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Ajay J. Varma, MD; Benjamin K. Fisher, MD; Michael K. Sarin, MD

Arch Intern Med. 1977;137(9):1207-1210.

Abstract
Bullous skin lesions that indicate sweat gland necrosis have been known to occur in drug-induced coma resulting from barbiturates and in carbon monoxide poisoning. To our knowledge, this is the first case in which diazepam is implicated in causing bullous lesions over pressure points, and the first case showing on biopsy specimen eccrine sweat gland and sweat duct necrosis. Penile and oral lesions are being described here for the first time to our knowledge. The following mechanisms could be responsible for the skin lesions: hypoxia, local pressure, hyperthermia with excessive sweating, and a specific toxic effect on the eccrine gland. With the increasing use of the benzodiazepines, such lesions could be seen more frequently in the future.

(Arch Intern Med 137:1207-1210, 1977)

Author Affiliations
From the Department of Medicine (Drs Varma and Sarin), the Division of Dermatology (Dr Fisher), The Wellesley (Toronto) Hospital, and the University of Toronto Medical School.

Footnotes
Accepted for publication Sept 21, 1976.

Reprint requests to Suite 326, Jones Building, The Wellesley Hospital, 160 Wellesley St E, Toronto, Ontario, Canada M4Y 1J3 (Dr Fisher).

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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Blisters of the Skin in Coma Induced by Amitriptyline and Clorazepate Dipotassium: Report of a Case With Underlying Sweat Gland Necrosis
Herschthal and Robinson
Arch Dermatol 1979;115:499-499.
ABSTRACT