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Gerard Marshall Raj* and Jayanthi Mathaiyan


Carbimazole-induced dermatitis in Graves’ disease: dose dependent A 24-year-old lady came to the Endocrinology Out-patient Department of a tertiary care hospital with darkening of the skin over the dorsal and palmar aspects of both the hands and feet (Figures 1 and 2). She also complained of severe itching at the sites of colour change. Her case records revealed that one month prior to the current visit, she had been diagnosed to have Graves‟ disease (Figure 3) and was started on tablet carbimazole (Neomercazole) 10 mg thrice daily and tablet propranolol 40 mg once daily. Two weeks after intake of medications she developed multiple small blisters over the fingers and toes. She also had cramps, fever and dry cough. Accidental rupture of the blisters with her fingernails resulted in watery discharge. This was associated with intense itching over the lesions. The patient stopped the drug on her own and she found that the blisters and itching began to subside. The patient was admitted with a provisional diagnosis of irritant dermatitis for observation and investigations. Haemogram suggested normocytic and normochromic erythrocytes with adequate number of platelets; mild leucopenia with normal eosinophil count. The KOH mount for fungus was negative, and also the Grams‟ staining for gram positive cocci, gram negative rods and yeast cells was negative. The patient was restarted on carbimazole tablets 5 mg twice a day. Skin biopsy, other investigations like DCT, ICT, CPK, LDH, ECG, Echo, viral markers and ANA were suggested for the patient. The patient did not report for these investigations. However, on enquiry over the telephone, she said that the skin lesions were improving and she was fine with the reduced dose of carbimazole. She also informed to be taking the tablets regularly.

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