Ultraviolet recall–like phenomenon occurring after piperacillin, tobramycin, and ciprofloxacin therapy

Radiation recall reactions: An oncologic enigma

Radiation recall reactions (RRR) are uncommon but are a well-known phenomenon to oncologists. Tissue damage in a prior irradiation portal is 'recalled' after the administration of a drug, historically cytotoxics, or more recently, targeted or immunotherapeutic agents. Even COVID-19 vaccines are a reported cause. RRR are enigmatic in that their cause is unknown, but they generally have the histopathological and clinical features of acute or chronic inflammation. They can occur in a variety of tissues, the commonest being skin, which accounts for two-thirds of reported cases. They are generally relatively mild and self-limiting once the trigger drug is stopped, although severe cases with tissue necrosis have occurred. Rechallenge with drug does not necessarily cause reactivation of the reaction. Symptomatic treatment with steroids and antihistamines are usually effective, but their impact on the clinical course is unclear. Various hypotheses have been proposed as to the mechanism of RRR; a non-immune fixed drug reaction-like condition, dysregulated release of reactive oxygen species, abnormalities of tissue vasculature and impaired DNA repair. All could lead to a characteristic inflammatory microenvironment, resulting in dysfunction of tissue stem cells, keratinocyte necrosis and dermal abnormalities. Alternatively or in addition, low levels of inflammatory tissue cytokines induced by previous irradiation might be further upregulated by drug exposure. Most information in this review refers to data derived from cutaneous RRR, since they are the most common form reported.

Docetaxel/Cyclophosphamide-Induced Phototherapy Recall

Phototherapy recall can occur unexpectedly as a result of treatment with commonly used medications and chemotherapy. These reactions are rare. The recall reaction is an inflammatory response that is triggered by many medications. Cyclophosphamide and docetaxel are widely used chemotherapeutic agents that are useful in the management of many different malignancies. The pathophysiology of phototherapy recall is not clearly understood. This case highlights the need for practitioners to be aware of this potential reaction, even though UV exposure may have occurred in the distant past. We present, to the best of our knowledge, the first phototherapy recall dermatitis that occurred years after UV exposure induced by cyclophosphamide and docetaxel. The frequency of administration of this drug and the profound implications of this adverse effect make this case an important contribution to the medical literature.

Recall Dermatitis to Metronidazole

Background and Objective

Recall dermatitis is an uncommon entity that has been noted with patch testing, repeat exposures to a medication or allergen, and the concurrent use of ultraviolet radiation and certain medications. Recall dermatitis from primary cutaneous exposure and subsequent oral exposure are rare, and the etiology remains unknown.

Conclusion

We report a case of recall dermatitis with a drug eruption secondary to metronidazole. Therapy with this medication was initially topical for rosacea and subsequently oral for a gastrointestinal infection. This case draws attention to the use of metronidazole and the risk of recall dermatitis.

Contexte et objectif

La dermatite immunitaire secondaire est une affection rare, qui s'observe a la suite de la realisation de tests epicutanes, de reexpositions à des medicaments ou a des allergenes ou encore de l'emploi concomitant des rayons ultraviolets et de certains medicaments. La dermatite immunitaire secondaire, liee a une premiere exposition a une substance par voie cutanee et à une exposition ultérieure par voie orale a cette même substance est un phénomène rare, de cause inconnue.

Conclusions

Sera expose ici un cas de dermatite immunitaire secondaire, se manifestant par une eruption d'origine médicamenteuse, consecutive à l'utilisation du metronidazole. Le medicament avait été employe une premiere fois par voie topique pour traiter la rosacee et une deuxième fois par voie orale pour traiter une infection gastro-intestinale. Ce cas attire l'attention sur l'utilisation du metronidazole et sur le risque de dermatite immunitaire secondaire.

Docetaxel-induced photo-recall phenomenon

Photo-recall phenomenon is a phototoxic eruption occurring on areas of previous ultraviolet-induced solar erythema following a systemic administration of a drug. It has been mostly described with methotrexate but remains rare with other antineoplastic drugs. We describe a case of docetaxel-induced photo-recall skin rash in a woman treated for a non-small-cell lung cancer. Although the patient has refused to receive a second infusion, chemotherapy can be carried on with photoprotection and the use of topical and/or systemic corticosteroids. In contrast, radiation recall is a well-known reaction by oncologists, most of them may not be aware of a similar phenomenon called photo-recall phenomenon. Recognizing this entity may avoid misdiagnosing a drug allergy and should avoid inappropriate decisions of drug discontinuation.

Patch-test-induced "flare-up" reactions to neomycin at prior biopsy sites

"Recall dermatitis" classically refers to the uncommon phenomenon of chemotherapy-induced reactivation of skin damage originally induced by radiotherapy months or years earlier. We compare this condition to ectopic flare-up reactions presenting as dermatitis at existing or previous sites by an inducing agent. Enhanced sensitization of an existent allergen by patch testing is rarely described. We describe a case of a 61-year-old man's developing localized allergic contact dermatitis at previous neomycin-treated sites following the diagnosis of neomycin sensitivity on patch testing, which we attribute to a "flare-up" phenomenon.

Ultraviolet recall reaction after total body irradiation, etoposide, and methotrexate therapy

Ultraviolet (UV) reactivation reactions are rare and can occur in areas of prior sunburn or UV light therapy after the administration of chemotherapy, antibiotics, and other medications. Reactions may occur within days, as described after methotrexate therapy, or may appear months later, as described with ampicillin. Such reactions have been variably termed "UV recall," "sunburn recall," "photo recall," and "photodermatitis reactivation," making classification difficult. We report a UV reactivation reaction in a patient with acute lymphocytic leukemia treated with total body irradiation, etoposide, and methotrexate. We propose the terms "UV recall" and "UV enhancement" be used in future reports to classify UV reactivation reactions in a scheme analogous to the terminology for cutaneous reactions after radiotherapy.

Radiation Recall Dermatitis with Cefotetan: A Case Study

Radiation recall dermatitis (RRD) is an inflammatory skin reaction that occurs in a previously irradiated body part following drug administration. This phenomenon may occur from days to years following exposure to ionizing radiation. The case of a 54-year-old Caucasian woman who was initially treated with external-beam radiation to the right thoracic region following the diagnosis of a poorly differentiated squamous cell carcinoma of the right lung is reported. She received four cycles of consolidated chemotherapy with docetaxel and carboplatin. Four months later, she was admitted to the hospital for acute cholecystitis and was placed on cefotetan. She developed a tender, erythematous rash on the posterior region of her right thorax 48 hours later. The drug was withdrawn, supportive care was instituted, and the patient subsequently improved. RRD should be suspected in patients who develop an erythematous rash in a previously irradiated region. To our knowledge this entity has not been associated with cefotetan previously.

Photo recall phenomenon: an adverse reaction to taxanes

Taxanes are a new group of chemotherapeutic agents, which share some pharmacological characteristics with methotrexate. Methotrexate has previously been reported to cause a photo recall phenomenon which develops 3-5 days after UV radiation, suggesting that taxanes can induce a similar reaction. This should be added to the list of cutaneous side-effects of this class of chemotherapeutic agents. We report a case of photo recall phenomenon in a 55-year-old Chinese woman with metastatic breast cancer who was undergoing chemotherapy with taxanes.