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Xiao H, Qin T, Wen Y, Ai L, Chen N, Cao L, Wu L. A 13-years pharmacovigilance analysis of novel hormonal agents in prostate cancer using the FDA adverse event reporting system database. Expert Opin Drug Saf 2024:1-10. [PMID: 39668443 DOI: 10.1080/14740338.2024.2442514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 11/17/2024] [Accepted: 11/18/2024] [Indexed: 12/14/2024]
Abstract
BACKGROUND Novel hormonal agents (NHAs), such as abiraterone, apalutamide, enzalutamide, and darolutamide, play a pivotal role in prostate cancer treatment. However, the toxicity spectrum of NHAs in the real-world has not been fully investigated. This study aims to analyze the adverse events (AEs) linked to NHAs. METHODS The safety profiles of NHAs were evaluated by using the United States FDA Adverse Event Reporting System (FAERS) database. Disproportionality analysis methods were applied to compare the safety signals of AEs associated with NHAs. RESULTS Our research has identified significant safety signals for all NHAs in vascular disorders, particularly noting elevated risk in the combined treatment involving docetaxel or poly ADP-ribose polymerase (PARP) inhibitors, specifically in blood and lymphatic system. Apalutamide, enzalutamide, and darolutamide displayed notable safety signals related to nervous system disorders, whereas abiraterone did not. Apalutamide exhibited specific AEs primarily linked to skin and subcutaneous tissue disorders, with severe AEs (SAEs) also concentrated in this category. Enzalutamide's specific AEs were predominantly associated with gastrointestinal disorders. Meanwhile, abiraterone's SAEs were mainly related to cardiac and hepatobiliary disorders. CONCLUSION Our study offers a comprehensive overview of safety signals associated with NHAs, providing a valuable reference for drug selection and future prospective research.
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Affiliation(s)
- Haiwei Xiao
- Department of Traditional Chinese Medicine, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, Guangdong Province, China
| | - Tao Qin
- Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Department of Oncology, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, Guangdong Province, China
| | - Yanping Wen
- Department of Medical Oncology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong Province, China
| | - Liang Ai
- Department of Traditional Chinese Medicine, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, Guangdong Province, China
- Department of Traditional Chinese Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Nabei Chen
- Department of Traditional Chinese Medicine, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, Guangdong Province, China
| | - Linhui Cao
- Department of Traditional Chinese Medicine, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, Guangdong Province, China
- Department of Traditional Chinese Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Lisha Wu
- Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
- Department of Oncology, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, Guangdong Province, China
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2
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Chu Y, Xu M, Dong X, Zhou J. TNF-α inhibitors as therapy for drug-induced severe cutaneous adverse reactions: a case series. J DERMATOL TREAT 2024; 35:2422924. [PMID: 39581580 DOI: 10.1080/09546634.2024.2422924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 10/23/2024] [Indexed: 11/26/2024]
Abstract
Background: Severe cutaneous adverse reactions (SCARs) including acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and its related diseases, and toxic epidermal necrolysis (TEN) are of great concern due to their high mortality rates. While systemic corticosteroids have been widely used to treat SCARs, their efficacy has been debated due to the increased risk of infection. In recent years, tumor necrosis factor (TNF)-α inhibitors have emerged as a new therapeutic option. Objectives: This study aimed to report the clinical outcomes of different types of SCARs treated with TNF-α inhibitors. Methods: Since 2020, our department has treated 4 SCAR patients, aged 20-54 years, with 1 diagnosed with AGEP and 3 with TEN. All patients received TNF-α inhibitor therapy, including etanercept and adalimumab. Results: All 4 patients achieved successful outcomes, with rapid recovery of skin lesions and mucosal involvement, and no subsequent complications. Notably, one patient improved after initial corticosteroid and intravenous immunoglobulin treatment failed. Discussion: The pathogenesis of SCARs involves T cell-mediated keratinocyte apoptosis, in which TNF-α plays a crucial role. TNF-α inhibitors, by downregulating the TNF-α signaling pathway, have demonstrated potential in the treatment of SCARs. However, large-scale clinical trials supporting their efficacy are still lacking, and their use remains limited, requiring a careful balance of treatment risks and benefits.
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Affiliation(s)
- Yanjun Chu
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengjun Xu
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoqing Dong
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiong Zhou
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Cattelan L, Dayan S, Fabi SG. Optimal Practices in the Delivery of Aesthetic Medical Care to Patients on Immunosuppressants and Immunomodulators: A Systematic Review of the Literature. Aesthet Surg J 2024; 44:NP819-NP828. [PMID: 38967686 DOI: 10.1093/asj/sjae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024] Open
Abstract
Nonsurgical aesthetic procedures have been steadily growing in popularity among patients of all ages and ethnicities. At present, the literature remains devoid of guidelines on optimal practices in the delivery of aesthetic medical care to patients on immunosuppressant medications. The authors of this review sought to determine the physiologic responses of immunocompromised patients related to outcomes and potential complications following nonsurgical aesthetic procedures, and to suggest recommendations for optimal management of these patients. A comprehensive systematic review of the literature was performed to identify clinical studies of patients who had undergone nonsurgical aesthetic procedures while immunosuppressed. Forty-three articles reporting on 1690 immunosuppressed patients who underwent filler injection were evaluated, of which the majority (99%; 1682/1690) were HIV patients, while the remaining 8 were medically immunosuppressed. The complication rate of filler in this population was 28% (481/1690), with subcutaneous nodules the most frequently reported adverse event. A detailed synthesis of complications and a review of the inflammatory responses and impact of immunosuppressants and HIV infection on filler complications is presented. The authors concluded that patients on immunomodulatory medications may be at increased risk of filler granuloma relative to the general population, while patients on immunosuppressants may be at increased risk of infectious complications. Rudimentary guidelines for optimal preprocedural patient assessment, aseptic technique, injection technique, and antibacterial and antiviral prophylaxis are reviewed. Ongoing advancements in our understanding of the mechanisms underlying these inflammatory processes will undoubtedly optimize management in this patient population. LEVEL OF EVIDENCE: 3
