However severe agranulocytosis can result in spontaneous infection and death, is a severe decrease in the amount of a specific kind of white blood cell called granulocytes. Clozapine carries a black box warning for drug-induced agranulocytosis. Rapid point-of-care tests may simplify the monitoring for agranulocytosis. Clozapine rechallenge
A clozapine "rechallenge" is when someone that experienced agranulocytosis while taking clozapine starts taking the medication again. In countries in which the neutrophil thresholds are higher than those used in the US a simple approach is, if the lowest ANC had been above the US cut off, to reintroduce clozapine but with the US monitoring regime. This has been demonstrated in a large cohort of patients in a hospital in London in which it was found that of 115 patients who had had clozapine stopped according to the US criteria only 7 would have had clozapine stopped if the US cut offs had been used. Of these 62 were rechallenged, 59 continued to use clozapine without difficulty and only 1 had a fall in neutrophils below the US cut off. Other approaches have included the use of other drugs to support neutrophil counts including lithium or granulocyte colony-stimulating factor (G-CSF). However, if agranulocytosis still occurs during a rechallenge, the alternative options are limited. Cardiac toxicity
Clozapine can rarely cause myocarditis and cardiomyopathy.
Tinea imbricata (also known in parts of Indonesia as “Kaskado”) is a superficial fungal infection of the skin limited to southwest Polynesia, Melanesia, Southeast Asia, India, and Central America. : 303  The skin lesions are often itchy, and mainly in the torso and limbs. The name is derived from the Latin for "tiled" (imbricata) since the lesions are often lamellar. It is often treated with griseofulvin or terbinafine.The risk of developing tinea imbricata is probably inherited as an autosomal recessive trait.Tinea imbricata is associated with Trichophyton concentricum. Tinea pseudoimbricata
The term "tinea pseudoimbricata" synonymous with "tinea indecisiva", was coined to describe a form of tinea mimicking the concentric rings of tinea imbricata, but is caused by local or systemic immunosuppression. Since then, 3 cases of Trichophyton tonsurans have been associated with it, as well as Trichophyton rubrum which can trigger mycosis fungoides. Mixed infections with scabies have been described to produce tinea pseudoimbricata.As of 2015 in India, corticosteroid–antifungal–antibacterial combinations sold as over-the-counter drug have led to an increase in chronic, recurrent, difficult to treat fungal infections of the skin, including tinea pseudoimbricata. See also
Skin lesion
List of cutaneous conditions

References


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