Can treatment with bromocriptine cause skin reactions?/nCLINICAL BACKGROUND: A 34-year old woman ha

Fråga: Can treatment with bromocriptine cause skin reactions?

CLINICAL BACKGROUND: A 34-year old woman has been treated with bromocriptine (2.5 mg x2) since 1986 except in 1989 when she was pregnant. No other medication was used. In the Summer of 1990 the treatment with bromocriptine was started again. In September 1991 the patient developed whitish nonitching skin lesions on the forehead and temples.

Sammanfattning: Cases of erythromelalgia-like skin eruption, morphea, exanthema, erythema multiforme, urticaria and fixed drug eruption associated with bromocriptine treatment have been reported. The skin lesion in the present patient might have been caused by the intake of bromocriptine.

Svar: Bromocriptine is an ergot alkaloid derivative which is a dopamine agonist. It is useful in small doses in the treatment of endocrine disorders and in larger doses in the treatment of patients with parkinsonism (1). In a report on the chronic use of bromocriptine in Parkinson´s Disease, a cutaneous eruption was noted and termed "erythromelalgia". This eruption has occurred in nine of 110 patients on chronic bromocriptine therapy (1). A skin eruption occurred after taking an average of 101 mg bromocriptine daily for a mean of 13 months (2 weeks to 5 years). The typical reaction of erythromelalgia was symmetric, tender, warm erythema of the feet, ankles, and anterior lower legs, accompanied by oedema that was relieved by elevating the legs. Histopathologic examination in three patients showed a prominent perivascular lymphocytic infiltration and perivascular oedema of the dermis, without frank vasculitis. The skin eruption occurred with high dose bromocriptine therapy but a similar reaction has been noted in a young woman taking 5 mg daily (1,2). This is a reversible unwanted effect of bromocriptine therapy.

In another report (3) a 51 year old woman developed swollen, firm, tender areas on both legs 12 months after initiating bromocriptine therapy for Parkinson´s Disease. This disorder, referred to as collagenoses like symptomatology, resolved when bromocriptine was discontinued and returned when therapy was resumed. A skin biopsy revealed changes that were compatible with scleroderma. The clinical and histologic descriptions agree with morphea (induration and thickening of the skin). In Swedish Adverse Drug Reaction Committee six cases of exanthema, one case of erythema multiforme, one case of urticaria and one case of fixed drug eruption are reported. As a suggestion the bromocriptine therapy might be discontinued for a period if this is clinically possibile. We suggest that this case is reported as a possible side effect to the Swedish Adverse Drug Reaction Committee.