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Lee EY, Gomes T, Drucker AM, Daneman N, Asaf A, Wu F, Piguet V, Juurlink DN. Oral Antibiotics and Risk of Serious Cutaneous Adverse Drug Reactions. JAMA 2024; 332:730-737. [PMID: 39115856 PMCID: PMC11310841 DOI: 10.1001/jama.2024.11437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/27/2024] [Indexed: 08/11/2024]
Abstract
Importance Serious cutaneous adverse drug reactions (cADRs) are potentially life-threatening drug hypersensitivity reactions involving the skin and internal organs. Antibiotics are a recognized cause of these reactions, but no studies have compared relative risks across antibiotic classes. Objectives To explore the risk of serious cADRs associated with commonly prescribed oral antibiotics, and to characterize outcomes of patients hospitalized for them. Design, Setting, and Participants Nested case-control study using population-based linked administrative datasets among adults aged 66 years or older who received at least 1 oral antibiotic between 2002 and 2022 in Ontario, Canada. Cases were those who had an emergency department (ED) visit or hospitalization for serious cADRs within 60 days of the prescription, and each case was matched with up to 4 controls who did not. Exposure Various classes of oral antibiotics. Main Outcomes and Measures Conditional logistic regression estimate of the association between different classes of oral antibiotics and serious cADRs, using macrolides as the reference group. Results During the 20-year study period, we identified 21 758 older adults (median age, 75 years; 64.1% female) who had an ED visit or hospitalization for serious cADRs following antibiotic therapy and 87 025 matched controls who did not. In the primary analysis, sulfonamide antibiotics (adjusted odds ratio [aOR], 2.9; 95% CI, 2.7-3.1) and cephalosporins (aOR, 2.6; 95% CI, 2.5-2.8) were most strongly associated with serious cADRs relative to macrolides. Additional associations were evident with nitrofurantoin (aOR, 2.2; 95% CI, 2.1-2.4), penicillins (aOR, 1.4; 95% CI, 1.3-1.5), and fluoroquinolones (aOR, 1.3; 95% CI, 1.2-1.4). The crude rate of ED visits or hospitalization for cADRs was highest for cephalosporins (4.92 per 1000 prescriptions; 95% CI, 4.86-4.99) and sulfonamide antibiotics (3.22 per 1000 prescriptions; 95% CI, 3.15-3.28). Among the 2852 case patients hospitalized for cADRs, the median length of stay was 6 days (IQR, 3-13 days), 9.6% required transfer to a critical care unit, and 5.3% died in the hospital. Conclusion and Relevance Commonly prescribed oral antibiotics are associated with an increased risk of serious cADRs compared with macrolides, with sulfonamides and cephalosporins carrying the highest risk. Prescribers should preferentially use lower-risk antibiotics when clinically appropriate.
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Affiliation(s)
- Erika Y. Lee
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Tara Gomes
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Aaron M. Drucker
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nick Daneman
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Vincent Piguet
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David N. Juurlink
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of General Internal Medicine and Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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López E, Cabrera R, Lecaros C. Targeted therapy for immune mediated skin diseases. What should a dermatologist know? An Bras Dermatol 2024; 99:546-567. [PMID: 38521706 PMCID: PMC11221168 DOI: 10.1016/j.abd.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/25/2023] [Accepted: 10/14/2023] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Molecularly targeted therapies, such as monoclonal antibodies (mAbs) and Janus Kinase inhibitors (JAKis), have emerged as essential tools in the treatment of dermatological diseases. These therapies modulate the immune system through specific signaling pathways, providing effective alternatives to traditional systemic immunosuppressive agents. This review aims to provide an updated summary of targeted immune therapies for inflammatory skin diseases, considering their pathophysiology, efficacy, dosage, and safety profiles. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was conducted on PubMed over the past 10 years, focusing on randomized clinical trials, case reports, and case series related to targeted immune therapies in dermatology. Eligibility criteria were applied, and data were extracted from each study, including citation data, study design, and results. RESULTS We identified 1360 non-duplicate articles with the initial search strategy. Title and abstract review excluded 1150, while a full-text review excluded an additional 50 articles. The review included 143 studies published between 2012 and 2022, highlighting 39 drugs currently under investigation or in use for managing inflammatory skin diseases. STUDY LIMITATIONS The heterogeneity of summarized information limits this review. Some recommendations originated from data from clinical trials, while others relied on retrospective analyses and small case series. Recommendations will likely be updated as new results emerge. CONCLUSION Targeted therapies have revolutionized the treatment of chronic skin diseases, offering new options for patients unresponsive to standard treatments. Paradoxical reactions are rarely observed. Further studies are needed to fully understand the mechanisms and nature of these therapies. Overall, targeted immune therapies in dermatology represent a promising development, significantly improving the quality of life for patients with chronic inflammatory skin diseases.
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Affiliation(s)
- Edinson López
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile
| | - Raúl Cabrera
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile.
