ECZEMA/TEGRETOL

MY 3 YEAR OLD DAUGHTER, RECENTLY DIAGNOSED WITH A SEIZURE DISORDER HAS DEVELOPED A CLASSIC ECZEMA LIKE RASH ON HER TRUNK AND EXTREMITIES.  SHE IS ON TEGRETOL AND THIS DOES NOT APPEAR TO MYSELF (A FAMILY PHYSICIAN), HER DERMATOLOGIST, OR HER NEUROLOGIST TO BE A DRUG RASH.  IT IS RESPONSIVE TO STEROID TOPICAL AND MOISTURIZATION.  THE TEGRETOL HAD TO BE STOPPED FOR A SIGNIFICANT DROP IN HER PLATLET COUNT, ALONG WITH A MILD PANCYTOPENIA.  THE TEGRETOL WAS REINTRODUCED AFTER TWO WEEKS BECAUSE THE HEMATOLOGIST WAS NOT CONVINCED THAT SHE DIDN'T HAVE A COEXISTING VIRUS THAT CAUSED THE CHANGE.  AFTER TWO DOSES OF THE TEGRETOL SHE HAS VERY WARM BRIGHT PINK CHEEKS AND IS SLIGHTLY ITCHY.  THE ECZEMA SEEMS TO HAVE FLAIRED.  OF NOTE HER BLOOD WORK DID NOT SHOW ANY LFT ABNORMALITY AND SHE HAS NOT HAD A FEVER SUGGESTIVE OF A TYPICAL HYPERSENSITITY RX.  HAS ECZEMA (IN HER CASE NUMULAR ) BEEN SEEN BEFORE WITH TEGRETOL?   I AM NOT THAT ANXIOUS TO STOP THIS MEDICATION BECAUSE OF LIMIT IN OUR OTHER CHOICES, UNLESS THIS REALLY IS FROM THE TEGRETOL

[Alan Rockoff, MD]

I see no reason for you to consider stopping the Tegretol.  Drug rashes are deep purple, progressive, and completely unresponsive to topical therapy.  So I think your daughter has ordinary eczema, which should be treated as such.

Best.

Dr. Rockoff