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Jeong MS, Choi YY, Ahn YH, Lee K, Park JS, Suh DI. Etanercept treatment for pediatric toxic epidermal necrolysis induced by deflazacort: a case report and literature review. Front Immunol 2024; 15:1342898. [PMID: 38333208 PMCID: PMC10850310 DOI: 10.3389/fimmu.2024.1342898] [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: 11/22/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous disorder commonly caused by drugs. TEN is often treated with corticosteroids, intravenous immunoglobulin (IVIG), or cyclosporine; however, the efficacy of these treatments is controversial. Etanercept (a TNF-α antagonist) was proven to decrease skin-healing time in a randomized clinical trial. Herein, we report the case of a 44-month-old boy who developed TEN due to deflazacort as the probable culprit drug and was successfully treated with etanercept. The patient presented to the emergency department complaining of erythematous maculopapular rashes and vesicles all over the face and body, with vesicles on the hands, feet, and trunk. Symptoms started 4 days before presentation, with edema of the upper lip, which progressed to erythematous macules over the body. He was started on deflazacort for nephrotic syndrome 21 days before the visit. Approximately 20% of the body surface area (BSA) was covered by vesicular lesions. Under the diagnosis of Steven Johnson syndrome/TEN, deflazacort was discontinued, and intravenous dexamethasone (1.5 mg/kg/day), a 5-day course of IVIG (0.4 mg/kg/day), and cyclosporine (3 mg/kg/day) were administered. The lesions seemed to be stationary for 3 days, but on the 6th day of hospitalization, when IVIG was discontinued, the vesicular lesions progressed to approximately 60% of the BSA. Etanercept 0.8 mg/kg was administered subcutaneously. Lesions stopped progressing, and bullous lesions started epithelialization. However, on the 15th day, around 30% of the BSA was still involved; thus, a second dose of etanercept was administered. No acute or sub-acute complications were observed. In conclusion, the use of etanercept in children with TEN that is not controlled with conventional therapy is both effective and safe.
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Affiliation(s)
| | | | | | | | - Ji Soo Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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Mpofana N, Chibi B, Gqaleni N, Hussein A, Finlayson AJ, Kgarosi K, Dlova NC. Melasma in people with darker skin types: a scoping review protocol on prevalence, treatment options for melasma and impact on quality of life. Syst Rev 2023; 12:139. [PMID: 37563624 PMCID: PMC10416367 DOI: 10.1186/s13643-023-02300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Melasma is one of the most encountered dermatoses in dermatology and skin care clinics. It is a challenging chronic, recurrent condition associated with hyperpigmentation. Its aetiology is poorly understood. Melasma affects all races and gender but is more prevalent in women with darker skin types. Being a facial lesion, melasma has a severe impact on quality of life due to its disfigurement. While many modalities of treatment for melasma exists, unfortunately, effectiveness and safety remain a huge concern. Treatment modalities are variable and often unsatisfactory. The objective of this scoping review is to systemically map available evidence from literature regarding melasma on people with darker skin types, garner insight as to how melasma affects the quality of life and begin to investigate and gain understanding on effectiveness of different treatments used for melasma. METHODS A scoping review guided by Arksey and O'Malley's framework, the enhancements and recommendations of Levac, Colquhoun and O'Brien, Daudt and associates and the 2015 Johanna Briggs Institute's guidelines will be conducted. Systematic electronic searches of databases and search engines will include Scopus, PubMed, CINAHL Complete, Cochrane, Science Direct, and Web of Science which will be conducted to attain published peer-reviewed articles of all study designs excluding reviews and grey literature. All literature that meets the inclusion criteria, research question and sub-question will be included in this review. All the retrieved literature will be exported to an Endnote X20 library. Quality appraisal of the included articles will be conducted using the mixed methods appraisal tool (MMAT) 2018 version. DISCUSSION We anticipate mapping relevant literature on the melasma, investigating the effectiveness of treatment options of melasma as well as evaluating its association with quality of life in people with darker skin types. This study is likely to reveal research gaps, which could guide future implementation research on melasma treatment interventions. SYSTEMATIC REVIEW REGISTRATION This protocol has been registered a priori with OSF and is accessible on this link: https://osf.io/ru3jc/ .