| | - Cristóbal Lecaros
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile
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6
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Yang X, Xu S. Tislelizumab-Induced Toxic Epidermal Necrolysis-Like Cutaneous Adverse Reaction: Rare Complication of Immune Checkpoint Inhibitor Therapy. Am J Ther 2024; 31:e470-e474. [PMID: 38976533 DOI: 10.1097/mjt.0000000000001682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Affiliation(s)
- Xiaoqin Yang
- Department of Dermatology, Shanghai Pudong New Area People's Hospital, Shanghai, China
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Guo Y, Liu Y, Li D, Wang X, Huang S, Yang L. Clinical observation and analysis of rash caused by lacosamide in children with epilepsy. Seizure 2024; 117:105-110. [PMID: 38367318 DOI: 10.1016/j.seizure.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/25/2024] [Accepted: 02/11/2024] [Indexed: 02/19/2024] Open
Abstract
PURPOSE To draw clinical attention to rashes caused by lacosamide. METHODS This retrospective analysis included patients admitted to the Department of Pediatrics, Second Affiliated Hospital of Xi'an Jiaotong University between January 2021 and September 2023. We focused on patients who developed rashes after lacosamide treatment and analyzed all patients who exhibited rashes after lacosamide treatment to analyze the risk factors. RESULTS In total, 190 patients received lacosamide, of whom four developed allergies (2.1 %). Three patients had severe rashes, and two patients had high fever. All of these adverse events improved after the withdrawal of lacosamide. Of the 13 patients reported to date, including the four patients in this study, eight used various antiseizure medicines, including seven patients who used four or more antiseizure medicines. Four patients underwent testing for HLA-B*1502, and two patients were positive. Patients developed rashes within 1-10 days after treatment initiation, and the duration of the rash ranged 2-37 days. CONCLUSIONS Lacosamide-induced rash was detected in 2.1 % of patients in our cohort. Rashes are potentially serious, and prompt evaluation is required. Rashes are more likely to occur when multiple antiseizure medicines are used simultaneously, typically within 10 days of treatment initiation.
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Affiliation(s)
- Yingying Guo
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Yu Liu
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Dan Li
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Xueying Wang
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Shaoping Huang
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China
| | - Lin Yang
- Department of Pediatric, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an 710004 Shaanxi Province, China.
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Kazaoka A, Kumagai K, Matsushita J, Aida T, Kuwahara S, Aoki S, Ito K. Pathological changes in various organs in HLA-B*57:01 transgenic mice with abacavir-induced skin eruption. Toxicol Res 2024; 40:223-235. [PMID: 38525129 PMCID: PMC10959918 DOI: 10.1007/s43188-023-00220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 03/26/2024] Open
Abstract
Several patients with cutaneous adverse drug reactions exhibit extracutaneous organ damages, and it becomes severe in a few patients resulting in death due to multiorgan failure. Understanding the sequential changes in various organs in patients with cutaneous eruption following drug administration will help understand disease onset and progression, aiding the development of prevention strategies and interventions. Therefore, we aimed to understand the effects of abacavir (ABC) on various organs in patients with ABC-induced eruptions by evaluating its effects in a mouse model. We found pathological changes in various organs of HLA-B*57:01 transgenic mice (B*57:01-Tg) following oral administration of ABC (20 mg/body/day). B*57:01-Tg exhibited a significant body weight decrease from day 1 of ABC administration, and reddening of the auricle was observed from day 5, and approximately 2/3 mice died by day 7. Histopathological examination revealed severe thymic atrophy after day 3, infiltration of inflammatory cells, predominantly lymphocytes with neutrophils, not only in the skin but also in the liver, kidney, and lung after day 5, and an increased number of lymphocytes with enlarged nuclei and granulocytic hematopoiesis were observed in the spleen after day 5. Blood chemistry revealed that albumin/globulin ratio was below 1.0 on day 5, reflecting a systemic inflammatory response, and the aspartate aminotransferase concentration rose to 193 ± 93.0 U/L on day 7, suggesting that cell damage may have occurred in various organs including liver accompanying inflammatory cell infiltration. These examinations of a mouse model of ABC-induced skin eruption show that disorders in various organs other than the skin should be considered and provide insights into the unexpected early systemic responses dependent on HLA-B*57:01. Supplementary Information The online version contains supplementary material available at 10.1007/s43188-023-00220-1.
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Affiliation(s)
- Akira Kazaoka
- Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-City, Chiba 260-8675 Japan
| | - Kazuyoshi Kumagai
- Medicinal Safety Research Laboratories, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Junya Matsushita
- Medicinal Safety Research Laboratories, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Tetsuo Aida
- Medicinal Safety Research Laboratories, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Saki Kuwahara
- Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-City, Chiba 260-8675 Japan
| | - Shigeki Aoki
- Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-City, Chiba 260-8675 Japan
| | - Kousei Ito
- Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-City, Chiba 260-8675 Japan
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Sutaria A, Rawlani S, Sutaria AH. Causes and Management of Cutaneous Adverse Drug Reactions: A Comprehensive Review. Cureus 2024; 16:e55318. [PMID: 38562325 PMCID: PMC10982164 DOI: 10.7759/cureus.55318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Cutaneous adverse drug reactions (CADRs) are one of the most broadly studied and rigorously researched conditions in recent dermatological advancements. Also termed as "toxidermia," they are heavily involved and are of utmost importance to be understood and studied in the modern healthcare industry. In simple terms, they are dermatological manifestations which result from systemic drug administration to patients. Since allopathy is influenced by the medicines and drugs provided to the patients, cutaneous skin eruptions are a common occurrence in recent times. It is a need of the hour to understand the causative factors for such skin eruptions and the correct management and handling of such disorders to provide better healthcare to patients. The withdrawal of the causative drug which induces the reaction plays a key role in treatment. The risk factors are to be thoroughly studied, and dosages must be in accordance with the patient's situation. They are some of the common public health problems. The age group which is affected is highly variable as people from all age groups can be affected. Those who are affected comprise approximately 10% of all hospitalized patients, and it is also observed in about 1-4% of people who are on multiple medications.
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Affiliation(s)
- Arsh Sutaria
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Shobha Rawlani
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Amita H Sutaria
- Dermatology, Byramjee Jeejeebhoy (BJ) Medical College and Civil Hospital, Ahmedabad, IND
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Wang Q, Cao H, Zhang X, Wu H, Tang Z. Case report: Apalutamide-induced severe lethal cutaneous adverse effects in China. Front Immunol 2024; 14:1291564. [PMID: 38274795 PMCID: PMC10808516 DOI: 10.3389/fimmu.2023.1291564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Apalutamide is a novel agent for castration-resistant prostate cancer while skin rashes are the most common untoward reactions. Up to now, most of the reported dermatologic adverse events (dAEs) allocated to mild and moderate with a fair prognosis. Herein, we report a case series of severe dAEs in China caused by apalutamide. Case presentation The four patients all developed severe and lethal drug eruptions including Stevens-Johnson syndrome and toxic epidermal necrolysis with a mean incubation period of 40 days. On the basis of the medical condition, all the patients were suggested to withdraw apalutamide and three of them recovered. Of note, attempts of rechallenges of apalutamide may be fatal. Discussion The incidence of dAEs in previously conducted clinical trials exceeded 20%, with maculopapular rashes being the most common feature. However, the incidence and severity varied in different geographic regions and ethnicities. Inadequate attention was paid to severe cutaneous adverse reactions. Long latency may easily lead to the misdiagnosis of dAEs, and immediate withdrawal of apalutamide is the cornerstone of therapies. Conclusion Special and adequate attention should be paid to apalutamide-attributed severe cutaneous adverse effects. Besides, the prognosis of severe drug eruptions may be disappointing, and in-time withdrawal is vital.
