Sweat-gland necrosis after beta-adrenergic antagonist treatment in a patient with pheochromocytoma

We describe the dermatological consequences of treatment with a beta-adrenergic antagonist, atenolol, in a patient with pheochromocytoma. There were acral skin lesions, histologically characterized by epidermal and sweat-gland necrosis. It is believed that the combined action of severe local ischaemia and profuse sweating produced these lesions, which resembled histologically the changes found in patients comatose as the result of carbon monoxide or drug poisoning. The importance of such lesions in diagnosis is discussed.