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Affiliation(s)
- Nomakhosi Mpofana
- Dermatology Department, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, 4000, South Africa.
- Department of Somatology, Durban University of Technology, Durban, 4000, South Africa.
| | - Buyisile Chibi
- Center of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Nceba Gqaleni
- Discipline of Traditional Medicine, University of KwaZulu-Natal, Durban, 4000, South Africa
- Faculty of Health Sciences, Durban University of Technology, Durban, 4000, South Africa
| | - Ahmed Hussein
- Department of Chemistry, Cape Peninsula University of Technology, Bellville, 7535, South Africa
| | | | | | - Ncoza Cordelia Dlova
- Dermatology Department, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, 4000, South Africa
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Morrow SE, Arianayagam S, Wilkinson M, Bourke J, Bertram CG, Buckley DA, Chowdhury MMU, Divekar P, Ghaffar SA, Green C, Holden C, Johnston GA, Mughal A, Dhonncha EN, Reckling C, Scharrer K, Stone N, Thompson D, Wakelin S, Cooper S. Recommendation to update the British Society for Cutaneous Allergy corticosteroid series. Clin Exp Dermatol 2023; 48:339-344. [PMID: 36763742 DOI: 10.1093/ced/llac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patch testing is an important investigation when dermatitis is unresponsive to, or worsened by, topical corticosteroid treatment. There is a balance to be struck between testing too many allergens, which is expensive, time consuming and risks causing sensitization, and testing too few, which risks missing the diagnosis. The current British Society for Cutaneous Allergy (BSCA) corticosteroid series comprises eight allergens and was last updated in February 2007. AIM To review and update the BSCA corticosteroid series. METHODS We retrospectively analysed data from 16 patch test centres in the UK and Ireland for all patients who were patch tested to a corticosteroid series between August 2017 and July 2019. We recorded the allergens tested, the number and percentage tested to a corticosteroid series and the number of positive results for each allergen. We identified the allergens that test positive in ≥ 0.1% of selectively tested patients. RESULTS Overall, 3531 patients were tested to a corticosteroid series in the 16 centres. The number of allergens tested ranged from 7 to 18 (mean 10). The proportion of patch test patients who were tested to a corticosteroid series ranged from 1% to 99%. Six allergens in the 2017 BSCA series tested positive in ≥ 0.1% of patients. Nine allergens not in the BSCA corticosteroid series tested positive in ≥ 0.1% of patients. CONCLUSION This audit demonstrates the importance of regular review of recommended series and the significant variations in practice. The new BSCA corticosteroid series that we recommend contains 13 haptens, with the addition of the patient's own steroid creams as appropriate.
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Affiliation(s)
- Sarah E Morrow
- Departments of Dermatology Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sanju Arianayagam
- Departments of Dermatology Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - John Bourke
- South Infirmary Victoria University Hospital, Cork, Ireland
| | | | | | | | | | | | - Cathy Green
- Ninewells Hospital and Medical School, Dundee, UK
| | - Catherine Holden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Avad Mughal
- Swansea Bay University Health Board, Port Talbot, UK
| | | | | | | | | | - Donna Thompson
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Susan Cooper
- Departments of Dermatology Oxford University Hospitals NHS Trust, Oxford, UK
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Smajdor J, Paczosa-Bator B, Piech R. Advances on Hormones and Steroids Determination: A Review of Voltammetric Methods since 2000. MEMBRANES 2022; 12:1225. [PMID: 36557132 PMCID: PMC9782681 DOI: 10.3390/membranes12121225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
This article presents advances in the electrochemical determination of hormones and steroids since 2000. A wide spectrum of techniques and working electrodes have been involved in the reported measurements in order to obtain the lowest possible limits of detection. The voltammetric and polarographic techniques, due to their sensitivity and easiness, could be used as alternatives to other, more complicated, analytical assays. Still, growing interest in designing a new construction of the working electrodes enables us to prepare new measurement procedures and obtain lower limits of detection. A brief description of the measured compounds has been presented, along with a comparison of the obtained results.