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Affiliation(s)
- Qi Wang
- Department of Dermatology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
- Department of Dermatology, Changxing People’s Hospital, Huzhou, China
| | - Huali Cao
- Department of Dermatology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xuetong Zhang
- Department of Dermatology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Huifeng Wu
- Department of Urology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhuangli Tang
- Department of Dermatology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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11
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Godfrey H, Jedlowski P, Thiede R. Medication Associations With Severe Cutaneous Adverse Reactions: A Case/Non-Case Analysis Using the FDA Adverse Event Reporting System. J Cutan Med Surg 2024; 28:51-58. [PMID: 38189282 DOI: 10.1177/12034754231220931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP) are potentially life-threatening severe cutaneous adverse reactions (SCARs). Although the classical causal agents of SCARs (antibiotics, anticonvulsants, nonsteroidal anti-inflammatory drugs, and allopurinol) are well characterized, there has been little update to this list to account for newly marketed medications. OBJECTIVE To provide an updated and stratified list of medications with significant reporting odds ratios (RORs) of SCARs. METHODS A case/non-case analysis using the United States FDA Adverse Event Reporting System was performed. RESULTS As expected, the prototypical medication classes made up the majority of reported cases of SJS, TEN, AGEP, and DRESS (77%, 64%, 75%, and 72%, respectively). In addition, several infrequently or previously undescribed classes/medications implicated in SCARs were identified to have significant ROR signals, including acetylcysteine, anticoagulants, diuretics, immunotherapies, proton pump inhibitors, antivirals, and antifungals. Among these reported for SJS were acetylcysteine (ROR: 64.38) and fluconazole (ROR: 17.13). For TEN, we identified furosemide (ROR: 26.32), spironolactone (ROR: 14.45), fluconazole (ROR: 30.21), amphotericin B (39.06), and acetylcysteine (ROR: 93.12). For AGEP, we identified acyclovir (ROR: 61.72), valacyclovir (ROR: 30.76), and enoxaparin (ROR: 27.37). For DRESS, we identified vemurafenib (ROR: 17.35), acyclovir (ROR: 30.63), abacavir (ROR: 26.62), raltegravir (ROR: 23.27), and valacyclovir (ROR: 21.77) to have strong reporting odds. CONCLUSION Our analysis provides an updated tool for physicians to reference when identifying suspected SCARs and a basis for future studies to investigate atypical medication causality.
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Affiliation(s)
- Hannah Godfrey
- University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Patrick Jedlowski
- Division of Dermatology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Rebecca Thiede
- Division of Dermatology, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
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12
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Zhu X, Luo G, Zheng L. Update on HLA-B*15:02 allele associated with adverse drug reactions. Pharmacogenomics 2024; 25:97-111. [PMID: 38305022 DOI: 10.2217/pgs-2023-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
HLA alleles, part of the major histocompatibility complex, are strongly associated with adverse drug reactions (ADRs). This review focuses on HLA-B*15:02 and explores its association with ADRs in various ethnic populations and with different drugs, aiming to provide insights into the safe clinical use of drugs and minimize the occurrence of ADRs. Furthermore, the review explores the potential mechanisms by which HLA-B*15:02 may be associated with ADRs, aiming to gain new insights into drug modification and identification of haptens. In addition, it analyzes the frequency of the HLA-B*15:02, genotyping methods, cost-effectiveness and treatment measures for adverse reactions, thereby providing a theoretical basis for formulating clinical treatment plans.
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Affiliation(s)
- Xueting Zhu
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Guanghua Luo
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Lu Zheng
- Clinical Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Zhang R, Wei Y, Wang T, Nie X, Shi Z, Deng Y, Li D. Exosomal miRNAs in autoimmune skin diseases. Front Immunol 2023; 14:1307455. [PMID: 38106405 PMCID: PMC10722155 DOI: 10.3389/fimmu.2023.1307455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Exosomes, bilaterally phospholipid-coated small vesicles, are produced and released by nearly all cells, which comprise diverse biological macromolecules, including proteins, DNA, RNA, and others, that participate in the regulation of their biological functions. An increasing number of studies have revealed that the contents of exosomes, particularly microRNA(miRNA), play a significant role in the pathogenesis of various diseases, including autoimmune skin diseases. MiRNA is a class of single-stranded non-coding RNA molecules that possess approximately 22 nucleotides in length with the capability of binding to the untranslated as well as coding regions of target mRNA to regulate gene expression precisely at the post-transcriptional level. Various exosomal miRNAs have been found to be significantly expressed in some autoimmune skin diseases and involved in the pathogenesis of conditions via regulating the secretion of crucial pathogenic cytokines and the direction of immune cell differentiation. Thus, exosomal miRNAs might be promising biomarkers for monitoring disease progression, relapse and reflection to treatment based on their functions and changes. This review summarized the current studies on exosomal miRNAs in several common autoimmune skin diseases, aiming to dissect the underlying mechanism from a new perspective, seek novel biomarkers for disease monitoring and lay the foundation for developing innovative target therapy in the future.
