Potentially serious Lamotrigine-related skin rash

ABSTRACT

To report our experience with lamotrigine [LTG]-related skin rash in children with epilepsy. We identified a series of consecutive children with epilepsy treated with LTG prospectively over a 5-year period ending 1st October 2005 at King Abdul-Aziz University Hospital and King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia. Of 207 children on LTG, 15 [7.2%] developed a skin rash with ages ranging between 3-12 years [mean 7.5]. We used LTG as monotherapy in 3/15 and as add on in 12/15, mostly [10/15] in addition to valproic acid [VPA]. The rash was mild with complete recovery in 7 children [47%]. The remaining 8 [3.9% of the total] had severe rash that necessitated admission to hospital. Seven out of these 8 children were also receiving VPA. One child had superimposed secondary bacterial infection and admitted for intravenous antibiotics. Two children recovered slowly with extensive post-inflammatory hyperpigmentation. We diagnosed Stevens-Johnson syndrome in 5 children [2.4% of the total]. One of these 5 children had progressive symptoms that evolved to toxic epidermal necrolysis. He required prolonged intensive care admission and developed sepsis with disseminated intravascular coagulopathy. He deteriorated despite supportive therapy, and died 5 weeks after the initiation of LTG therapy. Lamotrigine is a novel antiepileptic drug with a favorable therapeutic profile and good tolerability. However, LTG-related skin rash is a potentially serious adverse event that should be carefully monitored. Although the risk is small, one should weigh this against the potential benefits, particularly in children on VPA