Case report: leg ulcers resolving after discontinuation of clozapine for schizophrenia

There is a high prevalence of skin conditions and metabolic disturbances in patients with schizophrenia. Skin ulcers, in particular those of the lower extremities, mostly arise from arterial and/or venous pathology. Diabetes is considered a prominent risk factor. Atypical antipsychotics carry an increased risk for cardiometabolic side effects, clozapine being among those with the highest risk. We explore the case of a 57-year-old female patient with refractory schizophrenia who received a combination of clozapine and haloperidol. She soon developed type 2 diabetes mellitus and persistent malleolar ulcerations shortly thereafter. We discontinued clozapine and the ulcerations resolved definitively. We discuss underlying ulcer pathophysiology and review the literature for metabolic and cutaneous side effects of antipsychotics. To our knowledge, this is the first report of a patient developing leg ulcers upon treatment with clozapine.
Psicosomàtica y Psiquiatría, Núm. 15 (2020)