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Affiliation(s)
- Ri Zhang
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujia Wei
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingmei Wang
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqi Nie
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zeqi Shi
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunhua Deng
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong Li
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wu D, Liu B, Xian W, Yang Y, Li J, Hong S, Li Y, Xiao H. New insight into the causal relationship between Graves' disease liability and drug eruption: a Mendelian randomization study. Front Immunol 2023; 14:1267814. [PMID: 38077385 PMCID: PMC10703291 DOI: 10.3389/fimmu.2023.1267814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Background Graves' disease (GD) and drug eruption are closely associated and frequently observed in the clinical setting. However, it remains unclear whether a causal relationship exists between these two conditions. The aim of the study is to investigate whether GD is causal to drug eruptions using two-sample Mendelian randomization. Methods We launched a two-sample MR to investigate whether GD is causal to drug eruption using Genome-wide association study (GWAS) summary data from Biobank Japan and FinnGen. Genetic variants were used as instrumental variables to avoid confounding bias. Statistical methods including inverse variance weighted (IVW), weighted median, MR-Egger, and MR-PRESSO were conducted to identify the robustness of the causal effect. Results Genetically predicted GD may increase the risk of drug eruption by 30.3% (OR=1.303, 95% CI 1.119-1.516, p<0.001) in the Asian population. In European populations, GD may increase the generalized drug eruption by 15.9% (OR=1.159, 95%CI 0.982-1.367, p=0.080). Conclusions We found GD is potentially causal to drug eruption. This finding expanded the view of the frequently observed co-existence of GD and adverse drug reactions involving the skin. The mechanism remains for further investigation.
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Affiliation(s)
- Dide Wu
- Department of Endocrinology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Boyuan Liu
- Department of Endocrinology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wei Xian
- Department of Endocrinology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuxin Yang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jinjian Li
- Department of Endocrinology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shubin Hong
- Department of Endocrinology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanbing Li
- Department of Endocrinology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Haipeng Xiao
- Department of Endocrinology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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15
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Fei W, Shen J, Cai H. Causes of Drug-Induced Severe Cutaneous Adverse Reaction Epidermal Necrolysis (EN): An Analysis Using FDA Adverse Event Reporting System (FAERS) Database. Clin Cosmet Investig Dermatol 2023; 16:2249-2257. [PMID: 37605788 PMCID: PMC10440110 DOI: 10.2147/ccid.s422928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
Purpose The purpose of the study is to analyze FAERS data to identify drugs associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), determine demographics, drug classes involved, most likely resulted in death, and highlight emerging trends in SJS/TEN reactions. Patients and Methods We reviewed the publicly available FAERS database from 2004-2021. Using search terms "Stevens-Johnson syndrome" or "Toxic epidermal necrolysis", we identified the reports of SJS/TEN or SJS/TEN followed by death that might associated with specific drugs. Then the amounts and trends were counted analyzed. Results During the study period of 2004-2021, the Food and Drug Administration (FDA) received a total of 14,363,139 reports of adverse reactions, among which 24,976 were linked to SJS or TEN. After excluding the cases with incomplete or insufficient information on age, gender, or country of origin, the median median age of patients was 53.82 (IQR = 57.52), the females accounted for 56.59% (12,827 cases) and 8,507 (38.34%) originated in the United States. The top 50 drugs were associated with 15,149 cases (60.65%). The subsequent fatal outcome occurring in 4878 out of 24,976 cases (19.53%). Top 3 drug classes associated with SJS/TEN in FAERS were antiepileptics, non-steroidal anti-inflammatory drugs (NSAIDs) and others. Top drug classes associated with SJS/TEN deaths were antineoplastic agents and cephalosporins. Linear regression showed that the annual percentage of monoclonal antibody-related SJS/TEN reactions increased at an average rate of 0.25% (95% confidence interval: 0.18, 0.32) from 0.00% in 2004 to 4.79% in 2021, faster than any other drug class except antigout drug (allopurinol). Conclusion By using the publicly available FAERS data, we have identified some important themes and trends in drug-related SJS/TEN reactions. Monoclonal antibodies and proton pump inhibitors are drugs with emerging trends causing SJS/TEN. Additionally, cephalosporin antibiotics have a higher mortality rate following SJS/TEN.
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Affiliation(s)
- Weiqiang Fei
- College of Nursing, Hangzhou Vocational & Technical College, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Jun Shen
- Nursing Department, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Hui Cai
- Nursing Department, Jiangsu Province Hospital Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
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Waters M, Dobry A, Le ST, Shinkai K, Beachkofsky TM, Davis MDP, Dominguez AR, Kroshinsky D, Markova A, Micheletti RG, Mostaghimi A, Pasieka HB, Rosenbach M, Seminario-Vidal L, Trinidad J, Albrecht J, Altman EM, Arakaki R, Ardern-Jones M, Bridges AG, Cardones AR, Chadha AA, Chen JK, Chen ST, Cheng K, Daveluy S, DeNiro KL, Harp J, Keller JJ, King B, Korman AM, Lowenstein EJ, Luxenberg E, Mancuso JB, Mauskar MM, Milam P, Motaparthi K, Nelson CA, Nguyen CV, Nutan F, Ortega-Loayza AG, Patel T, Rahnama-Moghadam S, Rekhtman S, Rojek NW, Sarihan M, Shaigany S, Sharma TR, Shearer SM, Shields BE, Strowd LC, Tartar DM, Thomas C, Wanat KA, Walls AC, Zaba LC, Ziemer CM, Maverakis E, Kaffenberger BH. Development of a Skin-Directed Scoring System for Stevens-Johnson Syndrome and Epidermal Necrolysis: A Delphi Consensus Exercise. JAMA Dermatol 2023; 159:772-777. [PMID: 37256599 PMCID: PMC10838134 DOI: 10.1001/jamadermatol.2023.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Importance Scoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) only estimate patient prognosis and are weighted toward comorbidities and systemic features; morphologic terminology for EN lesions is inconsistent. Objectives To establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN. Evidence Review A Delphi consensus using the RAND/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement. Findings In round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated. Conclusions and Relevance This consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.
