A patient has received diclofenac, 50 mg x 2, together with dextropropoxyphen and paracetamol becau

Fråga: A patient has received diclofenac, 50 mg x 2, together with dextropropoxyphen and paracetamol because of low back pain. Ten days after starting the treatment the patient developed an allergic skin reaction, with spots, erythema, facial angio-oedema, and pruritus.

The patient had no previous history of hypersensitivity to acetyl salicylic acid. Could the reaction have been caused by diclofenac?

Sammanfattning: Generally, NSAIDs are known to cause allergic skin reactions. In the reports available, skin reactions following treatment with diclofenac have occurred within a range from a few days to one week after starting the therapy.

It is therefore possible that the reactions described in this case are caused by the treatment with diclofenac.

Svar: Allergic skin reactions to diclofenac are described in the literature, and questions on this subject have been answered by us (1). These include Stevens-Johnson syndrome and severe skin eruptions (2).

In the two cases reported, skin eruptions developed within one week, and a few days after commencing therapy, respectively. Whether these patients had a previous history of hypersensitivity to ASA is not known.

One case of death caused by Stevens-Johnson syndrome is described, one week after beginning diclofenac treatment. However, the casual relationship is not clear, since the patient also received indomethacin (3). 1 Drugline nr 04639 (year 1985) 2 Side effects of drugs. Ed by MNG Dukes. Elsevier, Amsterdam. 1984; Annual 8: 105-106 3 Side effects of drugs. Ed by MNG Dukes. Elsevier, Amsterdam. 1981; Annual 5: 103