[Side effects of beta receptor blockers on the skin. Review and personal observations]

This review presents the wide spectrum of cutaneous and extracutaneous side effects of beta-adrenoreceptor-blocking agents. In addition, personal clinical observations are described. An induction period before the occurrence of clinical manifestations is characteristic, which is usually of approximately 1 year duration. The clinical picture is extremely polymorphous and may imitate many classical dermatoses. Psoriasiform, lichen planus-like, and eczematous "chronic" rashes are mainly observed. When these are associated with serious, sometimes life-threatening damage to other organs, they result in syndromelike symptom complexes. This is exemplified by the oculomucocutaneous syndrome and the pseudolupus erythematosus syndrome. Fibrinous peritonitis, in particular, may be lethal. In most cases, the histology of the cutaneous side effects corresponds to a lichenoid drug eruption. The pathogenetic mechanisms which appear to operate are the pharmacological effect on the epidermal beta-adrenergic adenylate cyclase-cyclic AMP system, on the one hand, and heterogeneous immunological reactions on the other. It may be concluded that caution should be observed in long-term therapy with beta-adrenoreceptor-blocking drugs.