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Affiliation(s)
- Margo Waters
- The Ohio State University College of Medicine, Columbus
| | - Allison Dobry
- Department of Dermatology, University of California, San Francisco
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco
| | | | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Arturo R Dominguez
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | | | - Alina Markova
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert G Micheletti
- Department of Dermatology and Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helena B Pasieka
- Departments of Dermatology, Uniformed Services University, Bethesda, Maryland
- The Burn Center, MedStar Washington Hospital Center, Washington, DC
| | - Misha Rosenbach
- Department of Dermatology and Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - John Trinidad
- Department of Dermatology, Massachusetts General Hospital, Boston
| | - Joerg Albrecht
- Department of Medicine, Division of Dermatology, Cook County Health, Chicago, Illinois
| | - Emily M Altman
- Department of Dermatology, University of New Mexico Health Sciences Center, Albuquerque
| | - Ryan Arakaki
- Department of Dermatology, University of California, San Francisco
| | | | - Alina G Bridges
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Adela R Cardones
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Angad A Chadha
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Jennifer K Chen
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston
| | - Kyle Cheng
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Jesse J Keller
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Brett King
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus
| | - Eve J Lowenstein
- Department of Dermatology, SUNY Downstate Medical Center and Kings County Medical Center, Oceanside, New York
| | - Erin Luxenberg
- Department of Dermatology, Hennepin Healthcare, Minneapolis, Minnesota
| | | | - Melissa M Mauskar
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Philip Milam
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Caroline A Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Fnu Nutan
- Department of Dermatology, Virginia Commonwealth University Medical Center, Richmond
| | | | - Tejesh Patel
- Department of Dermatology, University of Tennessee Health Science Center, Memphis
| | | | - Sergey Rekhtman
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Nathan W Rojek
- Department of Dermatology, University of California, Irvine
| | - Mansi Sarihan
- Department of Dermatology, Valleywise Health-Creighton University, University of Arizona, Mayo Clinic, Phoenix, Arizona
| | - Sheila Shaigany
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Timmie R Sharma
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sabrina M Shearer
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Bridget E Shields
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Lindsay C Strowd
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Cristina Thomas
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Karolyn A Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Andrew C Walls
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lisa C Zaba
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Carolyn M Ziemer
- Department of Dermatology, University of North Carolina Chapel Hill, Chapel Hill
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Li D, Gou J, Zhu J, Zhang T, Liu F, Zhang D, Dai L, Li W, Liu Q, Qin C, Du Q, Liu S. Severe cutaneous adverse reactions to drugs: A real-world pharmacovigilance study using the FDA Adverse Event Reporting System database. Front Pharmacol 2023; 14:1117391. [PMID: 37081961 PMCID: PMC10110972 DOI: 10.3389/fphar.2023.1117391] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/23/2023] [Indexed: 04/07/2023] Open
Abstract
Background: Sound drug safety information is important to optimize patient management, but the widely recognized comprehensive landscape of culprit-drugs that cause severe cutaneous adverse reactions (SCARs) is currently lacking.Objective: The main aim of the study is to provide a comprehensive landscape of culprit-drugs for SCARs to guide clinical practice.Methods: We analyzed reports associated with SCARs in the FDA Adverse Event Reporting System database between 1 January 2004 and 31 December 2021 and compiled a list of drugs with potentially serious skin toxicity. According to this list, we summarized the reporting proportions of different drugs and drug classes and conducted disproportionality analysis for all the drugs. In addition, the risk characteristic of SCARs due to different drugs and drug classes was summarized by the positive–negative distribution based on the results of the disproportionality analysis.Results: A total of 77,789 reports in the FDA Adverse Event Reporting System database were considered SCAR-related, of which lamotrigine (6.2%) was the most reported single drug followed by acetaminophen (5.8%) and allopurinol (5.8%) and antibacterials (20.6%) was the most reported drug class followed by antiepileptics (16.7%) and antineoplastics (11.3%). A total of 1,219 drugs were reported as culprit-drugs causing SCARs in those reports, and the largest number of drugs belonged to antineoplastics. In disproportionality analysis, 776 drugs showed at least one positive pharmacovigilance signal. Drugs with the most positive signals were lamotrigine, acetaminophen, furosemide, and sulfamethoxazole/trimethoprim.Conclusion: Our study provided a real-world overview of SCARs to drugs, and the investigation of SCAR positive–negative distribution across different drugs revealed its risk characteristics, which may help optimize patient management.
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Affiliation(s)
- Dongxuan Li
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Jinghui Gou
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhu
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tongyan Zhang
- Infectious Disease Department, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Feng Liu
- Center for Medical Information and Statistics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daojun Zhang
- Department of Dermatology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liyang Dai
- Center for Medical Information and Statistics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenjun Li
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinglong Liu
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunmeng Qin
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Qian Du
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
- *Correspondence: Qian Du, ; Songqing Liu,
| | - Songqing Liu
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Qian Du, ; Songqing Liu,
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18
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Chen X, Chen X, Xiao Z, Wu H, Hu L, Yu R. Platelet-to-lymphocyte ratio predicts the duration of glucocorticoid therapy in the treatment of cutaneous adverse drug reactions. Toxicol Appl Pharmacol 2023; 468:116498. [PMID: 37023865 DOI: 10.1016/j.taap.2023.116498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Glucocorticoid (GC) remains the mainstay of treatment for cutaneous adverse drug reactions (cADRs) but has been associated with side effects, emphasizing the importance of precisely managing the duration of high-dose GC treatment. Although the platelet-to-lymphocyte ratio (PLR) has been proven to be closely related to inflammatory disorders, its ability to predict the timing of GC dose reduction (Tr) during cADRs treatment remains obscure. METHODS Hospitalized patients diagnosed with cADRs treated with glucocorticoids were analyzed in the present study to evaluate the association between PLR values and Tr values using linear, locally weighted scatter plot smoothing (LOWESS) and Poisson regression. Subgroup and ROC curve analyses were conducted to identify confounding variables and assess the predictive performance, respectively. RESULTS A total of 308 patients were included in the study, with a median age of 47.0 (31.0-62.0) years old and a median incubation period of 4 days. Antibiotics (n = 113, 36.7%) were the most common cause of cADRs, followed by Chinese herbs (n = 76, 24.7%). PLR values were positively correlated with Tr values during linear regression (P < 0.001, r = 0.414) and LOWESS regression analyses. Poisson regression showed PLR was an independent risk factor for higher Tr values (the incidence rate ratio ranged from 1.016 to 1.070 and P < 0.05 for all). The area under the curve of PLR for predicting Tr < 7 days was 0.917. CONCLUSIONS PLR is a simple and convenient parameter with huge prospects for application as a biomarker to assist clinicians in optimally managing patients treated with glucocorticoid therapy for cADRs.
