Epidermal necrolysis (EN) is a rare, but potentially life threatening disease, characterized by epidermal necrosis and sub-epidermal detatchment, and is predominantly medication-induced. Methazolamide is a sulfonamide derivative and carbonic anhydrase inhibitor used for lowering of intraocular pressure in glucomatous patients. Common side effects of methazolamide include metabolic acidosis, hypokalemia, tinnitus, transient myopia, and renal calculi; however, EN caused by methazolamide is very rare. We report on two cases of EN induced by methazolamide treatment and review previously published cases.
Acidosis ; Carbonic Anhydrases ; Humans ; Hypokalemia ; Intraocular Pressure ; Methazolamide ; Myopia ; Necrosis ; Tinnitus

Methazolamide is a sulfonamide derivative and carbonic anhydrase inhibitor used to lower intraocular pressure in glaucomatous eyes. Stevens-Johnson syndrome (SJS)-toxic epidermal necrolysis (TEN) associated with methazolamide treatment has been reported in Korean and Japanese patients. We report two cases of SJS-TEN associated with methazolamide treatment. The result of HLA typing of our two patients was a positive reaction for HLA-B59, which is specific to Koreans and Japanese. This suggests a possible relationship between genetic background and SJS-TEN associated with methazolamide treatment. Therefore, methazolamide should be prescribed with caution to Korean or Japanese patients.
Asian Continental Ancestry Group ; Carbonic Anhydrases ; Histocompatibility Testing ; Humans ; Intraocular Pressure ; Methazolamide* ; Stevens-Johnson Syndrome*

There have been reports between Stevens-Johnson syndrome (SJS)induced by methazolamide treatment and genetic background especially in Japanese and Korean descent.We report 6 cases of SJS and the results of HLA (human leukocyte antigen)typing that suggest a relationship between genetic background and SJS induced by methazolamide treatment. We observed 6 patients as the subjects of this research, who had been suffering from SJS induced by methazolamide treatment at the Department of Ophthalmology, Catholic University.SJS appeared about 2 weeks after the patient started taking methazolamide (100 or 200 mg/d).After 15~30 days of treatment, they recovered with no serious complication.The results of HLA typing carried out 6 patients that all of the patients had HLA-A2, 5 patients were HLA-Cw1 and HLA-B59. Methazolamide should be carefully prescribed in patients of Japanese or Koreans descent and should not prescribe sulfonamide in SJS patients. A further systematic research on more cases is required to explaining ethnic peculiarity of the syndrome.
Asian Continental Ancestry Group ; Histocompatibility Testing ; HLA-A2 Antigen ; Humans ; Leukocytes ; Methazolamide* ; Ophthalmology ; Stevens-Johnson Syndrome*

Recently, Stevens-Johnson syndrome associated with methazolamide has been reported in Koreans, more frequently. Methazolamide is a carbonic anhydrase inhibitor commonly used for lowering intraocular pressure in glaucoma and other ophthalmologic diseases. We reported five cases of Stevens-Johnson syndrome induced by methazolamide. All patients showed atypical clinical manifestations, compared to classical Stevens-Johnson syndrome. Methazolamide induced Stevens-Johnson syndrome showed scattered or confluent maculopapular eruptions initially, which are similar to morbiliform drug eruption with mild lip erosion and palmar erythema. Even though there was no skin erosion initially, it showed rapid progression to severe erosion on the trunk and palmoplantar erythema within 5 to 7 days. Therefore, our data indicated that methazolamide induced Stevens-Johnson syndrome should be checked for a patient who has a history of ophthalmologic treatment with a drug eruption like skin lesion.
Carbonic Anhydrases ; Drug Eruptions ; Erythema ; Glaucoma ; Humans ; Intraocular Pressure ; Lip ; Methazolamide ; Skin ; Stevens-Johnson Syndrome

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the potentially life-threatening, acute hypersensitivity reaction to inciting drugs. These diseases have been often associated with systemic carbonic anhydrase inhibitor such as acetazolamide or methazolamide in Korean and Japanese patients. Dorzolamide is a recently developed topical carbonic anhydrase inhibitor with few significant systemic adverse effects. To the best of our knowledge, there have been only a few reports of SJS or TEN caused by topical dorzolamide in the literature. We herein present two cases of TEN and one case of SJS related with topical use of dorzolamide. It should be emphasized that although rarely, topical dorzolamide may cause serious sulfonamide hypersensitivity such as SJS or TEN in the susceptible patient through the systemic absorption.
Absorption ; Acetazolamide ; Asian Continental Ancestry Group ; Carbonic Anhydrases ; Epidermal Necrolysis, Toxic ; Humans ; Hypersensitivity ; Methazolamide ; Stevens-Johnson Syndrome ; Sulfonamides ; Thiophenes

Methazolamide is a carbonic anhydrase inhibitor commonly used for lowering intraocular pressure in glaucoma and other ophthalmologic diseases. Carbonic anhydrase inhibitors are sulfonamide derivatives that are known to cause many adverse side effects, including dermatologic reactions. Recently, Stevens-Johnson syndrome (SJS) associated with methazolamide treatment has been reported in Japanese and Japanese Americans, and it suggested a relationship between genetic background and methazolamide-induced SJS. We report four cases of SJS induced by methazolamide. Methazolamide should be prescribed with caution in patients of Japanese or Korean descent.
Asian Americans ; Asian Continental Ancestry Group ; Carbonic Anhydrase Inhibitors ; Carbonic Anhydrases ; Glaucoma ; Humans ; Intraocular Pressure ; Methazolamide* ; Stevens-Johnson Syndrome*

