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Díaz-Calvillo P, Vílchez-Márquez F, Ramos-Pleguezuelos FM, Arias-Santiago S. Poikilodermatous Plaque-like Hemangioma: Case Presentation and Literature Review. Dermatopathology (Basel) 2024; 11:147-153. [PMID: 38804360 PMCID: PMC11130884 DOI: 10.3390/dermatopathology11020015] [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: 04/18/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
Poikilodermatous plaque-like hemangioma (PPH) is a recently described clinical and pathological entity, with only 18 cases reported in the literature. Although uncommon, this benign condition presents consistent clinical and histological findings. We present a new case of PPH in an 81-year-old male and review the existing literature. The persistence over time and the need to distinguish PPH from more significant lesions underscore the importance of its clinical and pathological recognition.
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Affiliation(s)
- Pablo Díaz-Calvillo
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Avenida de Madrid 15, 18012 Granada, Spain; (F.V.-M.); (S.A.-S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid 15, 18012 Granada, Spain
| | - Francisco Vílchez-Márquez
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Avenida de Madrid 15, 18012 Granada, Spain; (F.V.-M.); (S.A.-S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid 15, 18012 Granada, Spain
| | | | - Salvador Arias-Santiago
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Avenida de Madrid 15, 18012 Granada, Spain; (F.V.-M.); (S.A.-S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid 15, 18012 Granada, Spain
- Department of Dermatology, University of Granada, Avenida de la Investigación 11, 18016 Granada, Spain
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2
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Hung SI, Mockenhaupt M, Blumenthal KG, Abe R, Ueta M, Ingen-Housz-Oro S, Phillips EJ, Chung WH. Severe cutaneous adverse reactions. Nat Rev Dis Primers 2024; 10:30. [PMID: 38664435 DOI: 10.1038/s41572-024-00514-0] [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] [Accepted: 03/21/2024] [Indexed: 06/15/2024]
Abstract
Severe cutaneous adverse reactions (SCARs), which include Stevens-Johnson syndrome and toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (also known as drug-induced hypersensitivity syndrome), acute generalized exanthematous pustulosis, and generalized bullous fixed drug eruption, are life-threatening conditions. The pathogenesis of SCARs involves T cell receptors recognizing drug antigens presented by human leukocyte antigens, triggering the activation of distinct T cell subsets. These cells interact with keratinocytes and various immune cells, orchestrating cutaneous lesions and systemic manifestations. Genetic predisposition, impaired drug metabolism, viral reactivation or infections, and heterologous immunity influence SCAR development and clinical presentation. Specific genetic associations with distinct SCAR phenotypes have been identified, leading to the implementation of genetic screening before prescription in various countries to prevent SCARs. Whilst systemic corticosteroids and conventional immunomodulators have been the primary therapeutic agents, evolving strategies, including biologics and small molecules targeting tumour necrosis factor, different cytokines, or Janus kinase signalling pathways, signify a shift towards a precision management paradigm that considers individual clinical presentations.
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Affiliation(s)
- Shuen-Iu Hung
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department and Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maja Mockenhaupt
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Riichiro Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Mayumi Ueta
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Saskia Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Université Paris Est Créteil EpiDermE, Créteil, France
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei/Linkou branches, and Chang Gung University, Taoyuan, Taiwan.
- Department of Dermatology, Chang Gung Memorial Hospital, Xiamen branch, Xiamen, China.
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3
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Sakamoto K, Fujihiro M, Sakamoto A, Yamada C, Nagao K, Honda T. A case of nonpigmented fixed-drug eruption with eosinophilic intraepidermal vesicle formation. J Dermatol 2024; 51:e120-e122. [PMID: 37950416 PMCID: PMC10987267 DOI: 10.1111/1346-8138.17022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Keiko Sakamoto
- Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Mayu Fujihiro
- Department of Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Atsushi Sakamoto
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Chika Yamada
- Yamada hihuka, 537-1 Aritamaminami-cho, Higashi-ku, Hamamatsu, Shizuoka, 431-3122, Japan
| | - Keisuke Nagao
- Cutaneous Leukocyte Biology Section, Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, 20852, USA
| | - Tetsuya Honda
- Department of Dermatology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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4
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Çelik HI, Akay E, Emeksiz ZŞ, Işık M, Yaralı HN, Mısırlıoğlu ED. Pediatric hemophilia patient: Successful desensitization for drug-induced fixed urticaria with prothrombin complex concentrate. Pediatr Allergy Immunol 2024; 35:e14105. [PMID: 38451071 DOI: 10.1111/pai.14105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Hatice Irmak Çelik
- Department of Pediatric Allergy/Immunology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Eray Akay
- Department of Pediatric Hematology/Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Zeynep Şengül Emeksiz
- Department of Pediatric Allergy/Immunology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Melek Işık
- Department of Pediatric Hematology/Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Hüsniye Neşe Yaralı
- Department of Pediatric Hematology/Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Emine Dibek Mısırlıoğlu
- Department of Pediatric Allergy/Immunology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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5
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Berna-Rico E, Naharro-Rodriguez J, Garcia-Mouronte E. Recurrent generalized rounded plaques. Eur J Intern Med 2024; 121:127-128. [PMID: 38087667 DOI: 10.1016/j.ejim.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 03/08/2024]
Affiliation(s)
- Emilio Berna-Rico
- Dermatology Department, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain
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6
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Zhang JS, Aggarwal I, Bain M. A case of bullous fixed drug eruption caused by tadalafil. JAAD Case Rep 2024; 45:44-46. [PMID: 38379872 PMCID: PMC10876462 DOI: 10.1016/j.jdcr.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Affiliation(s)
- Jane Sun Zhang
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
| | - Ishita Aggarwal
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
| | - Michelle Bain
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
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7
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Valbuena MC, Bravo C, Rolón-Cadena MC. Fixed Sunlight Eruption: A Series of 13 Cases in Bogotá, Columbia. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:288-292. [PMID: 37244395 DOI: 10.1016/j.ad.2023.04.030] [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: 02/05/2023] [Revised: 03/09/2023] [Accepted: 04/02/2023] [Indexed: 05/29/2023] Open
Abstract
Few reports describing an association between UV radiation and fixed skin eruptions have been published since 1975. These reactions have received various names, including fixed sunlight eruption, fixed exanthema due to UV radiation, and broad-spectrum abnormal localized photosensitivity syndrome. We present a series of 13 patients (4 men [30.8%] and 9 women [69.2%]) aged between 28 and 56 years who were evaluated for fixed eruptions induced by UV radiation at a dermatology referral hospital in Bogotá, Colombia. The lesions were located on the inner thighs, buttocks, popliteal region, anterior and posterior axilla, and dorsum of the feet. Photoprovocation reproduced lesions in all the affected areas, and histopathology showed changes similar to those seen in fixed drug eruptions. While these UV-provoked reactions may be a type of fixed skin eruption, we cannot rule out that they may also be a distinct condition that simply shares a pathogenic mechanism with fixed eruptions.