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Affiliation(s)
- Xiaoli Chen
- Department of Dermatology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | | | - Zupeng Xiao
- Department of Dermatology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Hanyi Wu
- Department of Dermatology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
| | - Li Hu
- Department of Dermatology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China.
| | - Rentao Yu
- Department of Dermatology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China.
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19
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Liu Y, Wang CW, Chen CB, Yu KH, Wu YJ, Choon SE, Chang WC, Yang F, Luo XQ, Chung WH, Zhao M, Lu QJ. DNA methylation of ITGB2 contributes to allopurinol hypersensitivity. Clin Immunol 2023; 248:109250. [PMID: 36738816 DOI: 10.1016/j.clim.2023.109250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUNDS HLA-B*58:01 allele was strongly associated with allopurinol induced severe cutaneous adverse drug reaction (SCAR). However, HLA-B genotype is not sufficient to predict the occurrence of allopurinol-induced SCAR. OBJECTIVE To discover DNA methylation markers for allopurinol-induced SCAR which may improve the prediction accuracy of genetic testing. STUDY DESIGN The study was designed as a retrospective case-control clinical study in multicenter hospitals across Taiwan, Mainland China, Malaysia and Canada. 125 cases of allopurinol-induced SCAR patients and 139 cases of allopurinol tolerant controls were enrolled in this study during 2005 to 2021. RESULTS The results of genome-wide DNA methylation assay of 62 patients revealed that ITGB2 showed strong discriminative ability of allopurinol-induced SCAR in both HLA-B*58:01 positive and negative patients with AUC value of 0.9364 (95% CI 0.8682-1.000). In validation study, significant hypermethylation of ITGB2 were further validated in allopurinol-induced SCAR patients compared to tolerant controls, especially in those without HLA-B*58:01(AUC value of 0.8814 (95% CI 0.7121-1.000)). Additionally, the methylation levels of 2 sites on ITGB2 were associated with SCAR phenotypes. Combination of HLA-B*58:01 genotyping and ITGB2 methylation status could improve the prediction accuracy of allopurinol-induced SCAR with the AUC value up to 0.9387 (95% CI 0.9089-0.9684), while the AUC value of HLA-B*58:01 genotyping alone was 0.8557 (95% CI 0.8030-0.9083). CONCLUSIONS Our study uncovers differentially methylated genes between allopurinol-induced SCAR patients and tolerant controls with positive or negative HLA-B*58:01 allele and provides the novel epigenetic marker that improves the prediction accuracy of genetic testing for prevention of allopurinol-induced SCAR.
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Affiliation(s)
- Yu Liu
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chuang-Wei Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei and Keelung, Taiwan China; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan China; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, China; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
| | - Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei and Keelung, Taiwan China; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan China; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, China; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan China; College of Medicine, Chang Gung University, Taoyuan, Taiwan China
| | - Kuang-Hui Yu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan China; Division of Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan China
| | - Yeong-Jian Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan China; Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chang Gung Memorial Hospital, Keelung and Linkou, Taiwan China
| | - Siew-Eng Choon
- Hospital Sultanah Aminah, Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia
| | - Wan-Chun Chang
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Fanping Yang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao-Qun Luo
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei and Keelung, Taiwan China; Cancer Vaccine and Immune Cell Therapy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan China; Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, China; Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China; Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan China; College of Medicine, Chang Gung University, Taoyuan, Taiwan China; Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan China; Department of Dermatology, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan China.
| | - Ming Zhao
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China; Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Qian-Jin Lu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China; Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, China; Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China; Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, China.
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20
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Yang W, Lu Y, Wu Z, Niu J. Toxic epidermal necrosis associated with afatinib: A case report and literature review. Front Oncol 2023; 12:1010052. [PMID: 36698415 PMCID: PMC9868907 DOI: 10.3389/fonc.2022.1010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To report a case of afatinib-induced toxic epidermal necrosis (TEN), in a patient with metastatic non-small cell lung cancer (NSCLC) and compare these findings with that of evaluate similarities and differences to other cases reported in the literature. Methods With use of the algorithm of drug causality for epidermal necrolysis (ALDEN), the effects of afatinib were evaluated in a NSCLC patient who developed TEN. In addition, previous case reports on this topic were included to provide a review of patients' clinical characteristics, treatment regimens and therapy outcomes in response to afatinib treatment. Results In our case, toxic epidermal necrolysis was observed at five days after afatinib therapy, while other Stevens-Johnson syndrome/toxic epidermal necrolysis responses, as associated with afatinib, did not seem to be induced until a latency period of over thirty days post-afatinib. Treatment with corticosteroids resulted in significant improvements of these clinical symptoms, and eventually to a complete remission. Conclusion Afatinib can result in grade four cutaneous adverse effects like SJS/TEN, with an uncertain latency period. The skin lesions which appear during this period of afatinib treatment should be closely monitored.
