Journal of Clinical and Aesthetic Dermatology

OCT 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

Issue link: http://jcadonline.epubxp.com/i/900562

Contents of this Issue

Navigation

Page 43 of 55

44 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY October 2017 • Volume 10 • Number 10 C A S E R E P O R T G Ginkgo biloba is also referred to as either "the silver apricot," describing its yellow drupe-like fruit, or "the maidenhair tree," since its leaves resemble some of the pinnae of the maidenhair fern. Ginkgo leaf extract has demonstrated efficacy in the treatment of Alzheimer's disease, dementia, intermittent claudication, schizophrenia, tinnitus, and vertigo. It has also been reported to have anticancer, cardioprotective, neuroprotective, memory enhancing, and stress alleviating effects. 1–11 Vinpocetine is also known as ethyl apovincaminate. It is a synthetic-derived vinca alkaloid from the leaves of the lesser periwinkle plant (Vinca minor). The agent has been used in the management of age-related memory impairment and cerebrovascular disorders. It is reported to increase cerebral blood flow. 12-16 Fixed drug eruption describes a cutaneous reaction to a systemic agent that typically presents as an annular or oval erythematous patch or blister and subsequently resolves with postinflammatory hyperpigmentation at the site. Repeat exposure to the same agent typically results in a new skin lesion developing at the same location that was previously affected; in addition, new lesions might also develop. Common locations for fixed drug eruptions include the lips, hands, and genitalia. 17-21 A man developed pruritus and macular erythema on his distal penile shaft after ingesting a natural product containing Ginkgo biloba and vinpocetine. Both the pruritus and erythema resolved after he discontinued the supplement. However, the same local symptom and skin lesion occurred after he restarted the product, confirming the suspected clinical diagnosis of a fixed drug eruption to the Ginkgo biloba/vinpocetine product. CASE REPORT A 36-year-old man developed pruritus and redness localized to his distal penile shaft. Additional inquiry revealed that he had begun daily ingestion of a preparation containing 120mg of Ginkgo biloba leaf extract (standardized to contain 24% Ginkgo flavone glycerides, 28.8g) and 5mg of vinpocetine [manufactured by Trunature (item #437959)] to increase cerebral blood flow and memory (Figure 1). Within the first day of treatment, he noticed that the affected area of his penis was itching; the itching persisted and the location became red during the next 3 to 4 days. He also noted that when he discontinued the Ginkgo biloba/vinpocetine supplement, the symptoms stopped immediately and the redness resolved over the next two weeks. The patient wanted to confirm the suspected diagnosis of fixed drug eruption to his A B S T R A C T BACKGROUND: Fixed drug eruption is a cutaneous reaction to a systemic agent that typically presents as an annular or oval erythematous patch or blister and subsequently resolves with postinflammatory hyperpigmentation at the site. Ginkgo biloba leaf extract and vinpocetine are nutritional supplements used to enhance memory in patients with dementia and age- related memory impairment conditions such as Alzheimer's disease. PURPOSE: To describe a fixed drug eruption in a man who repeatedly developed pruritus and macular erythema on his distal penile shaft after ingesting a natural product containing Ginkgo biloba and vinpocetine. METHODS: The medical literature was retrospectively reviewed using PubMed, searching specifically for the terms cutaneous/skin adverse/side effects, fixed drug eruption, Ginkgo biloba, and vinpocetine. Patient reports and previous reviews of the subject were critically assessed, and the salient features of cutaneous adverse effects in patients receiving either Ginkgo biloba or vinpocetine are presented. RESULTS: Cutaneous adverse effects from Ginkgo biloba and vinpocetine are infrequent. Ginkgo biloba fruit can result in contact dermatitis (following topical exposure) and mucosal symptoms of the mouth and anus (following oral exposure); in addition, an erythematous maculopapular generalized eruption or possibly Steven- Johnson syndrome can occur after oral ingestion of the Ginkgo biloba leaf extract. Facial erythema has been associated with vinpocetine ingestion. Pruritus and an annular erythema localized to the distal penile shaft developed after initial and repeat ingestion of a Ginkgo biloba/vinpocetine product. CONCLUSION: Ginkgo biloba and vinpocetine should be added to the agents that can potentially cause a fixed drug eruption. KEYWORDS: Fixed drug eruption, genitalia, Ginkgo biloba, penis, vinpocetine Fixed Drug Eruption to Supplement Containing Ginkgo Biloba and Vinpocetine: A Case Report and Review of Related Cutaneous Side Effects by PHILIP R. COHEN, MD Dr. Cohen is from the Department of Dermatology at the University of California San Diego, La Jolla, California. J Clin Aesthet Dermatol. 2017;10(10):44–47 FUNDING: No funding was provided for this study. DISCLOSURES: The author has no financial conflicts relevant to the content of this article. CORRESPONDENCE: Philip R. Cohen, MD; Email: mitehead@gmail.com

Articles in this issue

Links on this page

Archives of this issue

view archives of Journal of Clinical and Aesthetic Dermatology - OCT 2017