Morphea-like reaction to D-penicillamine therapy

Area of Science:

• Dermatology
• Rheumatology
• Pharmacology

Background:

• D-penicillamine is a chelating agent used in treating rheumatoid arthritis and Wilson's disease.
• Drug-induced skin reactions are a known complication of various medications, including D-penicillamine.

Observation:

• A 48-year-old woman developed morphea-like plaques after one year of daily D-penicillamine (250 mg) for seronegative erosive arthritis.
• The lesions presented as erythematous, itchy patches on the trunk, progressing to thickened, shiny plaques over three months.
• Histopathology revealed increased dermal fibrosis and perivascular inflammation, but atypical epidermal changes.

Findings:

• Cessation of D-penicillamine therapy resulted in the cessation of new lesion development within months.
• Complete resolution and depigmentation of the plaques were observed within one year after drug withdrawal.

Implications:

• This case highlights a potential iatrogenic cause of morphea-like dermatosis.
• Discontinuation of D-penicillamine should be considered in patients presenting with similar skin manifestations.
• Further investigation into the mechanism of D-penicillamine-induced morphea is warranted.