands and over the metacarpophalangeal joints of the left hand (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Histology revealed focal degeneration of collagen and elastic fibers, mucin deposits, and a perivascular and interstitial lymphohistiocytic infiltrate in the upper and mid dermis, confirming the diagnosis of GA (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). There were no significant findings in the blood tests requested. The patient was initially treated with topical tacrolimus and corticosteroids, and subsequently with oral corticosteroid therapy, with no improvement. On reviewing her medical history, we observed a chronological relationship between the introduction of topiramate and the appearance of the GA lesions. With a suspicion of GA secondary to topiramate, we decided, with the consent of the psychiatry department, to withdraw the drug, and this led to complete resolution of the lesions within a month.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Four types of drug-induced granulomatous dermatitis have been identified: interstitial granulomatous dermatitis, exacerbation of rheumatoid nodules secondary to methotrexate, drug-induced sarcoidosis, and drug-induced GA.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The first case of drug-induced GA, published in 1980, was associated with gold salts for the treatment of juvenile arthritis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Other cases have been reported since that time, mainly involving allopurinol, calcitonin, diclofenac, anti-tumor necrosis factor drugs, calcium channel blockers, and various chemotherapeutic agents.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2–7</span></a> However, we have only found 3 cases involving topiramate (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>),<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1–3</span></a> all with lesions affecting the lower limbs, in contrast to our patient, in whom the lesions were on her hands. As in the 3 cases described in the literature, we detected a chronological relationship between treatment with topiramate and the appearance of GA in our patient, as the lesions appeared very soon after the introduction of topiramate and disappeared within 2 to 3 weeks of withdrawal of the drug, with no subsequent recurrence.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,3</span></a> Additionally, although it is widely known that GA lesions sometimes resolve after biopsy,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1–3</span></a> we observed no improvement in our patient after performing biopsy. However, confirmation of the reappearance of GA lesions after rechallenge with topiramate has not been performed in our patient.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Topiramate is an antiepileptic drug that has a structure based on D-fructose, a monosaccharide, and differs considerably from other antiepileptic drugs. It is indicated in the treatment of partial or generalized seizures, migraine prophylaxis, and in impulse control.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> It has a multiple mechanism of action, including inactivation of the voltage-gated sodium channels and potentiation of amino-butyric acid-mediated neurotransmission, and it is a glutamate receptor antagonist.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Rare cutaneous side effects reported with topiramate include alopecia, oligohydrosis, pemphigus, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrosis<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>; the appearance of GA is very rare. The pathogenesis of GA secondary to topiramate is unknown, but, given the extensive use of this drug, the disorder is probably underdiagnosed. In patients with GA refractory to the usual treatments, a detailed medical history should therefore be taken to exclude the possible implication of any drug in its onset.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Heras-González S, Piqueres-Zubiaurre T, Salinas-Quintana AMd, González-Pérez R. Granuloma anular posiblemente secundario a la ingesta de topiramato. Actas Dermosifiliogr. 2017;108:952–954.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 794 "Ancho" => 750 "Tamanyo" => 109043 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Granuloma annulare over the metacarpophalangeal joint of the left hand.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 787 "Ancho" => 750 "Tamanyo" => 108205 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Granuloma annulare on the dorsum of the phalanges of the right hand.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 747 "Ancho" => 995 "Tamanyo" => 239230 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Focal degeneration of collagen and elastic fibers, mucin deposits, and a perivascular and interstitial lymphohistiocytic infiltrate in the upper and mid dermis. Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×10.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Latency Period Until the Appearance of GA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Latency Period Until the Disappearance of GA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cassone G et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left lower limb \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lagier L et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsum of the feet Lower limbs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ruzzetti F et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 wk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsum of the hands<br>Lower limbs<br>Dorsum of the feet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heras S et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dorsum of the hands \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1607278.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cases of Topiramate-Induced Granuloma Annulare.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Granuloma annulare as a possible new adverse effect of topiramate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. 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| año/Mes | Html | Total | |
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| 2023 Febrero | 193 | 28 | 221 |
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| 2022 Diciembre | 155 | 37 | 192 |
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| 2022 Febrero | 151 | 30 | 181 |
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| 2021 Diciembre | 152 | 54 | 206 |
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| 2021 Octubre | 160 | 67 | 227 |
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| 2019 Abril | 2 | 0 | 2 |
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