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Phenolphthalein-induced toxic epidermal necrolysis
R J Artymowicz1, A L Childs, L Paolini
1Burdette Tomlin Memorial Hospital, Cape May Court House, NJ 08210, USA.
The Annals of Pharmacotherapy
|October 24, 1997
Summary
Phenolphthalein, found in some laxatives, can cause severe skin reactions like toxic epidermal necrolysis (TEN). This case highlights phenolphthalein as a rare but serious cause of TEN, even when other medications are involved.
Area of Science:
- Dermatology
- Toxicology
- Pharmacology
Background:
- Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous reaction.
- Drug-induced TEN is often associated with specific medications, but causative agents can be challenging to identify.
- Phenolphthalein, a stimulant laxative, has been rarely implicated in TEN.
Observation:
- A 78-year-old male developed TEN after ingesting an over-the-counter laxative containing phenolphthalein and docusate sodium.
- The patient had a similar reaction previously to the same laxative.
- Despite concurrent use of furosemide, spironolactone, allopurinol, and hydroxyurea, phenolphthalein was identified as the likely culprit after rechallenge with other medications did not cause recurrence.
Findings:
- Phenolphthalein was identified as the causative agent of toxic epidermal necrolysis (TEN) in this patient.
- The patient's TEN resolved with antibiotics, corticosteroids, and wound care.
- Reintroduction of other potential offending medications did not trigger a recurrence, supporting phenolphthalein as the sole cause.
Implications:
- Clinicians should consider phenolphthalein as a potential cause of drug-induced TEN, even in patients taking multiple medications.
- Accurate medication history, including over-the-counter products, is crucial for diagnosing and managing TEN.
- Identifying the specific causative agent prevents unnecessary withdrawal of essential medications and avoids future exposures.