CARBAMAZEPINE-INDUCED PELLAGROID DRUG REA CTION

All-year-old girl suffering from grand mal epilepsy underwent antiepil eptic therapy with carbamazepine (600 mg/daily). Two weeks after incre asing the dose (900 mg/day) she suddenly developed relatively sharply limited, sunburn-like brown reddish macular lesions with central scali ng and partly hyperkeratotic areas on the hands, feet, face, knees, gl uteal and axillar regions. Otherwise no health disorders were found; i n particular no neurological or gastrointestinal symptoms occurred. Af ter reduction of the dosis (450 mg/day) these skin lesions faded away. With exception of elevated serum levels of carbamazepine, nicotinamid e and vitamin B6, all blood tests were in normal range. Interactions o f carbamazepine with the vitamin B6-nicotinamide metabolism are the re ason for these previously undescribed cutaneous side effects in connec tion with carbamazepine therapy. The present case demonstrates a toxic , non-allergic reaction during carbamazepine treatment with pellagroid skin symptoms.