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Affiliation(s)
- M C Valbuena
- Hospital Universitario, Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia.
| | - C Bravo
- Dermatología, Pontificia Universidad Javeriana, Bogotá, Colombia
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8
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Valbuena MC, Bravo C, Rolón-Cadena MC. [Translated article] Fixed Sunlight Eruption: A Series of 13 Cases in Bogotá, Colombia. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T288-T292. [PMID: 38219907 DOI: 10.1016/j.ad.2024.01.008] [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: 02/05/2023] [Accepted: 04/02/2023] [Indexed: 01/16/2024] Open
Abstract
Few reports describing an association between UV radiation and fixed skin eruptions have been published since 1975. These reactions have received various names, including fixed sunlight eruption, fixed exanthema due to UV radiation, and broad-spectrum abnormal localized photosensitivity syndrome. We present a series of 13 patients (4 men [30.8%] and 9 women [69.2%]) aged between 28 and 56 years who were evaluated for fixed eruptions induced by UV radiation at a dermatology referral hospital in Bogotá, Colombia. The lesions were located on the inner thighs, buttocks, popliteal region, anterior and posterior axilla, and dorsum of the feet. Photoprovocation reproduced lesions in all the affected areas, and histopathology showed changes similar to those seen in fixed drug eruptions. While these UV-provoked reactions may be a type of fixed skin eruption, we cannot rule out that they may also be a distinct condition that simply shares a pathogenic mechanism with fixed eruptions.
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Affiliation(s)
- M C Valbuena
- Dermatologist, Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia.
| | - C Bravo
- Dermatology resident, Pontificia Universidad Javeriana, Bogotá, Colombia
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9
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Roy Chowdhury S. Genital Ulcers Are Not Always Because of Sexually Transmitted Infections: A Case Report of an Unusual Presentation of Fixed Drug Eruption in a Pediatric Patient. J Pediatr Health Care 2024:S0891-5245(23)00375-9. [PMID: 38260927 DOI: 10.1016/j.pedhc.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
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10
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Gupta H, Choudhary B, Singh S. Adolescent boy with red violaceous plaques. Emerg Med J 2023; 41:19-33. [PMID: 38135451 DOI: 10.1136/emermed-2023-213535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Himanshu Gupta
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bharat Choudhary
- Trauma and Emergency (Pediatrics), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Saurabh Singh
- Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Terry D, Eads AV. Alogliptin Induced Stomatitis: An Adverse Drug Event Case Report. J Pharm Pract 2023; 36:1516-1518. [PMID: 35702931 DOI: 10.1177/08971900221108721] [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: 11/15/2022]
Abstract
Background: Dipeptidyl peptidase (DPP)-4 inhibitors are commonly used agents to treat type 2 diabetes mellitus (T2DM). Although generally well tolerated, stomatitis has been previously reported as an adverse event with sitagliptin and linagliptin. Stomatitis with alogliptin has not been reported in post-marketing data to date. Objective: To report a case of suspected drug-induced stomatitis in a patient who received alogliptin for T2DM which resolved upon discontinuation of the offending agent. Summary: A 60-year-old male with T2DM began treatment with a DPP-4 inhibitor, alogliptin. After 4 doses of alogliptin, the patient reported inflammation and irritation along the lateral borders of his tongue, along with open fissures and oral ulcerations on the dorsal surface of the mucosa. He was subsequently diagnosed with stomatitis. Patient discontinued alogliptin and reported improvement in symptoms within 48 hours. Lesions re-epithelialized within 4 weeks after cessation of alogliptin. The Naranjo Algorithm was used to assess causality. The total score was 7, which when interpreted, implicates alogliptin as a "probable" cause of the reaction. Conclusion: A causality assessment determined alogliptin was a "probable" cause of stomatitis experienced by this patient. This adverse effect has not been reported with alogliptin to the authors' knowledge.
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Affiliation(s)
- Danielle Terry
- Veterans Health Care System of the Ozarks, Fayetteville, AR, USA
| | - Andrea V Eads
- Veterans Health Care System of the Ozarks, Fayetteville, AR, USA
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12
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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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Bhattarai HB, Yadav J, Sapkota S, Adhikari A, Bhattarai M, Singh I, Shrestha S, KC J, Karki P, Basnet B. Cutaneous drug reaction secondary to antitubercular regimen: A case report from Nepal. SAGE Open Med Case Rep 2023; 11:2050313X231210390. [PMID: 37954539 PMCID: PMC10637153 DOI: 10.1177/2050313x231210390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Cutaneous adverse drug reactions are known side effects of first-line antitubercular therapy, which ranges from mild pruritus to life-threatening toxic epidermal necrolysis. Severe cutaneous adverse drug reactions can lead to antitubercular therapy discontinuation and further complicates tuberculosis treatment. Here we present the case of a 49-year-old obese male who developed a generalized maculopapular rash within 24 hours of initiation of therapy followed by bullae over palms in 3 days. Antitubercular therapy was immediately discontinued, and he was managed with antihistamines, intravenous fluid, and electrolyte supplementation. He was discharged on antihistamines, a short course of systemic steroids, moxifloxacin, and bedaquiline (second-line antitubercular therapy (ATT)). Proper guidelines about rechallenge therapy will enormously aid in managing cutaneous adverse drug reactions, and efficient treatment of tuberculosis in these patients, and ceasing its progression to multisystemic complications. This article aims to discuss the presentation and management of cutaneous adverse drug reactions in the setting of Nepal.
