Toxic epidermal necrolysis after treatment with lamotrigine (Lamictal®)

Toxic epidermal necrolysis (TEN) is a rare, but very severe cutaneous disorder characterized by necrosis of keratinocytes leading to a loosening of the epidermis’**. As a consequence, lifethreatening dehydration and severe infections may occur. TEN can occur as a result of an adverse reaction to drugs (i.e. Lye11 syndrome) or may be the result of staphylococcal toxins (i.e. staphylococcal scalded skin syndrome, SSSS)‘. We report a case of TEN following treatment with a new antiepileptic drug (AED). Lamotrigine (3,5-diamino-6-(2,3-dichlorophenyl)-1,2,4-triazine) has recently been developed for oral treatment of epilepsy. Clinical trials have shown that lamotrigine is efficacious in controlling epilepsp. Contraindications to treatment are scarce, but include allergy. Reported sideeffects include: maculopapular rash, angioedema and Stevens-Johnson’s syndrome. Minor sideeffects include diplopia, headache, dizziness, ataxia, GI-disturbances and restlessness, but may at least in part be attributed to increased side-effects of concommitant AEDs’. sponse to flickerstimulation and not characteristic for juvenile myoclonic epilepsy. She had previously been treated with valproic acid, phenytoin and vigabatrin. Then she was witout antiepileptic medication for two months. Carbamazepine medication was started at 100 mg BID wih the intention to increase after two weeks, but as the patient had no reduction in seizures and as lamotrigine was a new possibility, carbamazepine was withdrawn and the patient was initated on lamotrigine 50mg/day. The dose was increased by 50 mg every four days. After 12 days she was on lamotrigine monotherapy 100 mg BID and was seizure-free. Seventeen days later (i.e. 29 days after initiation of lamotrigine monotherapy), the patient developed cutaneous symptoms and the medication was immediately changed to .phenobarbital 150 mg/day. Later medication was changed to a combination of phenobarbital 150 mg/day and clobazame 25 mg/day with acceptable effect on her seizures, but with sedative side-effects.