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Pigmented Purpuric Dermatosis Associated With Creatine Supplementation

Pigmented Purpuric Dermatosis Associated With Creatine Supplementation Report of a Case An otherwise healthy 28-year-old man with a history of allergic rhinitis was seen for a rash of the legs. The lesions had developed intermittently during the past 3 months. Physical examination revealed six 1- to 2-cm annular, erythematous, nonscaly plaques of the thighs with a cayenne pepper–like appearance, suggesting a pigmented purpuric dermatosis (PPD) (Figure 1). A biopsy specimen of a lesion revealed histologic findings consistent with PPD (Figure 2). Microscopically, there was a superficial, perivascular, lymphocytic infiltrate with extravasation of erythrocytes in the papillary dermis. The patient was a weightlifter and had been taking a commercial dietary supplement containing creatine and hydroxymethylbutyrate for the past 6 years. It was decided that the patient should discontinue taking this supplement, and within 2 weeks, the lesions had resolved leaving some mild postinflammatory changes. A rechallenge with the supplement was not undertaken. Figure 1. View LargeDownload Clinical features of pigmented purpuric dermatosis affecting the right thigh. The patient developed six 1- to 2-cm annular erythematous plaques on the legs. Figure 2. View LargeDownload Histologic findings in the biopsy specimen include a superficial perivascular lymphocytic infiltrate with extravasated red blood cells. Comment While most cases of PPD are idiopathic, certain medications can cause PPD, including nonsteroidal anti-inflammatory drugs, antihypertensive agents, lipid-lowering agents, diuretics, antidepressants, and various antibiotics. In some of these cases, the patients have taken the causative drug for years before developing the lesions.1 In this case, the dietary supplement was suspected of causing the PPD because the lesions quickly regressed following discontinuation of supplement ingestion. A literature review failed to identify any reported associations between creatine or hydroxymethylbutyrate and PPD. Alternative explanations in this case are that the PPD was caused by another ingredient in the dietary supplement, such as an inactive compound or a contaminant, or that the resolution of the PPD was coincidental with the discontinuation of supplement ingestion. To the best of our knowledge, this is the first report of an association between creatine and hydroxymethylbutyrate supplementation and PPD. It is suggested that for the athletic patient who presents with PPD, dietary supplement use should be investigated. Correspondence: Dr Cohen, 499 E Hampden Ave, No. 450, Englewood, CO 80113 (denverskindoc@yahoo.com). Financial Disclosure: None reported. References 1. Nishioka KKatayama IMasuzawa M et al. Drug-induced chronic pigmented purpura. J Dermatol 1989;16220- 222PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Pigmented Purpuric Dermatosis Associated With Creatine Supplementation

Chorny, Joe A.; Cohen, Joel
Archives of Dermatology , Volume 142 (12) – Dec 1, 2006
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References (1)

Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.142.12.1662
Publisher site
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Abstract

Report of a Case An otherwise healthy 28-year-old man with a history of allergic rhinitis was seen for a rash of the legs. The lesions had developed intermittently during the past 3 months. Physical examination revealed six 1- to 2-cm annular, erythematous, nonscaly plaques of the thighs with a cayenne pepper–like appearance, suggesting a pigmented purpuric dermatosis (PPD) (Figure 1). A biopsy specimen of a lesion revealed histologic findings consistent with PPD (Figure 2). Microscopically, there was a superficial, perivascular, lymphocytic infiltrate with extravasation of erythrocytes in the papillary dermis. The patient was a weightlifter and had been taking a commercial dietary supplement containing creatine and hydroxymethylbutyrate for the past 6 years. It was decided that the patient should discontinue taking this supplement, and within 2 weeks, the lesions had resolved leaving some mild postinflammatory changes. A rechallenge with the supplement was not undertaken. Figure 1. View LargeDownload Clinical features of pigmented purpuric dermatosis affecting the right thigh. The patient developed six 1- to 2-cm annular erythematous plaques on the legs. Figure 2. View LargeDownload Histologic findings in the biopsy specimen include a superficial perivascular lymphocytic infiltrate with extravasated red blood cells. Comment While most cases of PPD are idiopathic, certain medications can cause PPD, including nonsteroidal anti-inflammatory drugs, antihypertensive agents, lipid-lowering agents, diuretics, antidepressants, and various antibiotics. In some of these cases, the patients have taken the causative drug for years before developing the lesions.1 In this case, the dietary supplement was suspected of causing the PPD because the lesions quickly regressed following discontinuation of supplement ingestion. A literature review failed to identify any reported associations between creatine or hydroxymethylbutyrate and PPD. Alternative explanations in this case are that the PPD was caused by another ingredient in the dietary supplement, such as an inactive compound or a contaminant, or that the resolution of the PPD was coincidental with the discontinuation of supplement ingestion. To the best of our knowledge, this is the first report of an association between creatine and hydroxymethylbutyrate supplementation and PPD. It is suggested that for the athletic patient who presents with PPD, dietary supplement use should be investigated. Correspondence: Dr Cohen, 499 E Hampden Ave, No. 450, Englewood, CO 80113 (denverskindoc@yahoo.com). Financial Disclosure: None reported. References 1. Nishioka KKatayama IMasuzawa M et al. Drug-induced chronic pigmented purpura. J Dermatol 1989;16220- 222PubMedGoogle Scholar

Journal

Archives of Dermatology – American Medical Association

Published: Dec 1, 2006

Keywords: creatine

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