Olmesartan: Induced maculopapular rash
A 45-year-old married female, a known case of diabetes since 2 years, was diagnosed with hypertension 4 months ago for which she was prescribed olmesartan medoxomil 10 mg once daily. Her diabetes was well controlled by metformin 500 mg once daily. The patient did not give any past or family history of allergy or dermatological diseases. Within 1 week of starting treatment with olmesartan, the patient developed itchy maculopapular erythematous rashes over the neck and lips as shown in . However, she did not attribute it to the drug and thought them to be due to photosensitivity. Inspite of extensive use of sunscreen, the rashes slowly progressed and affected forearms as well. The rashes were becoming larger, more pruritic and had spread all over the body within 2 months. She consulted a dermatologist who prescribed topical fluticasone ointment and levocetrizine 5 mg once daily. The differential diagnosis of sun allergy and drug allergy were considered. The patient was already taking sun protection measures hence polymorphous light eruption was ruled out and no new drug except olmesartan was taken by the patient, which was stopped by the dermatologist. She was also advised to consult an endocrinologist, who suspected olmesartan to be the causal drug and an alternative drug, nebivolol 5 mg once daily was prescribed for hypertension. The patient was regularly followed up and remarkable improvement in her condition was seen over a period of 2 weeks following the change of medication. No adverse sequelae were reported.