A 78-year-old male presented with a case of erythroderma secondary to silodosin, an α1-adrenoceptor antagonist, prescribed for benign prostatic hyperplasia (BPH). The patient did not have any previous dermatologic comorbidities. Though erythroderma due to drugs is well-documented, to the best of our knowledge this is the first case report of erythroderma due to silodosin.

Introduction

Erythroderma or exfoliative dermatitis is a rare skin disorder characterized by generalized reddening and scaling of over 90% of the skin. It was first describe by Von Hebra in 1868. It can be induced by several pre-existing skin diseases like psoriasis, contact dermatitis, mycosis fungoides, sarcoidosis, dermatomyositis etc.1 It can also be induced by drugs like nonsteroidal a n t i i n f l a m m a t o r y d r u g s ( N S A I D s ) , a n t i - tubercular drugs,2 carbamazepine,3 lisinopril,4 etc. We herein report a case of erythroderma induced by silodosin, a drug used for benign prostatic hyperplasia (BPH).

Case report

A 78-year-old male, presented with complaints of redness, itching and skin peeling all over the body since last 5 days. The symptoms started 2 days after the patient was started on silodosin 8 mg/day for BPH by a urologist. Redness and irritation started on the trunk and rapidly spread throughout the body within the next 48 hours.

The patient was a known hypertensive which was under control with bisoprolol fumarate (β-blocker) 5 mg twice-daily for the last 20 years. He was not a known diabetic and he was not on any other medication prior to the onset of the skin eruption. There was no history of any pre-existing skin diseases. On examination, diffuse erythema and scaling was observed all over the body-scalp, face, trunk and limbs (Figs. 1-3). There was significant scaling on palms and soles and pedal edema. There was no significant lymphadenopathy or hepatosplenomegaly. Systemic examination was otherwise normal. Laboratory investigations revealed normal total blood counts, including eosinophil count. His liver functions and renal functions showed normal results.

Skin biopsy from the back showed hyperkeratosis, parakeratosis, spongiosis and sparse perivascular lymphocytic infiltrate in the dermis.

A diagnosis of silosodin-induced erythroderma was made. The medication was already withdrawn when the patient came to us. He was started on methylprednisolone tablets 30 mg/day, levocetirizine 10 mg/day and topical liquid paraffin as an emollient. He was also put on protein, iron and other nutritional supplements. The skin eruption gradually improved over the next few weeks.

Discussion

Erythroderma is a serious skin disorder which has significant morbidity and can be life-threatening.

The most common causative factors are pre-existing dermatoses (72.0%) followed by drug reactions (17%), idiopathic causes (6.1%) and malignancies (4.9%). Among the pre-existing dermatoses, psoriasis is the most common etiology (30.5%); other conditions include contact dermatitis, mycosis fungoides, sarcoidosis, dermatomyositis and hypereosinophilic syndrome.

Several drugs have been implicated in causation of erythroderma. They include NSAIDs,1 antitubercular drugs,2 carbamazepine,3 angiotensin-converting enzyme (ACE)-inhibitors like lisinopril,4 tyrosine kinase inhibitor like imatinib mesylate5 and Chinese herbal medications.1 Some studies6 have implicated carbamazepine as the most common drug (27.8%) causing erythroderma.

Silodosin is an α1-adrenoceptor antagonist, prescribed for BPH. It works by relaxing muscles in the prostate and bladder. It is marketed in India under brand names like silofast, rapilif, silodal, etc. and internationally as Rapaflo. It can cause side effects like retrograde ejaculation, insomnia, dizziness, low blood pressure, headache, nasal congestion and abnormal liver function tests. Post-marketing reports of purpura, skin rash, pruritus and urticaria have been mentioned in the product information insert.

To the best of our knowledge, this is the first case report of silodosin-induced erythroderma in the literature. Fortunately the condition was recognized early in our patient, the drug withdrawn and patient improved well with oral steroids and antihistamines.

Conclusion

We report this case for its rarity. Silodosin now gets added to the growing list of medications which can cause a serious drug eruption like erythroderma. Since, BPH is a common condition in the elderly and silodosin is one of the frequently prescribed agents for the same, it is important to remember the occurrence though rare, of this serious side effect of silodosin.

References

1. Yuan XY, Guojy, Dangy P, et al. Erythroderma: A clinical-etiological study of 82 cases. Eur J Dermatol 2010;20(3):373-7.
2. Jai Suresh K. Pyrazinamide-induced-exfoliative dermatitis in a patient on haemodialysis; a rare complication. Case Rep Nephrol 2013;18.
3. Shah SV, Dava JN, Aggrawal V. Letter to editor: Carbamazepine induced exfoliative dermatitis. IJDVL 2002;68(4):246.
4. Broski SE, Regan TD, et al. Lisinopril-induced erythroderma in an 85 year old male. J Drugs Dermatol 2008;7(2):163-6.
5. Sanghavi SA, Dongre AM, Khopkar US. Imatinib mesylate induced erythroderma, net letter. IJDVL 2012;78(3):408.
6. Khaled A, Sellami A, et al. Acquired erythroderma in adults: a clinical and prognostic study. J Eur Acad Dermatol Venereol 2010;24(7):781-8.