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Affiliation(s)
| | - Jeshika Yadav
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Adarsha Adhikari
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | | | - Ishani Singh
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - Sujan Shrestha
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Jwala KC
- Nobel Medical College Teaching Hospital, Biratnagar, Nepal
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Chai L, Liu ZH. Generalized Bullous Fixed Drug Eruption. Dermatitis 2023; 34:364-365. [PMID: 36976825 DOI: 10.1089/derm.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Li Chai
- From the Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ze-Hu Liu
- From the Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Marrero Castillo M, Kaufman D, Valdes Camacho J, Bourgoyne K, Jacob J, Amalraj B, Gulati N. Chlorthalidone-Induced Fixed-Drug Eruption: Unmasking an Uncommon Reaction to a Common Diuretic. Cureus 2023; 15:e46199. [PMID: 37908922 PMCID: PMC10613783 DOI: 10.7759/cureus.46199] [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] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Fixed-drug eruptions (FDEs) are dermatological reactions characterized by specific skin lesions triggered by certain medications. Our case reports commonly used medications that can cause drug-induced skin reactions. Chlorthalidone, a widely used diuretic, had not been prominently linked to FDEs. Here, we present the case of a 45-year-old African-American male who developed classic FDE skin lesions following the initiation of chlorthalidone therapy. This case underscores the imperative for further investigation and heightened awareness among healthcare professionals regarding chlorthalidone-associated FDEs. Findings suggest that such reactions might be more prevalent than previously acknowledged, underscoring the significance of prompt diagnosis and effective management of drug-induced skin responses. Notably, the patient's lesions showed complete resolution upon discontinuing the diuretic, reinforcing the causal relationship. This case is an essential reminder of the importance of vigilance in monitoring patients for adverse drug reactions, even in unlikely medications, such as chlorthalidone..
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Affiliation(s)
- Mariana Marrero Castillo
- Internal Medicine, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - David Kaufman
- Allergy and Immunology, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - Juanita Valdes Camacho
- Allergy and Immunology, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - Kesler Bourgoyne
- Allergy and Immunology, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - John Jacob
- Internal Medicine, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - Benedict Amalraj
- Internal Medicine, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
| | - Neerja Gulati
- Pulmonary Medicine, Ochsner Louisiana State University Health Shreveport - Academic Medical Center, Shreveport, USA
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16
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Choi S, Kim SH, Hwang JH, Jang HW, Oh SH, Kim DY, Kim TG. Rapidly progressing generalized bullous fixed drug eruption after the first dose of COVID-19 messenger RNA vaccination. J Dermatol 2023; 50:1190-1193. [PMID: 37102209 DOI: 10.1111/1346-8138.16808] [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] [Received: 10/05/2022] [Revised: 03/01/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Abstract
Generalized bullous fixed drug eruption (GBFDE) is a rare type of life-threatening severe cutaneous adverse reaction that is considered a medical emergency because of its potential lethality. Currently, only a few cases of bullous adverse reactions have been reported after coronavirus disease 2019 (COVID-19) vaccination. We describe a patient with distinct clinical, histopathological, and immunological findings that are consistent with severe GBFDE, after Pfizer messenger RNA COVID-19 vaccination. An 83-year-old man presented with a fever and well-demarcated multiple erythematous patches that occurred only 4 h after receiving the first dose of COVID-19 Pfizer vaccination. Over the next few days, the patches became generalized and turned into blisters covering approximately 30% of the body surface. The patient was started on intravenous methylprednisolone and oral cyclosporine. There were no additional blistering lesions after 10 days of treatment, prompting a gradual dose reduction. Our case suggests that a stepwise vaccination adhering to the standard dosing schedule should be warranted with close monitoring for possible significant side effects.
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Affiliation(s)
- Sooyeon Choi
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Hee Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Hye Hwang
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Woo Jang
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Do-Young Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Gyun Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Paulmann M, Reinkemeier F, Lehnhardt M, Mockenhaupt M. Case report: Generalized bullous fixed drug eruption mimicking epidermal necrolysis. Front Med (Lausanne) 2023; 10:1125754. [PMID: 37644986 PMCID: PMC10461315 DOI: 10.3389/fmed.2023.1125754] [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: 12/16/2022] [Accepted: 07/13/2023] [Indexed: 08/31/2023] Open
Abstract
Generalized bullous fixed drug eruption (GBFDE) is the most severe form of fixed drug eruption and can be misdiagnosed as epidermal necrolysis (EN). We report the case of a 42-year-old male patient presenting with more than 50% skin detachment without defined areas of exanthema or erythema and a history of one prior event of EN caused by acetaminophen (paracetamol), allopurinol, or amoxicillin 1.5 years ago. The initial diagnosis was GBFDE or EN. The histology of a skin biopsy was unable to distinguish between the two diseases. The course of the disease, the later clinical presentation, and the medical and medication history, however, were in favor of a diagnosis of GBFDE with two potentially culprit drugs: metamizole and ibuprofen. Moxifloxacin, enoxaparin sodium, hydromorphone, and insulin human were administered concomitantly, which makes them suspicious as well. Unfortunately, the patient received an additional dose of metamizole, one of the possible causative drugs, and he developed another bullous reaction within 1 month. This led to the diagnosis of GBFDE due to metamizole. This report highlights the challenges of distinguishing two rare diseases and elucidates the importance of distinct clinical presentation and detailed medication history.
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Affiliation(s)
- Maren Paulmann
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center—University of Freiburg, Freiburg, Germany
| | - Felix Reinkemeier
- Department of Plastic Surgery and Hand Surgery, Burn Center, Sarcoma Center, Berufsgenossenschaft University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery and Hand Surgery, Burn Center, Sarcoma Center, Berufsgenossenschaft University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Maja Mockenhaupt
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center—University of Freiburg, Freiburg, Germany
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18
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Alzahrani AH. Fixed Drug Eruptions With Flavoured Liquid Formulations of Over-the-Counter Analgesics: A Case Report. Cureus 2023; 15:e43436. [PMID: 37711934 PMCID: PMC10499053 DOI: 10.7759/cureus.43436] [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] [Accepted: 08/12/2023] [Indexed: 09/16/2023] Open
Abstract
Type 4 hypersensitivity reactions convey a number of conditions that include fixed drug eruptions (FDEs). They share similar pathophysiologic backgrounds and sometimes presentation but can have very variable prognostications. Drugs are amongst the possible causes with acetaminophen and other NSAIDs being reported very frequently. We present a case of a patient reacting to flavoured oral ibuprofen and acetaminophen formulations, exhibiting FDEs with bullae formation. We describe our successful challenge to non-flavoured acetaminophen and ibuprofen. We briefly discuss FDEs in regard to their incidence, pathophysiology, and management.
