From the 'Juvenile Rheumatism Unit, Canadian Red Cross Memorial Hospital, Taplow, and the 2Department

SuMMARY We report the case of a 48-year-old woman who developed morphea-like plaques after 1 year of treatment with D-penicillamine at 250 mg daily for a seronegative erosive arthritis of rheu-matoid type. The rash began as several red itchy patches on the trunk; these became thickened and shiny over about 3 months. The histological appearance was of increased dermal fibrosis with an inflammatory infiltrate round dermal capillaries. However, epidermal changes were not typical of morphea. New lesions ceased to appear within a few months of stopping penicillamine, and by 1 year all the plaques were pale and symptomless. Late skin reactions to D-penicillamine are well known as a reason for withdrawing therapy. Some lesions such as increased friability, cutis laxa, and elastosis perforans serpiginosa are probably dose-related1 and may be due to the lathyrogenic effect of D-penicillamine inhibiting the stabilisation of cross-links in newly formed collagen.2 Indeed the drug may slow or reverse the early active skin lesions of scleroderma.3 Eczematous reactions are the commonest late rashes. Lichenoid eruptions, with dense lymphocytic infiltration in the upper dermis, are seen less often.4 Bullous pemphigus, with intercellular immuno-globulin in the prickly cell layer, is probably rare, though there are several reports.5 Drug-induced systemic lupus erythematosus may occur with an erythematosus rash as a feature,6 7 and there may be