Photosensitive Lichenoid Eruption due to Enalapril

Amrinder J. Kanwar, Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh (India) Cutaneous reactions to enalapril, an angiotensin-converting enzyme inhibitor, are relatively less frequent as compared to capto-pril [1]. We describe a patient who developed a photosensitive lichenoid eruption shortly after starting enalapril for essential hypertension. A 44-year-old housewife presented with erythematous lichenoid papular scaly plaques on the forehead and extensors of the forearms of 3 weeks’ duration. The lesions were moderately itchy. She was diagnosed to have essential hypertension about 6 months back for which she was prescribed nifedipine 10 mg three times a day. However, as the blood pressure was not under control, enalapril 10 mg twice a day was substituted about 6 weeks back by her general practitioner. There was no history of any other drug intake. The lichenoid eruption was considered to be due to enalapril, and on its withdrawal and treatment with topical corticoste-roids and systemic antihistaminics, the rash resolved over a period of 3 weeks. Angiotensin-converting enzyme inhibitors are being increasingly prescribed in patients with hypertension as these are highly effective and relatively free from side effects. Though cutaneous adverse effects with enalapril have been reported [2, 3], these are much less as compared to captopril because enalapril does not contain the thiol group which is thought to be responsible for skin eruption. The resolution of the lesions on withdrawal of enalapril suggested it to be due to this drug. The patient did not agree to a challenge test. References Moots RJ. Keeling PJ. Morgan SH: Aduli Schönlein-Henoch purpura after enalapril Lancet 1992;340:304-305. Furness PN, Goodfield MJ. MacLennan KA et al: Severe cutaneous reactions to captopri and enalapril: Histopathological studies an¢ comparison with mycosis fungoides. J Clii Pathol 1986;39:902-907. Barnes JN, Davies ES, Gent CB: Rash, eosin ophilia and hyperkalemia associated with ena lapril. Lancet 1983;i:41-42.