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Affiliation(s)
- Ali H Alzahrani
- Allergy and Immunology, King Abdulaziz University, Jeddah, SAU
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19
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Hazarika N, Dhamija P, Upadhyaya A, Rauthan M. Fixed drug eruption - Experience from a tertiary care center in Uttarakhand. Indian J Pharmacol 2023; 55:270-271. [PMID: 37737083 PMCID: PMC10657620 DOI: 10.4103/ijp.ijp_177_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Affiliation(s)
| | - Puneet Dhamija
- Department of Pharmacology, AIIMS, Rishikesh, Uttarakhand, India
| | - Amrita Upadhyaya
- Department of Dermatology, AIIMS, Raebareli, Uttar Pradesh, India
| | - Manisha Rauthan
- Assistant Professor, JBIT college of Pharmacy, Dehradun, Uttarakhand, India
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20
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Moreno-Lozano L, de Aramburu-Mera T, Bermúdez-Hormigo C, Pérez-Darnaudguilhem GL. [A drink with an unexpected ending... Adverse reaction by tonic water: A case report]. REVISTA ALERGIA MÉXICO 2023; 70:107-110. [PMID: 37566774 DOI: 10.29262/ram.v70i2.1243] [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: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Quinine is an alkaloid with antipyretic and anti-infective properties, and also an ingredient in tonic waters. Adverse reactions have been reported with this product, such as photosensitivity, vasculitis, and contact dermatitis. CASE REPORT A 31-year-old male patient who, after 3-4 hours of consuming "Schweppes®" gin with tonic water, manifested ulcers on the lips and oral cavity, and a fixed erythematous lesion on the second phalanx of the hand, 24 hours later. Skin tests with aeroallergens and food were negative, and 48-hour patch tests were positive (quinine [++] and "Schweppes®" [++]). Based on the test findings, the diagnosis of an adverse reaction to quinine, contained in the tonic water, will be established. CONCLUSIONS Quinine can be found in other types of foods or medications, so it is important to establish an accurate diagnosis and offer adequate recommendations to the patient with the consumption of this product.
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21
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Smith MH, Mintline M. Acute Immune-Mediated Lesions of the Oral Cavity. Oral Maxillofac Surg Clin North Am 2023; 35:247-259. [PMID: 37019507 DOI: 10.1016/j.coms.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Although acute immune-mediated lesions of the oral cavity (AIML) can have an onset over several months, they often demonstrate rapid onset and can be self-limited. Despite the self-limiting nature of some disorders, patients with AIML can have significant pain and multisystem involvement. It is vital for the oral health care provider to arrive at the proper diagnosis with distinction from overlapping conditions, as the oral manifestations may be harbingers of more serious systemic complications.
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Affiliation(s)
- Molly Housley Smith
- Pathology and Cytology Laboratory, 290 Big Run Road, Lexington, KY 40503, USA.
| | - Mark Mintline
- WesternU Health Oral Pathology, 701 East 2nd Street, Room 3204, Pomona, CA 91766, USA
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22
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Pereira AS, Flor D, Gonçalo M. A case of fixed drug eruption from cetirizine with cross-reaction to levocetirizine and hydroxyzine. Contact Dermatitis 2023; 88:318-319. [PMID: 36562721 DOI: 10.1111/cod.14270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Ana Sofia Pereira
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal
| | - Duarte Flor
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal
| | - Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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23
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Selvaraj KJ, Stewart TJ. Fixed drug eruption: the often forgotten cutaneous adverse drug reaction. Med J Aust 2023; 218:160. [PMID: 36733993 DOI: 10.5694/mja2.51841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/23/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
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24
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Palma LF, Campos L, de Oliveira SF, Penido L, Morimoto S, de Moraes LOC. Photobiomodulation Therapy for Multiple Painful Fixed Drug Eruptions: The First Case Report. J Lasers Med Sci 2023; 14:e4. [PMID: 37089767 PMCID: PMC10114002 DOI: 10.34172/jlms.2023.04] [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: 01/08/2023] [Accepted: 01/21/2023] [Indexed: 04/25/2023]
Abstract
Introduction: Fixed drug eruption (FDE), a very specific adverse drug reaction and one of the most common types of drug eruption, generally resolves spontaneously within 7-10 days upon withdrawal of the causative agent; however, extensive and severe cases may also require systemic drug therapy. The present study aimed to report a case in which a broad spectrum of severe, painful lesions of FDE was managed with photobiomodulation therapy (PBMT). Case Report: A 31-year-old Caucasian woman presented with many extremely painful mucocutaneous lesions of FDE which had arisen 8 days before, following a long period of hospitalization. The lesions were not responsive to either corticosteroids or analgesics within 5 days, and then seven daily sessions of PBMT were proposed. Pain alleviation was achieved on the 1st day of PBMT, and the lesions showed an advanced course of healing on the 3rd day. Within 7 days of PBMT, the lesions were almost completely repaired. In a 3-month follow-up period, no relapse of any FDE lesion was reported. Conclusion: PBMT may be a promising strategy for the management of painful lesions of FDE refractory to conventional medication therapy. However, further studies are needed to confirm this hypothesis.
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Affiliation(s)
- Luiz Felipe Palma
- Department of Pathology, Federal University of São Paulo, São Paulo, SP, Brazil
- Correspondence to Luiz Felipe Palma,
| | - Luana Campos
- Graduate Program in Implantology, University of Santo Amaro, School of Dentistry, São Paulo, SP, Brazil
| | | | - Ludmila Penido
- Dermatology Center, São Camilo Hospital, São Paulo, SP, Brazil
| | - Susana Morimoto
- School of Dentistry, Department of Orthodontics and Pediatric Dentistry, University of São Paulo, São Paulo, SP, Brazil
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25
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Tsang DA, Lim SYD, Justin WSB, Hui LLY. Generalized Bullous Fixed Drug Eruption to Iodinated Contrast Media in Skin of Color. Am J Med 2022; 135:1326-1329. [PMID: 35901912 DOI: 10.1016/j.amjmed.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Denise Ann Tsang
- Department of Dermatology, Singapore General Hospital, Singapore.