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21
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Wang M, Lin L, Wang L, Li L. Severe Cutaneous Adverse Reaction Caused by Carbamazepine and Levofloxacin After Varicella Zoster Virus Infection. Infect Drug Resist 2023; 16:1705-1711. [PMID: 37020799 PMCID: PMC10067444 DOI: 10.2147/idr.s402267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/16/2023] [Indexed: 04/07/2023] Open
Abstract
Severe cutaneous adverse reactions (SCARs) to drugs are associated with morbidity, mortality, healthcare costs, and challenges in drug development. It is important to identify the SCAR type early by using strict diagnostic criteria because they may require different treatments, follow-ups, and short- or long-term prognoses. A 68-year-old woman admitted to our hospital presented with fever and rashes for 10 days. This case exhibited many features that suggested acute generalized exanthematous pustulosis (AGEP). However, the course of treatment and verified clinical features led to a diagnosis of AGEP and drug rash with eosinophilia and systemic symptoms (DRESS) syndrome that was induced by carbamazepine and levofloxacin after a herpes zoster infection. AGEP combined with DRESS syndrome is a complicated and rare drug-induced dermatological eruption that follows a course similar to DRESS syndrome and more recalcitrant than the course seen with typical AGEP. The associated factors for the SCARs in our patient included age, history of allergy, viral infection, and drugs interacting with specific HLA loci. Improving our understanding of these factors can improve the treatment and prevention of SCARs in these patients.
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Affiliation(s)
- Meifang Wang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Li Lin
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Leyi Wang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Linfeng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Linfeng Li, Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China, Tel +86-13693620186, Email
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22
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Characteristics of cutaneous adverse drug reactions with special respect to the incubation period based on hospitalized patients. An Bras Dermatol 2023; 98:227-232. [PMID: 36707353 PMCID: PMC9984701 DOI: 10.1016/j.abd.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 01/26/2023] Open
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23
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Wang S, Li T, Wang Y, Wang M, Liu Y, Zhang X, Zhang L. 5-Fluorouracil and actinomycin D lead to erythema multiforme drug eruption in chemotherapy of invasive mole: Case report and literature review. Medicine (Baltimore) 2022; 101:e31678. [PMID: 36451432 PMCID: PMC9704884 DOI: 10.1097/md.0000000000031678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE 5-Fluorouracil (5-FU) and actinomycin D (ActD) are often used in chemotherapy for various cancers. Side effects are more common in bone marrow suppression, liver function impairment, and gastrointestinal responses. Skin effects are rare and easy to be ignored by doctors and patients, which can lead to life-threatening consequence. PATIENT CONCERNS We reported a 45-year-old woman patient developed skin erythema and fingernail belt in chemotherapy of 5-FU and ActD. DIAGNOSIS Erythema multiforme drug eruption. INTERVENTIONS Laboratory tests including blood and urine routine, liver and kidney function, electrolytes and coagulation function and close observation. OUTCOMES The rash was gone and the nail change returned. LESSONS Delays in diagnosis or treatment may lead to serious consequence. We should pay attention to the dosage of 5-FU and ActD, monitor adverse reactions strictly, to reduce occurrence of skin malignant events.
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Affiliation(s)
- Shan Wang
- Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Tengfei Li
- Departments of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Yuan Wang
- Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Mengdi Wang
- Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yibin Liu
- Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xiaoguang Zhang
- Departments of Dermatology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Lijuan Zhang
- Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- * Correspondence: Lijuan Zhang, Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China (e-mail: )
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Ao S, Gao X, Zhan J, Ai L, Li M, Su H, Tang X, Chu C, Han J, Wang F. Inhibition of tumor necrosis factor improves conventional steroid therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis in a cohort of patients. J Am Acad Dermatol 2022; 86:1236-1245. [PMID: 35121075 DOI: 10.1016/j.jaad.2022.01.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/04/2022] [Accepted: 01/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Systemic steroid therapies for Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) have been challenged because of their limited benefits. Whether additional tumor necrosis factor (TNF) α inhibition provides an optimized approach remains unexplored. OBJECTIVE To investigate the efficacy of TNF-α inhibition combined with a steroid to treat SJS/TEN and to identify potential biomarkers. METHODS Twenty-five patients with SJS/TEN were recruited and divided into 2 groups: 10 patients received methylprednisolone and 15 patients received etanercept plus methylprednisolone. Serum levels of granzyme B, perforin, interferon-γ, interleukin (IL) 6, IL-15, IL-18, macrophage inflammatory protein 1α, macrophage inflammatory protein 1β, and TNF-α were measured by multiplex cytokine analysis kits during the acute and resolution phases. RESULTS Compared with the steroid monotherapy, the combination therapy significantly shortened the course of the initial steroid treatment and the duration of the acute stage, hospitalization stay, and skin re-epithelialization. Although both therapies significantly reduced IL-15 levels; the combination therapy also decreased IL-6 and IL-18 levels. While the level of IL-15 was positively correlated with skin re-epithelialization time in both groups, the level of IL-6 served as an additional marker for the course of the disease in the combination therapy group. LIMITATIONS The cohort size is relatively small. CONCLUSION Additional TNF-α inhibition to steroid treatment appeared to improve outcomes for SJS/TEN.
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Affiliation(s)
- Suiting Ao
- Department of Dermatology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Xuemei Gao
- Department of Dermatology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jipang Zhan
- Department of Dermatology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Lu Ai
- Department of Laboratory Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Minyi Li
- Department of Dermatology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Huilin Su
- Department of Dermatology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Xuhua Tang
- Department of Dermatology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Coco Chu
- Jill Roberts Institute for Research in Inflammatory Bowel Disease, Weill Cornell Medicine, Cornell University, New York, New York
| | - Jiande Han
- Department of Dermatology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Fang Wang
- Department of Dermatology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
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Singh OP, Sarkhel S, Sarkar S. Management of Psychiatric Disorders with HIV and Dermatological Disorders. Indian J Psychiatry 2022; 64:S449-S457. [PMID: 35602376 PMCID: PMC9122157 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_14_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Om Prakash Singh
- Department of Psychiatry, West Bengal Medical Education Services, West Bengal, India
| | - Sujit Sarkhel
- Department of Psychiatry, Institute of Psychiatry, Kolkata, West Bengal, India
| | - Sharmila Sarkar
- Department of Psychiatry, National Medical College and Hospital, Kolkata, West Bengal, India E-mail:
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