In vivo enalapril-induced acantholysis

Enalapril is a widely used antihypertensive drug with a very powerful in vi tro acantholytic effect, It has been known to potentially induce pemphigus in genetically predisposed subjects. The action mechanism is complex and st ill only partially understood. We describe the case of a 66-year-old man, a ffected with intermediary basal cell carcinoma, in whom the histological ex amination showed suprabasal acantholytic clefts in the perilesional epiderm is. Surprisingly a second biopsy taken from the apparently healthy skin of his back confirmed the presence of acantholytic changes. Clinical signs of pemphigus were absent. The patient's history did not reveal any relevant da ta but a mild arterial hypertension that had been treated for 1 year with 1 0 mg enalapril. Taking into account the patient's history (enalapril long-t erm administration), the absence of any bullous or erosive lesions and the histological findings, a diagnosis was made of in vivo enalapril-induced ac antholysis.