Lal S, Bloom D, Silver B, Desjardins B, Krishnan B, Thavundayil J, Thompson T
McGill Centre for Research in Schizophrenia, Montreal, Quebec, Canada.
J Psychiatry Neurosci. 1993 Jul;18(4):173-7.
This paper describes the outcome of 15 patients with chlorpromazine (CPZ)-induced abnormal skin pigmentation (ASP) in whom CPZ was replaced with other neuroleptics for three to 13 years. Complete resolution of ASP occurred over a period of six months to five years following substitution with haloperidol (four patients), levomepromazine (three patients), trifluoperazine (one patient), thioproperazine (one patient) as the sole neuroleptic, by a combination of two of the three phenothiazines (four patients) or haloperidol plus pipotiazine (one patient). Resolution was maintained during the remainder of the follow-up period. In one patient, at final follow-up, marked improvement was present three years after CPZ was replaced with levomepromazine. Bilateral lenticular pigmentary deposits persisted in all eight patients examined 3.3 to 13 years after replacing CPZ and less than three months to nine years after resolution of ASP; improvement was noted in only one of these patients. Bilateral endothelial corneal deposits, present in five patients while on CPZ therapy, had disappeared in two patients seven and 13 years, respectively, after replacing CPZ; improvement was noted in two other patients. These findings indicate that: 1. CPZ-induced ASP is completely reversible in most, if not all, patients if CPZ is withdrawn; 2. a variety of neuroleptics including other phenothiazines can be used to replace CPZ without risk of re-emergence of ASP; 3. CPZ-induced lenticular changes persist whereas corneal changes may resolve slowly over a period of many years following replacement of CPZ; 4. ASP and ocular changes induced by CPZ may be subserved by two different pathophysiological mechanisms.
本文描述了15例氯丙嗪（CPZ）所致皮肤色素沉着异常（ASP）患者的治疗结果，这些患者停用CPZ并换用其他抗精神病药3至13年。换用氟哌啶醇（4例）、左美丙嗪（3例）、三氟拉嗪（1例）、硫利达嗪（1例）作为唯一抗精神病药，或联合使用三种吩噻嗪类药物中的两种（4例），或氟哌啶醇加哌泊噻嗪（1例）后，ASP在6个月至5年内完全消退。在随访期的剩余时间里，病情持续缓解。1例患者在CPZ换用左美丙嗪后3年的最终随访中，有明显改善。在停用CPZ后3.3至13年、ASP消退后不到3个月至9年接受检查的所有8例患者中，双侧晶状体色素沉着均持续存在；其中仅1例患者有改善。5例患者在CPZ治疗期间出现双侧角膜内皮沉着，分别在停用CPZ后7年和 13年，其中2例消失；另外2例患者有改善。这些发现表明：1. 如果停用CPZ，CPZ所致的ASP在大多数（即便不是全部）患者中是完全可逆的；2. 包括其他吩噻嗪类药物在内的多种抗精神病药可用于替代CPZ，而不会有ASP复发的风险；3. CPZ所致的晶状体改变持续存在，而角膜改变在停用CPZ后的许多年里可能会缓慢消退；4. CPZ所致的ASP和眼部改变可能由两种不同的病理生理机制引起。