There have been recent reports on the increasing number of Stevens-Johnson syndrome cases resulting from methazolamide and its relatively higher incidence in Japanese and Korean than any other people. The objective of this study is to examine its developement potential in Korean people.We observed three patients as the subjects of this research, who had been suffering from skin eruption during glaucoma treatment in the Department of Ophthalmology Catholic University, College of Medicine. All of them, for lowering IOP, took methazolamide 50mg a day for more than two weeks, but they had no history of systemic disease but glaucoma or hypersensitivity induced by other medications. With regard to their skin, vesicular eruption came out in their whole body and particularly oral mucosa severely. Also, systemic symptom such as slight fever and general malaise was accompained . However, by quitting the use of methazolamide and medicating corticosteriods instead, they recovered with no serious complication.It can be concluded, therefore, that they had Stevens-Johnson syndrome mainly by methazolamide based on the condition of their skin eruptionand the fact that they got well again by stopping the use of methazolamide on which they chiefly relied. However, a further systematic research on more cases os required with a view to elucidating confirmatory diagnosis and ethnic pecularity of the syndrome.
Asian Continental Ancestry Group ; Diagnosis ; Fever ; Glaucoma ; Humans ; Hypersensitivity ; Incidence ; Methazolamide* ; Mouth Mucosa ; Ophthalmology ; Skin ; Stevens-Johnson Syndrome*

PURPOSE: Acute mountain sickness (AMS) commonly occurs when unacclimatized individuals ascend to altitudes above 2500 m. Acetazolamide, a carbonic anhydrase inhibitor (CAI), is recommended for AMS prophylaxis, but may have adverse effects such as paresthesia. Methazolamide has the same pharmacologic effect, but diffuses more rapidly into tissue and is more potent than acetazolamide. But, little is known about methazolamide as an AMS prophylactic agent. This study was conducted to prospectively compare metazolamide with acetazolamide for its preventive effect for AMS in adolescents. METHODS: Nineteen adolescents aged 13~18 years attempting an ascent of Mt. Kalapatar (5500 m) were randomly divided to receive acetazolamide (n=10) or methazolamide (n=9). Oxygen saturation (SpO2) and pulse rate were measured at each altitude. The incidence of AMS was calculated using the Lake Louise questionnaire. Difference in incidence between two groups was analyzed using generalized estimating equation. Difference in Lake Louise scores (LLS) was analyzed using linear mixed model testing. RESULTS: Overall incidence of AMS was 68.4%. Fatigue or malaise was the most frequent symptom (94.7%) followed by headache (84.2%). SpO2 decreased as the altitude increased (p<0.001). There was no difference in SpO2 and pulse rate between the two groups (p=0.44). There was no difference in LLS (p=0.22) and incidence of AMS (p=0.07) between the two groups with increasing altitude. Paresthesia was less common in the methazolamide group, but was not statistically different (p=0.35). CONCLUSION: Methazolamide is equally effective as acetazolamide in preventing AMS among adolescents.
Acetazolamide ; Adolescent ; Aged ; Altitude ; Altitude Sickness ; Carbonic Anhydrases ; Fatigue ; Headache ; Heart Rate ; Humans ; Incidence ; Lakes ; Methazolamide ; Oxygen ; Paresthesia ; Prospective Studies ; Surveys and Questionnaires

Among various dermatological entities, toxic epidermal necrolysis (TEN) is a rare but potentially fatal delayed hypersensitivity reaction to numerous medications. A 38-year-old male presented with systemic hypersensitivity reaction, such as high fever, pain in the eyes, and diffuse pruritic erythematous maculopapular eruptions with multiple targetoid plaques that became vesicular and bullous. Oral mucosa and conjunctivae were involved. The first sign appeared about 1 week after taking methazolamide (50 mg twice a day) for the management of glaucomatous eyes. Although methazolamide was discontinued, blistering and skin denudation progressed to affect up to 80% of the body surface area and a positive Nikolsky sign was noted. High fever also persisted. Skin lesions started to improve after 2 weeks of management and fever subsided. Cutaneous lesions improved with minimal permanent sequele 2 months later. HLA-B*5901 was found by high-resolution genotyping. The lymphocyte activation test performed 6 months after remission showed a positive response to methazolamide challenge. This is the first case of methazolamide-induced TEN in which methazolamide was confirmed as a culprit drug by the lymphocyte activation test.
Adult ; Blister ; Body Surface Area ; Conjunctiva ; Fever ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Lymphocyte Activation* ; Lymphocytes* ; Male ; Methazolamide ; Mouth Mucosa ; Skin ; Stevens-Johnson Syndrome*

A 53-year-old man having glaucoma treated with acetazolamide. After 7 days, he developed diffuse erythematous papules on both forearms and hands with multiple erosive lesions on his lips and genitalia. In the diagnosis of Stevens-Johnson syndrome, he was treated with systemic prednisolone with no sequale. Acetazolamide, which is a kind of sulfa drug and carbonic anhydrase inhibitor is commonly prediscribed by ophthalmologists. However severe side effects such as Stevens-Johnson syndrome has been overlooked. Moreover, according to recent research, HLA-B59 was known to be detected in Stevens-Johnson syndrome caused by methazolamide, which is analogous to acetazolamide. For these reasons, we emphasized the possibility of adverse drug reaction due to acetazolamide and the need caution about genetic risk factor through HLA typing.
Acetazolamide* ; Carbonic Anhydrases ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Forearm ; Genitalia ; Glaucoma ; Hand ; Histocompatibility Testing ; Humans ; Lip ; Methazolamide ; Middle Aged ; Prednisolone ; Risk Factors ; Stevens-Johnson Syndrome*