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Svendsen SV, Bach RO, Mortz CG. Prevalence of contact allergy to corticosteroids in a Danish patient population. Contact Dermatitis 2022; 87:273-279. [PMID: 35460519 PMCID: PMC9544555 DOI: 10.1111/cod.14135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/07/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
Background Allergic contact dermatitis to corticosteroids can be a challenging diagnosis as corticosteroids are used in the treatment of dermatitis. The prevalence of contact allergy to corticosteroid varies between previous studies. Objective To study the prevalence of sensitization to budesonide, tixocortol‐21‐pivalate and hydrocortisone‐17‐butyrate in a Danish patient population from 2006‐2020, cross‐sensitization, risk factors and clinical relevance. Methods A retrospective analysis of patch test data and MOAHLFA index was performed among 6823 patients consecutively patch tested with TRUE test as part of the baseline series. Results A positive patch test for corticosteroids was found in 185 patients (1.2% budesonide, 1.6% tixocortol‐21‐pivalate, 1.0% hydrocortisone‐17‐butyrate) without gender difference. For women, the prevalence of tixocortol‐21‐pivalate sensitization increased significantly from 1.3% in 2006–2008 to 2.9% in 2018–2020. Tixocortol‐21‐pivalate sensitization had more frequently clinical relevance in women (61.3%) compared to men (34.5%). Age above 40 years was positively associated to corticosteroid sensitization. Budesonide and hydrocortisone‐17‐butyrate accounted for 67.7% of co‐sensitizations. Conclusions The prevalence of corticosteroid sensitization was 2.7%. Age was the only risk factor for corticosteroid sensitization. The frequency of corticosteroid sensitization was stabile over time except for tixocortol‐21‐pivalate sensitization for women. About one third of sensitized patients had co‐sensitizations to other corticosteroid groups.
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Affiliation(s)
- Sebastian Vigand Svendsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Rasmus Overgaard Bach
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
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Abstract
ABSTRACT Allergic contact dermatitis from topical drugs is frequent and is seen in 10% to 17% of patients patch tested for suspected contact dermatitis. More than 360 drugs have been implicated as contact allergens, of which-generally-antibiotics, corticosteroids, local anesthetics, and nonsteroidal anti-inflammatory drugs are the most frequent culprits. This article provides an overview of allergic contact dermatitis to topical drugs, discussing their prevalence of sensitization, predisposing factors, clinical manifestations (both typical and atypical), the drugs described as allergens, cross-reactivity and coreactivity, and diagnostic procedures.
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Abstract
Eczematous drug eruptions are a heterogenous group of skin reactions that resemble eczema both clinically and histologically. We reviewed the literature and cataloged the systemically administered medications that cause these eruptions, along with their characteristic clinical presentations. We identified three primary pathophysiologic etiologies: (1) cutaneous immunomodulation, (2) skin dehydration, and (3) delayed hypersensitivity. Notably, eczematous eruptions caused by altered immunity in the skin may be increasing in incidence as some responsible drugs, in particular biologic therapies (such as tumor necrosis factor-α and interleukin-17 inhibitors) and targeted cancer treatments (including immune checkpoint inhibitors and epidermal growth factor receptor inhibitors), become more commonly employed in clinical practice. Other notable causes of eczematous eruptions include antiviral agents for hepatitis C virus and cardiovascular medications in elderly individuals, and notable subtypes of eczematous reactions include systemic contact dermatitis and photoallergic reactions, which are also discussed. The diagnostic gold standard is drug rechallenge and most reactions may be treated effectively with emollients, topical corticosteroids, and oral antihistamines.
