By Gary M. White, MD
White papules in eosinophilia myalgia
Skin lesions in eosinophilia myalgia include morphea-like sclerosis, urticarial and papular lesions and generalized sclerosis. Eosinophilia, myalgia, fever, weakness and fatigue are also typical. Tryptophan is and essential amino acid and a metabolic precursor of serotonin. It was purchased by many as an over the counter sleeping pill. During production, a di L-tryptophan molecule was formed which is thought to be the etiologic agent.
Consumption of tryptophan should of course be stopped. No single therapy is consistently effective. Prednisone (e.g. 20-100 mg/day) has been used. Patients tend to improve over time.
The death rate was 19% in one study from South Carolina (approximate 3 year period) [AIM 1996;156;973]. Survivors had morbidity from myalgia, arthralgia, weakness, rash, alopecia and sclerodermoid skin changes.
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