Deposits of Plasma Proteins in the Skin during Treatment with Carbamazepine and Diphenylhydantoin

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Abstract
Biopsies from skin of normal appearance from 18 patients treated with carbamazepine and diphenylhydantoin were investigated by a direct immunofluorescence technique. Seventeen had deposits of plasma proteins at the dermoepidermal junction, 16 had deposits in the vessel walls and 1 had autofluorescence of the nuclei in the epidermis and vessel walls. These findings did not correlate with changes in serum Ig[immunoglobulin]G, IgA, IgM, IgD, IgE or .alpha.2-macroglobulin. Eight patients had elevated alkaline phosphatase, 4 elevated IgG and 1 elevated IgA. Three had low values of IgA and all had normal values of IgM, IgD and IgE and blood cells. In 3 patients, carbamazepine was withdrawn, whereupon the deposits disappeared in 2 and decreased in the 3rd, who changed to another drug. Changes were quantitatively and qualitatively similar to those seen in systemic lupus erythematosus induced by these drugs.