| | | | | | - Laura Li Yao Hui
- Department of Dermatology, Singapore General Hospital, Singapore
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26
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Copaescu AM, Ben-Shoshan M, Trubiano JA. Tools to improve the diagnosis and management of T-cell mediated adverse drug reactions. Front Med (Lausanne) 2022; 9:923991. [PMID: 36313986 PMCID: PMC9606226 DOI: 10.3389/fmed.2022.923991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
Delayed drug T-cell immune-mediated hypersensitivity reactions have a large clinical heterogeneity varying from mild maculopapular exanthema (MPE) to severe cutaneous adverse reactions (SCARs) such as acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) and severe skin necrosis and blistering as seen in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Given the knowledge gaps related to the immunopathogenesis of these conditions, the absence of validated diagnostic tools and the significant associated morbidity and mortality, patients with SCARs often have limited drug choices. We performed a comprehensive review aiming to evaluate in vivo diagnostic tools such as delayed intradermal skin and patch testing and ex vivo/in vitro research assays such as the lymphocyte transformation test (LTT) and the enzyme-linked ImmunoSpot (ELISpot) assay. We searched through PubMed using the terms “drug allergy,” “in vivo” and “ex vivo” for original papers in the last 10 years. A detailed meticulous approach adapted to the various clinical phenotypes is recommended for the diagnostic and management of delayed drug hypersensitivity reactions. This review highlights the current diagnostic tools for the delayed drug hypersensitivity phenotypes.
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Affiliation(s)
- Ana Maria Copaescu
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, VIC, Australia,Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), Montreal, QC, Canada,The Research Institute of the McGill University Health Centre, McGill University Health Centre (MUHC), Montreal, QC, Canada,*Correspondence: Ana Maria Copaescu,
| | - Moshe Ben-Shoshan
- The Research Institute of the McGill University Health Centre, McGill University Health Centre (MUHC), Montreal, QC, Canada,Division of Allergy, Immunology and Dermatology, Montreal Children’s Hospital, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Jason A. Trubiano
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, VIC, Australia,Department of Oncology, Sir Peter MacCallum Cancer Centre, The University of Melbourne, Parkville, VIC, Australia,Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia,The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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27
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McClatchy J, Yap T, Nirenberg A, Scardamaglia L. Fixed drug eruptions – the common and novel culprits since 2000. J Dtsch Dermatol Ges 2022; 20:1289-1302. [DOI: 10.1111/ddg.14870] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Jessica McClatchy
- Dermatology Department The Royal Melbourne Hospital Melbourne Australia
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australia
| | - Tami Yap
- Dermatology Department The Royal Melbourne Hospital Melbourne Australia
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australia
- Melbourne Dental School The University of Melbourne Melbourne Australia
| | - Alexander Nirenberg
- Dorevitch Pathology Melbourne Australia
- Australasian College of Cutaneous Oncology Melbourne Australia
| | - Laura Scardamaglia
- Dermatology Department The Royal Melbourne Hospital Melbourne Australia
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australia
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28
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McClatchy J, Yap T, Nirenberg A, Scardamaglia L. Fixes Arzneimittelexanthem – häufige und neue Auslöser seit dem Jahr 2000. J Dtsch Dermatol Ges 2022; 20:1289-1303. [DOI: 10.1111/ddg.14870_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/13/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Jessica McClatchy
- Dermatology Department The Royal Melbourne Hospital Melbourne Australien
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australien
| | - Tami Yap
- Dermatology Department The Royal Melbourne Hospital Melbourne Australien
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australien
- Melbourne Dental School The University of Melbourne Melbourne Australien
| | - Alexander Nirenberg
- Dorevitch Pathology Melbourne Australien
- Australasian College of Cutaneous Oncology Melbourne Australien
| | - Laura Scardamaglia
- Dermatology Department The Royal Melbourne Hospital Melbourne Australien
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Australien
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29
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Ibekwe PU, Ajibola HO, Babba Z, Otokpa G, Solomon R, Ukonu BA. Hypopigmented penile fixed drug eruption. Clin Case Rep 2022; 10:e6364. [PMID: 36188052 PMCID: PMC9508801 DOI: 10.1002/ccr3.6364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Fixed drug eruptions (FDE) are typically associated with residual hyperpigmentation or non‐pigmenting lesions. There is no distinctive histopathological feature; though, drug provocation tests (DPT) can be confirmatory within 7 days. We describe a patient with penile FDE associated with residual hypopigmentation, a prolonged refractory period to DPT and recurrent meatal stenosis.
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Affiliation(s)
- Perpetua U. Ibekwe
- Department of Medicine, College of Health Sciences University of Abuja Abuja Nigeria
| | | | - Zainabb Babba
- Dermatology Unit Federal Medical Center Abuja Nigeria
| | - Grace Otokpa
- Dermatology Unit University of Abuja Teaching Hospital Abuja Nigeria
| | - Raphael Solomon
- Pathology Department, College of Health Sciences University of Abuja Abuja Nigeria
| | - Bob A. Ukonu
- Dermatology Unit, Department of Medicine, College of Health SCIENCES University of Abuja Abuja Nigeria
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30
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Agarwal A, Das A, Panda M, Kumar P. Uncommon variants of fixed drug eruption. Indian J Dermatol Venereol Leprol 2022; 89:475-481. [DOI: 10.25259/ijdvl_502_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 11/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Piyush Kumar
- Department of Dermatology, Katihar Medical College, Katihar, Bihar, India
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31
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Seol JE, Ahn SW, Jang SH, Hong SM, Kim MY, Kim H. A case of recurrent fixed drug eruption following the administration of 2 different coronavirus disease 2019 vaccines verified using intradermal and patch tests. JAAD Case Rep 2022; 33:23-26. [PMID: 36062201 PMCID: PMC9420036 DOI: 10.1016/j.jdcr.2022.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Jung Eun Seol
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Sang Woo Ahn
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Seung Hee Jang
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Seong Min Hong
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Mi Yeong Kim
- Department of Internal Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hyojin Kim
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea,Correspondence to: Hyojin Kim, MD, PhD, Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University. 75, Bokji-ro, Busanjin-gu, Busan, Korea 47392.
