IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 8 Ver. 3 (August. 2018), PP 34-35 www.iosrjournals.org DOI: 10.9790/0853-1708033435 www.iosrjournals.org 34 | Page An Unusual side effect of Clomiphene Citrate (Clomid) Dr. Ambika Rajendran Minu MBBS 1 , Dr. Nidhi Shankar Kikkeri MBBS 2 , Dr. Norcross James DO 3 , Dr. Valayamkandathil MohanShibillaMBBS 1 Clinical Extern, Saint John Patrick Medical Clinic, Long Beach, CA, USA, 2 Clinical Observer, University ofMissouri,Columbia,MO,USA, 3 Physician, Naples Medical Group, Long Beach, CA, USA Corresponding Author:Dr. Ambika Rajendran Minu MBBS Abstract: Clomiphene citrate(Clomid) is a Selective Estrogen Modulator used to induce ovulation. 1 Many side effects of Clomiphene citrate were reported including mood swings and hot flashes. 2 Stimulation of multiple follicles and consequently multiple gestation is a complication of Clomid. Skin rash is a reported non-serious and un common side effect of Clomid. 3 We report a case of a 31-year-old female who developed thinning and whitening of the vulvararea after taking clomid. KeyWords: Clomiphene citrate (Clomid), Lichensclerosus like lesion, Thinning of skin, Side effect --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 28-07-2018 Date Of Acceptance: 12-08-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Clomiphene citrate is a widely used drug for ovulation induction in women desiring pregnancy. 4 It is mainly used to increase follicular number and fertility. 5 It primarily acts at the hypothalamus to block the negative feedback effect of circulating estradiol by binding and depleting hypothalamic estrogen receptors 6,7 . Clomiphene thereby causes a hypoestrogenic effect. This in turn leads to an increase in hypothalamic gonadotropin-releasing hormone (GnRH) pulse frequency, thereby leading to increased concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) 8 . The dose of clomiphene to be administered is titrated based on the response of thepatient. 3 Clomid is reported to have produced a 70%-80% ovulatory rate in patients receiving the drug. 3 II. Case Report A 31-year-old female, P0A1L0 presents with severe vaginal itching and excoriation since 2 months. She first noticed the itching 3 days after finishing a cycle of Clomid (Clomiphene Citrate). She was prescribed Clomiphene Citrate 50mg for the first cycle,100 mg for the second cycle and 150 mg for the third cycle from day 5 to day 7. She first developed itching 3 days after finishing the first cycle of Clomid. The itching gradually became severe with excoriations. The itching initially started around the vulva and spread to the perianal area. She developed a dull lower abdominal pain 2 days after the itching started. The pain was diffuse, over the pelvic region,4/10 in intensity, non-radiating with no aggravating and relieving factors. She denied the presence of any vaginal discharge. Past and family history insignificant. No history of previous STIs. On Physical examination, there was mild erythema over the vulvar and perianal region, but there was no vaginal discharge. There was no cervical motion tenderness. Abdomen was soft, non-tender, non-distended and bowel sounds were heard in all four quadrants. Cervical swab taken at that time was negative for Chlamydia and Gonorrhea. The pain subsided after two days but the itching persisted. She was advised to keep the area dry and to avoid the use of soaps and detergents. As she was trying to conceive, steroids were not prescribed. The itching reduced in intensity over the next 2 weeks but did not completely resolve. The itching worsened immediately after the second cycle of clomid. She also noticed bleeding PR but denied abdominal or pelvic pain. She also noticed that her menstrual flow turned black after the first cycle of Clomid. The itching became so severe as to affect her daily functioning. On physical examination the vulvar and perianal regions were erythematous and edematous. There were excoriations all around the perineal area. The labia majora appeared thinner, whitish and wrinkled, resembling lichen sclerosus. There was no vaginal discharge. There were no hemorrhoids or fissures around the anal area. There was no active bleeding per rectum. Patient was advised to stop Clomid and was prescribed topical steroid. The symptoms gradually improved, and the steroid was tapered off after a week of application. During follow-up visit one month later, the patient was symptom free. On physical examination, there was no erythema or edema. The labia majora and perianal area looked normal. The majora no longer looked thinner nor whitish. There were