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Affiliation(s)
| | - Susan Burgin
- Harvard Medical School, Boston, MA, USA.
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
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Contact Allergy to Topical Drugs. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Someshwar S, Lodha A. Comparative evaluation of steroid sensitivity in various dermatoses with control group through histopathological examination and patch testing. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2021. [DOI: 10.4103/mjmsr.mjmsr_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Topical Drugs. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_38-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Goossens A, Gonçalo M. Contact Allergy to Topical Drugs. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_38-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Contact Allergy to Topical Mometasone Furoate Confirmed by Rechallenge and Patch Test. Am J Ther 2019; 25:e497-e498. [PMID: 28328785 DOI: 10.1097/mjt.0000000000000581] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Lee YI, Lee M, Lee S, Kim DY. A Permanent Hair Loss in a Patient with Hypersensitivity to Intralesional Triamcinolone Injection. Ann Dermatol 2019; 31:217-220. [PMID: 33911573 PMCID: PMC7992691 DOI: 10.5021/ad.2019.31.2.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/04/2018] [Accepted: 04/11/2018] [Indexed: 11/08/2022] Open
Abstract
Despite multiple possible side effects, mesotherapy with a diverse mixture of unapproved products has been performed for the treatment of hair loss. In this case report, we present a rare case of permanent hair loss due to an allergic reaction from a mesotherapy mixture including triamcinolone acetonide. The patient showed a positive intradermal allergic skin test result for triamcinolone and therefore was diagnosed with scarring alopecia due to delayed type IV hypersensitivity to corticosteroid. This case study suggests that dermatologists should always be fully aware that both IgE-mediated and non-IgE-mediated hypersensitivity reactions from the corticosteroids as well as their mesotherapy excipients are possible in an effort to prevent irreversible adverse event from the mesotherapy.
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Affiliation(s)
- Young In Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Minseok Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sewon Lee
- Yonsei Leeand Skin Clinic, Seoul, Korea
| | - Do Young Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Simonsen A, Johansen J, Deleuran M, Mortz C, Skov L, Sommerlund M. Children with atopic dermatitis may have unacknowledged contact allergies contributing to their skin symptoms. J Eur Acad Dermatol Venereol 2018; 32:428-436. [DOI: 10.1111/jdv.14737] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/20/2017] [Indexed: 12/30/2022]
Affiliation(s)
- A.B. Simonsen
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
- National Allergy Research Centre; Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - J.D. Johansen
- National Allergy Research Centre; Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - M. Deleuran
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
| | - C.G. Mortz
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
| | - L. Skov
- Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - M. Sommerlund
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
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Matsubara R, Kumagai K, Shigematsu H, Kitaura K, Nakasone Y, Suzuki S, Hamada Y, Suzuki R. Fexofenadine Suppresses Delayed-Type Hypersensitivity in the Murine Model of Palladium Allergy. Int J Mol Sci 2017; 18:ijms18071357. [PMID: 28672829 PMCID: PMC5535850 DOI: 10.3390/ijms18071357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 02/07/2023] Open
Abstract
Palladium is frequently used in dental materials, and sometimes causes metal allergy. It has been suggested that the immune response by palladium-specific T cells may be responsible for the pathogenesis of delayed-type hypersensitivity in study of palladium allergic model mice. In the clinical setting, glucocorticoids and antihistamine drugs are commonly used for treatment of contact dermatitis. However, the precise mechanism of immune suppression in palladium allergy remains unknown. We investigated inhibition of the immune response in palladium allergic mice by administration of prednisolone as a glucocorticoid and fexofenadine hydrochloride as an antihistamine. Compared with glucocorticoids, fexofenadine hydrochloride significantly suppressed the number of T cells by interfering with the development of antigen-presenting cells from the sensitization phase. Our results suggest that antihistamine has a beneficial effect on the treatment of palladium allergy compared to glucocorticoids.
