THERAPEUTIC HOTLINE Frictional purpuric eruption associated with angiotensin II receptor blockers Caterina Foti*, Anna Maria Carbonara‡, Stefania Guida*, Annarita Antelmi*, Antonio Mazzocca†, Paolo Romita*, Domenico Bonamonte*, & Giovanni Angelini* *Department of Biomedical Sciences and Human Oncology, Section of Dermatology, †Department of Emergency and Organ Transplantation, Section of Internal Medicine, Allergology and Clinical Immunology, University of Bari Medical School, Bari, and ‡Dermatology Department, Di Venere Hospital, Bari-Carbonara, Italy ABSTRACT: Angiotensin II receptor blockers (ARBs) are drugs generally well tolerated. There are few reports about cutaneous side effects of ARBs. The present authors describe herein four cases of purpuric eruption mainly involving sites of friction in patients taking ARBs. These eruptions completely cleared after stopping the drug and implementing preservative measures to reduce friction. KEYWORDS: angiotensin II receptor blockers, cutaneous side effects, purpuric dermatitis Introduction Angiotensin II receptor blockers (ARBs) are widely used alone or in combination with other drugs for the treatment of hypertension (1), heart failure (2) and proteinuric chronic kidney disease (3). Herein, the present authors report four cases of purpuric dermatitis mainly involving sites of friction in patients taking ARBs. Case reports Case no. 1 A 58-year-old woman with an asymptomatic pur- puric eruption presented to our attention. Her medical history revealed previous allergic contact dermatitis to nickel sulfate and surgery for colon cancer 10 years earlier. One year before our con- sultation, she had been treated for hypertension with a combination of valsartan and hydrocloro- tiazide (HCT) (80/12.5 mg), one tablet daily. After 7 days of therapy, she complained a purpuric eruption involving the palms with subsequent spread to the forearms (FIG. 1). The rash cleared progressively in 2 months after stopping the drug. Address correspondence and reprint requests to: Caterina Foti, Associate Professor, Department of Biomedical Sciences and Human Oncology, Section of Dermatology, University of Bari Medical School, 70124 Bari, Italy, or email: c.foti@dermatologia.uniba.it. Conflict of interest: None. Financial support: None. 97 Dermatologic Therapy, Vol. 27, 2014, 97–100 Printed in the United States · All rights reserved © 2013 Wiley Periodicals, Inc. DERMATOLOGIC THERAPY ISSN 1396-0296