Practolol rash

Although the so-called psoriasiform rash is the main practolol rash , Assem and Banks (1973) reported lichenoid eruptions in a patient on practolol and various other types of mixed eruptions have also been reported (Felix et al. 1974). Figures generated in November 1977 indicated that the average time on practolol to development of the practolol rash was 19.1 months, with a range of 1-84 months (Nicholls 1978). 

Practolol (Figure 8.13) was the prototype cardioselective p-adrenoceptor blocking agent. Selectivity was achieved by substitution in the para position with an acetyl anilino function. The similarity of this drug with those outlined above is obvious. Practolol caused severe skin and eye lesions in some patients which led to its withdrawal from the market [6]. These lesions manifested as a rash, hyperkeratosis, scarring, even perforation of the cornea and development of a fibrovascular mass in the conjunctiva, and sclerosing peritonitis. Some evidence is available that the drug is oxidatively metabolized to a reactive product that binds irreversibly to tissue pro-... 

This antihypertensive drug was withdrawn from use after a number of cases of occulomucocutaneous syndrome (skin rashes, keratinization of the eye, and other tissues). Mechanism is unknown, but there is evidence for metabolism (microsomal enzyme mediated) to a reactive intermediate capable of reacting with protein and forming antigenic conjugates. Antipractolol antibodies are detected in patients. Syndrome is not reproducible in animals, but in hamsters, practolol accumulates in the eye. 

Rashes were part of the practolol (oculomucocutaneous) syndrome, but are infrequent with other beta-adrenoceptor antagonists. The eruptions can be urticarial, morbilliform, eczematous, vesicular, bullous, psoriasiform, or lichenoid (250-255). 

Practolol. This antihypertensive drug was withdrawn from use after a number of cases of occulomucocutaneous syndrome (skin rashes, keratinization of the eye and other tissues). Mechanism... 

The main target tissues incorporated in the oculomucocutaneous syndrome are skin, conjunctiva, serosal surfaces, and peritoneum, but there are reports of fibrotic reactions affecting the lungs and liver which appear to be the result of practolol therapy. Brown et al. (1978) reported two patients who developed biliary cirrhosis after long-term practolol administration. One of the patients also had an eczematous rash and complained of dry eyes, and the second had the typical psoriasiform rash. 

Scott, D.F. and Williams, P. (1975) Skin rash, conjunctivitis and plastic peritonitis with practolol therapy (Letter). Med. J. Aust., I, 44. 

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