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Affiliation(s)
- Ryota Matsubara
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-3-1 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan.
- Department of Rheumatology and Clinical Immunology, Clinical Research Center for Rheumatology and Allergy, Sagamihara National Hospital, National Hospital Organization, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan.
| | - Kenichi Kumagai
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-3-1 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan.
- Department of Rheumatology and Clinical Immunology, Clinical Research Center for Rheumatology and Allergy, Sagamihara National Hospital, National Hospital Organization, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan.
| | - Hiroaki Shigematsu
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-3-1 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan.
- Department of Rheumatology and Clinical Immunology, Clinical Research Center for Rheumatology and Allergy, Sagamihara National Hospital, National Hospital Organization, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan.
| | - Kazutaka Kitaura
- Department of Rheumatology and Clinical Immunology, Clinical Research Center for Rheumatology and Allergy, Sagamihara National Hospital, National Hospital Organization, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan.
| | - Yasunari Nakasone
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-3-1 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan.
- Department of Rheumatology and Clinical Immunology, Clinical Research Center for Rheumatology and Allergy, Sagamihara National Hospital, National Hospital Organization, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan.
| | - Satsuki Suzuki
- Section of Biological Science, Research Center for Odontology, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20 Fujimi, Chiyoda-ku, Tokyo 102-8159, Japan.
| | - Yoshiki Hamada
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-3-1 Tsurumi, Tsurumi-ku, Yokohama 230-8501, Japan.
| | - Ryuji Suzuki
- Department of Rheumatology and Clinical Immunology, Clinical Research Center for Rheumatology and Allergy, Sagamihara National Hospital, National Hospital Organization, 18-1 Sakuradai, Minami-ku, Sagamihara 252-0392, Japan.
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Simonsen A, Johansen J, Deleuran M, Mortz C, Sommerlund M. Contact allergy in children with atopic dermatitis: a systematic review. Br J Dermatol 2017; 177:395-405. [DOI: 10.1111/bjd.15628] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 12/30/2022]
Affiliation(s)
- A.B. Simonsen
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
- National Allergy Research Centre; Department of Dermatology and Allergy; Copenhagen University Hospital Gentofte - Herlev; Kildegaardsvej 28 2900 Hellerup Denmark
| | - J.D. Johansen
- National Allergy Research Centre; Department of Dermatology and Allergy; Copenhagen University Hospital Gentofte - Herlev; Kildegaardsvej 28 2900 Hellerup Denmark
| | - M. Deleuran
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
| | - C.G. Mortz
- Department of Dermatology and Allergy; Odense University Hospital; Odense Denmark
| | - M. Sommerlund
- Department of Dermatology and Venereology; Aarhus University Hospital; Aarhus Denmark
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Kot M, Bogaczewicz J, Kręcisz B, Woźniacka A. Contact allergy in the population of patients with chronic inflammatory dermatoses and contact hypersensitivity to corticosteroids. Postepy Dermatol Alergol 2017; 34:253-259. [PMID: 28670256 PMCID: PMC5471381 DOI: 10.5114/ada.2017.67848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/13/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Clinical studies indicate that contact allergy to glucocorticosteroids (GCS) is not rare and has been increasingly reported over the past decade. Among the risk factors for developing contact hypersensitivity to topical corticosteroids, chronic inflammatory skin diseases and polyvalent contact allergy seem to be most important. AIM To present the structure of contact allergy in the population of patients with chronic inflammatory dermatoses (CID) and contact hypersensitivity to corticosteroids. MATERIAL AND METHODS Twenty-seven patients with contact allergy to GCS and chronic inflammatory dermatoses were patch tested with 28 European Baseline Series allergens and 8 corticosteroid allergens. This study group consisted of 5 patients with atopic dermatitis (AD), 15 patients with contact eczema (CE) and 7 with chronic leg eczema (CLE). Nineteen (70.4%) patients were females and 8 (29.6%) were males. RESULTS In the study group, the most sensitizing non-steroidal allergens were nickel sulfate (51.8%), cobalt chloride (33.3%) and balsam of Peru (29.6%). The most sensitizing corticosteroid allergens were budesonide (77.8%), betamethasone valerate and clobetasol propionate (55.5% each). A total of 77.8% of patients allergic to GCS also showed sensitivity to at least one non-steroidal allergen from the European Baseline Series. CONCLUSIONS The most important risk factors for developing contact allergy to corticosteroids appear to be chronic inflammatory dermatoses, long disease duration, extended on-and-off topical corticosteroid use, patients presenting two or more positive patch test results and polyvalent contact allergy to metal salts and to other non-steroidal haptens.