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32
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Sargent B, Saeed L, Zhao D, Hosking AM, Skupsky H, Safaee M. Nicotine-Induced Bullous Fixed Drug Eruption,. JAAD Case Rep 2022; 29:6-8. [PMID: 36186412 PMCID: PMC9522872 DOI: 10.1016/j.jdcr.2022.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Brynn Sargent
- School of Medicine, University of California, Irvine
- Correspondence to: Brynn Sargent, BS, School of Medicine, University of California, Irvine 1001 Health Sciences Road, Irvine, CA 92617.
| | - Lina Saeed
- Department of Dermatology, University of California, Irvine
| | - Dani Zhao
- Department of Dermatology, University of California, Irvine
| | | | - Hadas Skupsky
- Department of Dermatology, University of California, Irvine
| | - Maryam Safaee
- Department of Dermatology, University of California, Irvine
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33
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Caseiro Alves ME, Cordeiro AI, Carvalho R, João A. Atypical presentation of erythema multiforme. BMJ Case Rep 2022; 15:e251076. [PMID: 35793857 PMCID: PMC9260799 DOI: 10.1136/bcr-2022-251076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- M Eduarda Caseiro Alves
- Pediatric Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rodrigo Carvalho
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Alexandre João
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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34
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Calvão J, Figueiredo C, Gonçalo M. Patch testing in fixed drug eruptions: a 12-year retrospective study. J Eur Acad Dermatol Venereol 2022; 36:e770-e772. [PMID: 35656639 DOI: 10.1111/jdv.18290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- J Calvão
- Dermatovenereology Department of Coimbra University Hospital, Coimbra, Portugal
| | - C Figueiredo
- Dermatovenereology Department of Coimbra University Hospital, Coimbra, Portugal
| | - M Gonçalo
- Dermatovenereology Department of Coimbra University Hospital, Coimbra, Portugal.,Faculty of Medicine of Coimbra University Hospital
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35
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Ophélie B, Alia G, Brigitte M, Paola S, Stéphanie K, Ruben G, Anne-Sophie D. Ectasy-Induced Fixed Drug Eruption. Contact Dermatitis 2022; 87:280-281. [PMID: 35452150 PMCID: PMC9543104 DOI: 10.1111/cod.14132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Barbier Ophélie
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
| | - Galadari Alia
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
| | - Milpied Brigitte
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
| | - Sanchez Paola
- Department of Pharmacoviligancy, Hôpital Pellegrin, CHU de Bordeaux, France
| | - Kassab Stéphanie
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, France
| | - Goncalves Ruben
- Department of Pharmacotoxicology, Hôpital Pellegrin, CHU de Bordeaux, France
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36
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Díaz-Espada F, Matheu V, Barrios Y. A review of hypersensitivity methods to detect immune responses to SARS-CoV-2. METHODS IN MICROBIOLOGY 2022; 50:189-222. [PMID: 38620993 PMCID: PMC8919898 DOI: 10.1016/bs.mim.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The investigation of the immune response after SARS-CoV-2 infection has been the goal of many researchers worldwide. The study of humoral immune responses and in vitro T cell production after infection requires the obtaining of individualized blood samples to test the presence of antibodies or activated T cells specific for the virus. In vitro T cell studies are especially troublesome due to the need for more specialized resources often outside the daily routine of clinical laboratories. For this reason the development of a simple and objective method to achieve these T cell studies is needed. In this manuscript we reviewed the hypersensitivity reactions, the theoretical basis and the historical background of delayed type hypersensitivity (DTH) which uses the principles of use of this test in the clinical setting for the past century. In the second part of the review, we focus on COVID adaptive immune responses, to understand the differences and challenges offered by this new application of DTH to investigate immune responses elicited after infection. In the last part of the review a vision provided for the use of this test to investigate the immunogenicity elicited by the vaccines. In our opinion, the clinical guidelines of immune assessment of SARS-CoV-2-infected or vaccinated individuals should include this simple and low-cost test to measure T-cell immunity. Rationale and improved vaccination schemes could be obtained after its implementation in the routine assessment of immunity in this pandemic situation.
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Affiliation(s)
| | - Victor Matheu
- Servicio de Alergología, Floor-2, Edificio de Actividades Ambulatorias, Hospital Universitario de Canarias, Tenerife, Spain
| | - Yvelise Barrios
- Laboratorio Immunología Central Lab, Planta 0, Edificio Principal, Hospital Universitario de Canarias, Tenerife, Spain
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37
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Raschi E, Fusaroli M, La Placa M, Ardizzoni A, Zamagni C, Poluzzi E, De Ponti F. Skin Toxicities with Cyclin-Dependent Kinase 4/6 Inhibitors in Breast Cancer: Signals from Disproportionality Analysis of the FDA Adverse Event Reporting System. Am J Clin Dermatol 2022; 23:247-255. [PMID: 34699032 DOI: 10.1007/s40257-021-00645-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cyclin-dependent kinase (CDK)-4/6 inhibitors have been associated with dermatologic reactions, especially alopecia, in pivotal trials. OBJECTIVE We aimed to comprehensively describe skin toxicities with CDK4/6 inhibitors reported in the real world through the US FDA Adverse Event Reporting System (FAERS). METHODS Cutaneous adverse events (AEs) were characterized in terms of spectrum and clinical features, including seriousness (with fatality proportion), latency, and discontinuation. Disproportionality analyses were performed through the reporting odds ratio (ROR) and 95% confidence interval (CI) by comparing CDK4/6 inhibitors with other anticancer drugs used in breast cancer. RESULTS As of December 2020, a total of 7986 cutaneous events were reported with CDK4/6 inhibitors (15% of total AEs with CDK4/6 inhibitors), mainly by consumers (39.6%), with 43.5% classified as serious and 25% requiring discontinuation. In 49% of the cases, five or more noncutaneous events were co-reported. The most frequently reported cutaneous events were alopecia (N = 3528), rash (N = 1493), and pruritus (N = 1211): rashes were recorded in the first month (median onset 28 days), whereas alopecia and nail alterations were recorded after a median of 67 and 112 days, respectively. Several cutaneous AEs were associated with increased reporting, including vitiligo (N = 6; ROR 8.88; 95% CI 2.95-22.46) and bullous dermatitis with ribociclib (N = 7; ROR 2.90; 95% CI 1.13-6.27); erythema multiforme with abemaciclib (N = 9; ROR 5.80; 95% CI 2.57-11.48); onychoclasis (N = 142, ROR 2.27; 95% CI 1.83-2.79) and trichorrhexis (N = 22; ROR 3.27; 95% CI 1.78-5.93) with palbociclib. CONCLUSIONS Although causality cannot be demonstrated, a diverse reporting pattern of cutaneous AEs emerged from FAERS, including dermal/epidermal conditions, hair/nail disorders, and serious bullous conditions, with variable onsets and a remarkable proportion of discontinuations. The potential differential reporting among CDK4/6 inhibitors deserves further investigation.
