Clozapine-induced cholinergic urticaria: a case report

Area of Science:

• Psychiatry
• Dermatology

Background:

• Clozapine is a vital antipsychotic for treatment-resistant schizophrenia.
• While effective, clozapine carries risks of severe side effects like hematological disorders and myocarditis.
• Dermatological adverse effects, though less common, can significantly impact patient quality of life.

Observation:

• A 25-year-old male with treatment-resistant schizophrenia developed a rare skin condition.
• Four months after initiating clozapine, he experienced intense itching and red lesions triggered by sweating.
• These symptoms, identified as cholinergic urticaria, persisted despite dose adjustments and antihistamines.

Findings:

• This is the first reported case of clozapine-induced cholinergic urticaria.
• The patient's condition improved significantly after switching to quetiapine.
• This highlights the potential for late-onset adverse dermatological reactions to clozapine.

Implications:

• Recognizing and managing late-emerging adverse effects is crucial for clozapine therapy.
• Individualized patient care and exploring alternative antipsychotics like quetiapine are important.
• Further research into the mechanisms of clozapine-induced cholinergic urticaria is warranted.