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Affiliation(s)
- Marek Kot
- Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland
| | - Jarosław Bogaczewicz
- Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland
| | - Beata Kręcisz
- Faculty of Medicine and Health Science, Jan Kochanowski University, Kielce, Poland
| | - Anna Woźniacka
- Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland
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Shams A, Khan IU, Iqbal H. Analysis of salicylic acid, arbutin and corticosteroids in skin whitening creams available in Pakistan using chromatographic techniques. Int J Cosmet Sci 2016; 38:421-8. [DOI: 10.1111/ics.12310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A. Shams
- Department of Chemistry; Government College University; Lahore 54000 Pakistan
| | - I. U. Khan
- Department of Chemistry; Government College University; Lahore 54000 Pakistan
| | - H. Iqbal
- Department of Chemistry; Government College University; Lahore 54000 Pakistan
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19
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Youn D, Kim MH, Koh SW, Kim JW, Yoon SE, Jeon HK, Cho YJ. Toxic epidermal necrolysis induced by deflazacort. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.3.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Dail Youn
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seok Woong Koh
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jung Won Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sang Eun Yoon
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyeon Kyeong Jeon
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young-Joo Cho
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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20
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Kreeshan FC, Hampton P. Delayed hypersensitivity reaction to intralesional triamcinolone acetonide following treatment for alopecia areata. Intradermal testing. J Dermatol Case Rep 2015; 9:107-9. [PMID: 26848319 DOI: 10.3315/jdcr.2015.1216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/13/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hypersensitivity reactions to intralesional corticosteroids are very rare and have been infrequently reported. Patch testing is considered the gold standard for diagnosing contact allergic dermatitis. However, intradermal testing is thought to be more accurate and sensitive in selected cases. MAIN OBSERVATION We describe a case of a delayed hypersensitivity reaction to intralesional triamcinolone acetonide following the treatment of alopecia areata. Patch testing to triamcinolone was negative but intradermal testing with a small volume of the same reagent elicited a strong reaction. CONCLUSIONS Patch testingmay be unsuccessful in detecting delayed reactions to intralesional corticosteroids. In such cases intradermal testing at a non-cosmetically sensitive sitemay be a useful diagnostic tool.