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Affiliation(s)
- Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
| | - Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Michelangelo La Placa
- Dermatology Division, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Andrea Ardizzoni
- Medical Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S. Orsola-Malpighi, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudio Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
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38
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Ercan N. Mucosal fixed drug eruption to levetiracetam with early positive patch test on non-lesional skin. Pediatr Allergy Immunol 2022; 33:e13723. [PMID: 35212050 DOI: 10.1111/pai.13723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nazli Ercan
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Gulhane Research and Training Hospital, University of Health Sciences Turkey, Ankara, Turkey
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39
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Bircher AJ, Imhof-Gex-Collet C, Scherer Hofmeier K. Aus den Augen, aus dem Sinn – Knacknuss-Anamnese bei disseminierten Arzneimittelexanthemen auf „vergessene“ Selbstmedikation. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1553-7278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungEs werden zwei Patienten vorgestellt, die zur Abklärung unklarer Exantheme zugewiesen wurden, bei beiden wurde die Diagnose initial nicht gestellt. Der erste Patient hatte ein ausgeprägtes Arzneimittelexanthem, die Patientin ein generalisiertes fixes Arzneimittelexanthem. Die wegen Verdacht auf Arzneimittelallergie durchgeführte aufwändige allergologische Diagnostik fiel zunächst unergiebig aus. Bei beiden wurde initial der Auslöser anamnestisch nicht erfasst, da die Patienten die Selbsttherapie mit frei verkäuflichen Medikamenten vergessen hatten oder als nicht relevant betrachteten. Erst auf intensive Befragung konnten die Auslöser Pseudoephedrin bzw. Paracetamol eruiert und bestätigt werden. Die zentrale Rolle einer umfassenden Anamneseerhebung und Dokumentation aller eingenommenen Therapeutika wird dargestellt.
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Affiliation(s)
- Andreas J. Bircher
- Allergologie, Universitätsspital Basel, Schweiz
- Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
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40
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Wantavornprasert K, Noppakun N, Klaewsongkram J, Rerknimitr P. Generalized bullous fixed drug eruption after Oxford-AstraZeneca (ChAdOx1 nCoV-19) vaccination. Clin Exp Dermatol 2021; 47:428-432. [PMID: 34482558 PMCID: PMC8652793 DOI: 10.1111/ced.14926] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 01/27/2023]
Affiliation(s)
- K Wantavornprasert
- Division of Dermatology, Skin and Allergy Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - N Noppakun
- Division of Dermatology, Skin and Allergy Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - J Klaewsongkram
- Division of Allergy and Clinical Immunology, Skin and Allergy Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Rerknimitr
- Division of Dermatology, Skin and Allergy Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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41
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Schunkert EM, Shah PN, Divito SJ. Skin Resident Memory T Cells May Play Critical Role in Delayed-Type Drug Hypersensitivity Reactions. Front Immunol 2021; 12:654190. [PMID: 34497600 PMCID: PMC8419326 DOI: 10.3389/fimmu.2021.654190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/06/2021] [Indexed: 12/31/2022] Open
Abstract
Delayed-type drug hypersensitivity reactions (dtDHR) are immune-mediated reactions with skin and visceral manifestations ranging from mild to severe. Clinical care is negatively impacted by a limited understanding of disease pathogenesis. Though T cells are believed to orchestrate disease, the type of T cell and the location and mechanism of T cell activation remain unknown. Resident memory T cells (TRM) are a unique T cell population potentially well situated to act as key mediators in disease pathogenesis, but significant obstacles to defining, identifying, and testing TRM in dtDHR preclude definitive conclusions at this time. Deeper mechanistic interrogation to address these unanswered questions is necessary, as involvement of TRM in disease has significant implications for prediction, diagnosis, and treatment of disease.
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42
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Federman D, Gruen JA, Merchant N. Tylenol or acetaminophen: a recurrent fixed drug eruption perpetuated through the use of inconsistent drug terminology. BMJ Case Rep 2021; 14:14/8/e241908. [PMID: 34344644 PMCID: PMC8336122 DOI: 10.1136/bcr-2021-241908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 87-year-old man with a history of osteoarthritis presented with worsening knee pain. He was prescribed acetaminophen with codeine. A few days later, he developed a rash on his right buttock and proximal thigh, similar to a rash he experienced in the past when he took over-the-counter (OTC) acetamenophen and an unknown lozenge to treat a presumed viral illness. A fixed drug eruption (FDE) was diagnosed and the patient was asked to avoid Tylenol and other OTC lozenges. Tylenol was entered as an allergy in the electronic medical records. However, since Tylenol, not acetaminophen was listed in the allergy profile, the order for acetaminophen and codeine did not generate an alert for the prescribing physician. Additionally, the dispensing pharmacist did not question the prescribing physician and the patient, unaware that acetaminophen in the pain medication is the same drug as Tylenol, took it and developed recurrent FDE.
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Affiliation(s)
- Daniel Federman
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Internal Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Jadry A Gruen
- Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Naseema Merchant
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA .,Internal Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, USA
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43
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Bohne AS, Dietrich C, Morrison K, Schwarz T, Wehkamp U, Kaeding M. Two cases of quinine-induced fixed 'drug' eruption induced by long drinks. J Eur Acad Dermatol Venereol 2021; 35:e774-e776. [PMID: 34138490 DOI: 10.1111/jdv.17453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A S Bohne
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C Dietrich
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K Morrison
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T Schwarz
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - U Wehkamp
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Kaeding
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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44
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Perks A, Bates TJ, Velangi S, Brown RM, Poveda-Gallego A. Probable etoricoxib-induced fixed drug eruption involving the oral mucosa: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e100-e107. [PMID: 33468439 DOI: 10.1016/j.oooo.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 11/15/2022]
Abstract
Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by recurrence of lesions at the same sites each time a specific drug is taken. Oral mucosal involvement is rare. Nonsteroidal anti-inflammatory drugs are one of the most common offending drug groups in FDE; however, selective cyclooxygenase-2 inhibitors, such as etoricoxib, are rarely implicated. We present a case of oral mucosal and cutaneous FDE induced by etoricoxib that, to the best of our knowledge, is the first reported case of this nature. We describe the diagnostic challenges and review the pertinent literature. The value of drug provocation testing and patch testing in FDE is also discussed.
