Abstract

ALLOPURINOL-INDUCED EXFOLIATIVE DERMATITIS IN A PATIENT WITH GOUT: A CASE REPORT

Dr. Deepa E.*, Dr. Rathai Rajagopalan, Dr. Anuradha H. V.

ABSTRACT

Background: Allopurinol, a xanthine oxidase inhibitor widely prescribed for gout and hyperuricaemia, is known to cause cutaneous adverse reactions ranging from mild maculopapular rashes to rare, life-threatening Severe Cutaneous Adverse Reactions (SCARs). Exfoliative dermatitis, or erythroderma, is one such rare manifestation, defined by erythema and desquamation involving more than 90% of the body surface area, with a reported incidence of 0.069% among allopurinol-treated patients globally. Case Description: A 60-year-old female developed progressive erythema, scaling, and peeling of skin over the face, neck, hands, and upper back approximately three to four weeks after initiating tablet allopurinol 100 mg twice daily for gout. She was admitted to the intensive care unit and managed with immediate drug withdrawal, oral antibiotics, antihistamines, topical luliconazole, and beclomethasone. Complete clinical resolution was achieved within one week of discontinuation. Discussion: Causality was rated Probable on both the WHO-UMC scale and the Naranjo algorithm. Severity was classified as Level 5 (Severe) on the Modified Hartwig and Siegel scale, given the requirement for ICU admission and permanent drug discontinuation. The reaction was deemed ‘Not Preventable’ by the Schumock and Thornton scale, as no prior allergy was documented and no prescribing error was identified. Conclusion: This case highlights the importance of initiating allopurinol at the lowest effective dose, recognising early cutaneous warning signs and reporting adverse drug reactions to national pharmacovigilance systems to strengthen drug safety surveillance.

Keywords: Allopurinol, Exfoliative Dermatitis, Adverse Drug Reaction, Pharmacovigilance, Gout.