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Affiliation(s)
| | - Philip Hampton
- Department of Dermatology, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
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21
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Fragrance sensitisers: Is inhalation an allergy risk? Regul Toxicol Pharmacol 2015; 73:897-902. [DOI: 10.1016/j.yrtph.2015.09.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 12/20/2022]
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22
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Mooney E, Rademaker M, Dailey R, Daniel BS, Drummond C, Fischer G, Foster R, Grills C, Halbert A, Hill S, King E, Leins E, Morgan V, Phillips RJ, Relic J, Rodrigues M, Scardamaglia L, Smith S, Su J, Wargon O, Orchard D. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement. Australas J Dermatol 2015; 56:241-51. [DOI: 10.1111/ajd.12313] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Emma Mooney
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Marius Rademaker
- Department of Dermatology; Waikato Hospital; Hamilton New Zealand
| | | | - Ben S Daniel
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Catherine Drummond
- Department of Dermatology; Canberra Hospital; Canberra Australian Capital Territory
- Australian National University; Canberra Australian Capital Territory
| | - Gayle Fischer
- Department of Dermatology; Royal North Shore Hospital; Sydney New South Wales
- Sydney Medical School; University of Sydney; Sydney New South Wales
| | - Rachael Foster
- Department Paediatric Dermatology; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - Claire Grills
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Anne Halbert
- Department Paediatric Dermatology; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - Sarah Hill
- Department of Dermatology; Waikato Hospital; Hamilton New Zealand
| | - Emma King
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Elizabeth Leins
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Vanessa Morgan
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- Department of Dermatology; Royal Melbourne Hospital; Melbourne Victoria
| | - Roderic J Phillips
- Department of Paediatrics; Monash University; Melbourne Victoria
- Department of Vascular Biology; Royal Children's Hospital; Melbourne Victoria
- Murdoch Children's Research Institute; Melbourne Victoria
| | - John Relic
- Department of Dermatology; Royal Newcastle Centre; Newcastle New South Wales
| | - Michelle Rodrigues
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- Department of Dermatology; St Vincent's Hospital; Melbourne Victoria
| | - Laura Scardamaglia
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- University of Melbourne; Melbourne Victoria
- Department of Dermatology; Royal Melbourne Hospital; Melbourne Victoria
- Department of Dermatology; Western Hospital; Melbourne Victoria
| | - Saxon Smith
- Department of Dermatology; Royal North Shore Hospital; Sydney New South Wales
- Sydney Medical School; University of Sydney; Sydney New South Wales
| | - John Su
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- University of Melbourne; Melbourne Victoria
- Department of Dermatology, Eastern Health; Murdoch Children's Research Institute; Melbourne Victoria
- Monash University; Melbourne Victoria
- Murdoch Children's Research Institute; Melbourne Victoria
| | - Orli Wargon
- Department Paediatric Dermatology; Sydney Children's Hospital; Sydney New South Wales
| | - David Orchard
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
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23
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Ferner RE. Adverse drug reactions in dermatology. Clin Exp Dermatol 2015; 40:105-9; quiz 109-10. [PMID: 25622648 DOI: 10.1111/ced.12572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 12/21/2022]
Abstract
Adverse drug reactions (ADRs) - that is, unintended and harmful responses to medicines - are important to dermatologists because many present with cutaneous signs and because dermatological treatments can cause serious ADRs. The detection of ADRs to new drugs is often delayed because they have a long latency or are rare or unexpected. This means that ADRs to newer agents emerge only slowly after marketing. ADRs are part of the differential diagnosis of unusual rashes. A good drug history that includes details of drug dose, time-course of the reaction and factors that may make the patient more susceptible, will help. For example, Stevens-Johnson syndrome with abacavir is much commoner in patients with HLA-B*5701, and has a characteristic time course. Newer agents have brought newer reactions; for example, acneiform rashes associated with epidermal growth factor receptor inhibitors such as erlotinib. Older systemic agents used to treat skin disease, including corticosteroids and methotrexate, cause important ADRs. The adverse effects of newer biological agents used in dermatology are becoming clearer; for example, hypersensitivity reactions or loss of efficacy from antibody formation and progressive multifocal leucoencephalopathy due to reactivation of latent JC (John Cunningham) virus infections during efalizumab treatment. Unusual or serious harm from medicines, including ADRs, medication errors and overdose, should be reported. The UK Yellow Card scheme is online, and patients can report their own ADRs.