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Affiliation(s)
- Alexandra Perks
- Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, UK.
| | - Timothy John Bates
- Oral Pathology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Shireen Velangi
- Dermatology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Rachel M Brown
- Oral Pathology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ana Poveda-Gallego
- Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, UK
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45
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Stingeni L, Bianchi L, Tramontana M, Pigatto PD, Patruno C, Corazza M, Foti C, Fabbrocini G, Micali G, Romita P, Napolitano M, Hansel K. Skin tests in the diagnosis of adverse drug reactions. GIORN ITAL DERMAT V 2020; 155:602-621. [DOI: 10.23736/s0392-0488.20.06698-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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46
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Danescu S, Salavastru C, Tiplica GS, Fritz K. [Treatment of pigmentation disorders in association with systemic diseases]. Hautarzt 2020; 71:932-943. [PMID: 33201325 DOI: 10.1007/s00105-020-04715-y] [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: 01/19/2023]
Abstract
Pigmentation disorders are a frequent skin problem and incorporate a broad spectrum of diseases, caused by an abnormal melanin pigmentation or also non-melanin pigmentation of the skin. Both hypermelanosis and hypomelanosis can be hereditary or acquired. This article summarizes the treatment approaches that are used in the majority of acquired pigmentation disorders of the skin. The following forms of hypermelanosis are addressed: lentiginosis, hyperpigmentation due to endocrine disorders or other systemic diseases, drug-induced hyperpigmentation. Acquired hypomelanoses include postinflammatory hypomelanosis, chemical depigmentation, idiopathic guttate hypomelanosis and punctate leucoderma. With reference to non-melanin pigmentation, the exogenous pigmentation due to chemicals, metals and drug exposure are discussed. The treatment is primarily based on finding the cause of the alterations to the pigment. The affected area, age and ethnic origin are also important factors. The spectrum of therapeutic options is broad: topical agents, chemical peeling, systemic agents, laser and light-based treatment. As some of these treatment procedures can have side effects, the availability of a protocol that contains information on the drug concentration, dose, parameters for laser treatment and the number of sessions is important. For every disorder the specific dermatological treatment is presented even when some pigmentation alterations that occur in association with systemic diseases, are cured by the treatment of the primary disease. Most diseases are exacerbated by exposure to UV light. Therefore, sun protection is recommended and a cosmetic coverage is indicated.
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Affiliation(s)
- Sorina Danescu
- Abteilung für Dermatologie, Universität Iuliu Hatieganu für Medizin und Pharmazie, Cluj, Rumänien
| | - Carmen Salavastru
- Abteilung für pädiatrische Dermatologie, Krankenhaus "Colentina", 19-21 Stefan cel Mare Av., Bukarest, Rumänien.
- Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien.
| | - G S Tiplica
- Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
- 2. Klinik für Dermatologie, Krankenhaus "Colentina", Bukarest, Rumänien
| | - K Fritz
- Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
- Hautärzte und Laserzentrum, Landau, Deutschland
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47
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Giraud-Kerleroux L, Charpentier C, Bernigaud C, Ortonne N, Hua C, Gaudron S, Nguyen QTR, Chosidow O, Wolkenstein P, Ingen-Housz-Oro S. Missed Diagnosis of Epilepsy-Associated Scald Burns: Two Cases Initially Diagnosed as Bullous Dermatosis. J Burn Care Res 2020; 42:569-572. [PMID: 33091119 DOI: 10.1093/jbcr/iraa184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Thermal burns can occur during seizure. This diagnosis can be difficult in case of atypical lesions, even more if the epilepsy is unknown and in case of seizures with loss of consciousness and/or an unwitnessed epileptic attack. We report two cases of cutaneous bullous lesions initially misdiagnosed as severe acute cutaneous adverse reactions (generalized bullous fixed drug eruption and Stevens-Johnson syndrome). In the two cases, the clinical aspect, necrotic evolution, and absence of obvious attributable medication allowed to revert to the diagnosis of burns due to boiling water revealing previously unknown epilepsy. For both, surgical management with skin graft was performed, and antiepileptic treatment was introduced. Facing unexplained burns, occult epilepsy should be investigated. Questioning of patient and relatives is crucial.
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Affiliation(s)
- Laura Giraud-Kerleroux
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Department of Dermatology, Grand Hôpital de l'Est-Francilien, site Marne La Vallée, France
| | - Chloé Charpentier
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Charlotte Bernigaud
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Faculté de santé, Université Paris Est Créteil Val de Marne, UPEC, France
| | - Nicolas Ortonne
- Faculté de santé, Université Paris Est Créteil Val de Marne, UPEC, France.,Department of Pathology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Camille Hua
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,EA 7379 EpidermE, UPEC, Créteil, France
| | - Sophie Gaudron
- Department of Dermatology, Grand Hôpital de l'Est-Francilien, site Marne La Vallée, France
| | | | - Olivier Chosidow
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Faculté de santé, Université Paris Est Créteil Val de Marne, UPEC, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Faculté de santé, Université Paris Est Créteil Val de Marne, UPEC, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Faculté de santé, Université Paris Est Créteil Val de Marne, UPEC, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
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48
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Vargas Mora P, García S, Valenzuela F, Morales C. Generalized bullous fixed drug eruption successfully treated with cyclosporine. Dermatol Ther 2020; 33:e13492. [PMID: 32356595 DOI: 10.1111/dth.13492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Pablo Vargas Mora
- Dermatology Department, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Santiago García
- Dermatology Department, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Fernando Valenzuela
- Dermatology Department, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Claudia Morales
- Dermathopatology Section, Pathology Service, Hospital Clínico Universidad de Chile, Santiago, Chile
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49
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Schwartz RA, Janniger CK. Generalized pustular figurate erythema: A newly delineated severe cutaneous drug reaction linked with hydroxychloroquine. Dermatol Ther 2020; 33:e13380. [PMID: 32253799 PMCID: PMC7235477 DOI: 10.1111/dth.13380] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/19/2022]
Abstract
A severe cutaneous drug reaction resembling acute generalized exanthematous pustulosis resulting from ingestion of hydroxychloroquine has been documented. It is distinguishable by its longer incubation period, more varied morphology with initially urticarial and later targetoid and arcuate plaques, recalcitrance to therapy and longer duration. Given the anticipated surge in the use of hydroxychloroquine due to its reported benefits in those with coronavirus disease 2019, specific recognition of this entity is pivotal. We delineate it as generalized pustular figurate erythema.
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