Letters to the Editor
Fungal Dermatitis with Olanzapine in Schizophrenia
Dear Editor:
Premarketing studies of olanzapine found a 2% incidence of fungal dermatitis vs 0% with placebo (1). To our knowledge, there are no other published reports of olanzapine fungal dermatitis. We report a patient with schizophrenia who developed fungal dermatitis soon after starting olanzapine.
Case Report
Mr A, age 24 years, was recently diagnosed with DSM-IV schizophrenia, paranoid type. His psychiatric history included 2 brief admissions for psychosis in other hospital centres. On both occasions, the patient stopped taking his medication immediately after discharge. Medical history, including a history of dermatologic disease, was otherwise negative. At the time of presentation to our hospital centre, Mr A denied using any psychiatric medication for 4 years. He initially received 1 dose of haloperidol for agitation and began olanzapine 20 mg daily, with lorazepam 1 mg daily, as needed. A physical examination revealed no physical abnormalities, including no dermatologic abnormalities.
Two weeks after beginning olanzapine, Mr A noticed a new, pale tan, circular, scaly, mildly pruritic patch on the anterior of his right shoulder. Three weeks later, the dermatologic abnormality persisted, and dermatology was consulted. The dermatologist confirmed the diagnosis of a fungal dermatitis, tinea versicolor, and prescribed topical ketoconazole cream. The infection appeared to be improving after several weeks. The patient was discharged but was noncompliant with follow-up.
Discussion
Tinea versicolor, a superficial mycosis, is caused by several of the species of the genus, Malassezia (2). It occurs primarily in the tropics but is not rare in North America (2). Other reported dermatologic adverse effects of olanzapine include vesiculobullous eruption, pruritus, and peripheral edema (3). Although other antipsychotic agents have been associated with various dermatologic manifestations—including exanthems, pruritus, photosensitivity, angioedema, exfolliative dermatitis, and cellulitis—none except for ziprasidone have reported occurrences of fungal dermatitis linked with their use (3). In this otherwise healthy patient with a negative history of fungal dermatitis, the infection arose 2 weeks after the initiation of pharmacotherapy, which supported the strength of this association. Resolution of the dermatitis after antifungal treatment, despite continuing olanzapine, makes it difficult to be certain about the causal nature of this relation. Nevertheless, physicians should be sensitive to the possibility of fungal dermatitis as a complication of olanzapine pharmacotherapy.
References
1. Eli Lilly Canada Inc. Product Monograph Zyprexa and Zyprexa Zydis, Toronto: Eli Lilly Canada Inc; 2000. p. 19–25.
2. Gupta AK, Bluhm R, Summerbell R. Pityriasis versicolor. J Eur Acad Derm Venereol 2002;16:19–33.
3. Litt JZ, editor. Drug Eruptions Reference Manual: DERM. 8th ed. New York: Parthenon Group; 2002.
Tomas Fogl, MD
Howard C Margolese, MD, CM, FRCPC
Montreal, Quebec
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