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Affiliation(s)
- R E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital Birmingham and School of Clinical and Experimental Medicine, Birmingham, UK
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24
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Immediate and delayed hypersensitivity to systemic corticosteroids: 2 case reports. Dermatitis 2013; 23:288-90. [PMID: 23169212 DOI: 10.1097/der.0b013e318277ca22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Both immediate, type I reactions and delayed hypersensitivity, type IV reactions to systemic corticosteroid preparations have been reported. Type I reactions are rare, with delayed hypersensitivity reactions being slightly more common. CASES A 33-year-old woman presented repeatedly to the emergency department with asthma attacks. She developed pruritus and hives approximately 30 minutes after the administration of parenteral corticosteroids. Her respiratory status deteriorated approximately 6 hours after she received the corticosteroids. An acute eczematous dermatitis on her face, neck, and upper body appeared 24 hours after administration of the corticosteroids. The dermatitis peaked at 72 hours. Intradermal testing to Solu-Medrol, Solu-Cortef, prednisone, and Decadron confirmed a type I, anaphylactoid reaction. The dermatitis that presented 24 hours after administration of the parenteral corticosteroids is consistent clinically with a type IV delayed hypersensitivity reaction to the corticosteroids. A second patient, a 51-year-old woman, developed urticarial lesions that lasted approximately 30 minutes, immediately after intralesional triamcinolone injections for keloid scars. Intradermal testing was performed. She showed a positive reaction to triamcinolone confirming a type I allergy to this steroid. CONCLUSIONS It is important to consider an allergy to corticosteroids in patients with worsening anaphylactic symptoms after administration of systemic corticosteroids.
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Grzybowski A, Pietrzak K. Tadeusz Reichstein (1897-1996): a cofounder of modern steroid treatment in dermatology. Clin Dermatol 2012; 30:243-7. [PMID: 22435119 DOI: 10.1016/j.clindermatol.2011.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Corticosteroids, which revolutionized dermatologic therapy a half century ago, owe their beginnings to Tadeusz Reichstein (1897-1996), who was born in Poland but emigrated in 1905 with his family to Switzerland. Between 1934 and 1944, he isolated and elucidated the chemical structure of 29 pure substances from the extract of the adrenal cortex. All of them turned out to be steroid derivatives, including corticosterone and hydrocortisone. In 1950, the Karolinska Institute in Stockholm awarded the Nobel Prize in Physiology or Medicine to Tadeusz Reichstein, along with Edward Kendall (1886-1972) and Phillip Hench (1896-1965), for their discoveries relating to the hormones of the adrenal cortex, their structures, and their biologic effects. In 1953, Reichstein isolated the pure crystalline form of a substance with a strong effect on electrolyte and water balance--aldosterone. Reichstein was an author or coauthor of 635 papers, the last ones at the age of 97. He described himself as “a Swiss of Polish-Jewish descent,” but his scientific achievements made him a world citizen.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, Poznan City Hospital, ul. Szwajcarska 3, 61-285 Poznań, Poland.
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26
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Abstract
PURPOSE OF REVIEW This monograph reviews recent studies, examining topical glucocorticoid use in children. Emphasis is placed on mechanism of action, relative potency, cutaneous absorption, adverse affects, steroid phobia, and treatment compliance. RECENT FINDINGS Recent literature has shown that over 80% of patients prescribed topical glucocorticoids are fearful of side effects and fail to use them appropriately. This lack of compliance leads to decreased therapeutic benefits. Despite this 'steroid phobia', multiple studies indicate that proper use of glucocorticoids in children is well tolerated and effective. Recent studies have failed to show clinically significant hypothalamic-pituitary-adrenal suppression and cutaneous atrophy in children. High-potency steroids have been shown to cause growth restriction when used during pregnancy. Steroid allergy occurs with a prevalence of 2.7% and should be considered in children who fail to respond as expected to topical glucocorticoids. SUMMARY Topical glucocorticoids continue to be well tolerated, effective and cost-effective in the treatment of inflammatory cutaneous conditions in children.
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