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Narala S, Saleem A, Brown RA, Novoa RA, Kim YH, Rieger KE. Histopathologic and Clinical Characterization of Brentuximab Vedotin-associated Rash. Am J Surg Pathol 2024:00000478-990000000-00369. [PMID: 38907612 DOI: 10.1097/pas.0000000000002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
Rash is one of the commonly observed adverse events with brentuximab vedotin (BV), a CD30-targeted antibody-drug conjugate used to treat cutaneous T-cell lymphoma (CTCL). However, clinical and histopathologic characterization of BV-associated rash (BVAR) is limited. Distinguishing BVAR from a patient's underlying CTCL can be challenging and can lead to treatment interruptions or even premature drug discontinuation. We performed a thorough clinical and histopathologic retrospective characterization of BVAR from a single institution. Utilizing polymerase chain reaction (PCR) and T-cell receptor high-throughput sequencing (TCR-HTS), we were able to isolate skin biopsy specimens from rash clinically suggestive of BVAR that also lacked a dominant TCR clone. A retrospective evaluation was performed of 26 biopsy specimens from 14 patients. Clinical features of BVAR included predominantly morbilliform or maculopapular morphology, delayed onset, and the trend toward moderate to severe classification, often requiring oral steroids. Most histopathologic specimens (25/26) showed spongiotic dermatitis as the primary reaction pattern. Many cases showed subtle findings to support a background interface or lichenoid eruption. Langerhans cell microabscesses were seen in one-fourth of specimens, and eosinophils were present in over one-half of the specimens. There were focal features mimicking CTCL, but these were not prominent. In 17 specimens with immunohistochemistry, the CD4:CD8 ratio in intraepidermal lymphocytes was relatively normal (1-6:1) in 65% (11/17) and 1:1 in 35% (6/17), demonstrating a trend toward increased CD8-positive cells compared with baseline CTCL. We have identified features that can help distinguish BVAR from a patient's CTCL, which can, in turn, help guide appropriate clinical management.
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Affiliation(s)
- Saisindhu Narala
- Departments of Pathology
- Dermatology, Stanford University School of Medicine, Stanford, CA
| | | | - Ryanne A Brown
- Departments of Pathology
- Dermatology, Stanford University School of Medicine, Stanford, CA
| | - Roberto A Novoa
- Departments of Pathology
- Dermatology, Stanford University School of Medicine, Stanford, CA
| | - Youn H Kim
- Dermatology, Stanford University School of Medicine, Stanford, CA
| | - Kerri E Rieger
- Departments of Pathology
- Dermatology, Stanford University School of Medicine, Stanford, CA
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Cole DW, Menge TD, Lowe L, Chan MP, Bresler SC. Clinical and Histopathologic Spectrum of Toxic Erythema of Chemotherapy: A Series of 56 Cases From a Single Institution. Am J Dermatopathol 2024; 46:337-345. [PMID: 38133527 DOI: 10.1097/dad.0000000000002450] [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: 12/23/2023]
Abstract
INTRODUCTION Although many individual cases and small series of toxic erythema of chemotherapy (TEC) have been described, the full spectrum of findings is not well understood. OBJECTIVE To provide a comprehensive review of the clinical and histopathologic features of TEC with an emphasis on novel histopathologic findings. METHODS We searched our electronic medical record for "toxic erythema of chemotherapy" or "neutrophilic eccrine hidradenitis." Fifty-six cases meeting clinical and histopathologic criteria were identified. The electronic medical record and accompanying hematoxylin and eosin-stained slides were retrospectively reviewed. RESULTS The clinical findings were heterogeneous but included classic presentations such as intertriginous eruptions (34%) and acral erythema (25%). The most common histopathologic features were apoptotic keratinocytes (95%), basal vacuolar change (91%), and epithelial dysmaturation (79%). Eccrine squamous syringometaplasia was seen in over half of the cases (33/56; 59%), whereas neutrophilic eccrine hidradenitis was uncommon (16%). Interestingly, many cases showed prominent interstitial histiocytes (55%). Other novel findings included irregular orthohyperkeratosis (23%), irregular epidermal hyperplasia (14%), and acantholysis (9%). LIMITATIONS As a retrospective study, it is subject to information bias. CONCLUSION This is the largest reported series of TEC. In addition to confirming previously reported features, we identify novel histopathologic findings to add to the spectrum of TEC.
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Affiliation(s)
- Daniel W Cole
- Department of Dermatology, University of Michigan, Ann Arbor, MI
| | - Tyler D Menge
- Dermatologists Department of Dermatology, VA Ann Arbor Healthcare System, Ann Arbor, MI
- Staff Dermatopathologist, CTA Pathology, Ann Arbor, MI; and
| | - Lori Lowe
- Dermatologists Department of Dermatology and Department of Pathology, University of Michigan, Ann Arbor, MI
| | - May P Chan
- Dermatologists Department of Dermatology and Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Scott C Bresler
- Dermatologists Department of Dermatology and Department of Pathology, University of Michigan, Ann Arbor, MI
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Wan Z, Huang J, Ou X, Lou S, Wan J, Shen Z. Psoriasis de novo or exacerbation by PD-1 checkpoint inhibitors. An Bras Dermatol 2024; 99:425-432. [PMID: 38388337 PMCID: PMC11074622 DOI: 10.1016/j.abd.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 02/24/2024] Open
Abstract
PD-1 (programmed Death-1) immune checkpoint inhibitors have provided significant benefits to tumor patients. However, a considerable proportion of the patients develop immune-related adverse events (irAEs), of which cutaneous irAEs (cirAEs, e.g., psoriasis) occur relatively early. This review provides an overview of the current progress in psoriasis de novo or exacerbation by PD-1 checkpoint inhibitors. It not only describes the relevant influencing factors but also theoretically analyzes the immunological mechanisms that lead to the onset or exacerbation of psoriasis. Finally, the authors present guidelines for the treatment of psoriasis de novo or exacerbation by PD-1 checkpoint inhibitors. The review is intended to assist dermatologists in the early recognition and effective individualized management of such cirAE, which is helpful to continue or adjust the tumor-targeted immunotherapy on the basis of ensuring the quality of life of tumor patients.
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Affiliation(s)
- Zi Wan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiangyuan Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaojie Ou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shuang Lou
- Department of Dermatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jianji Wan
- Department of Dermatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhu Shen
- Department of Dermatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
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Magalhães C, Costa M, Campainha S, Coelho A, César A. Histopathologic findings of drug-induced eruptive porokeratosis under nivolumab therapy. J Cutan Pathol 2023; 50:298-300. [PMID: 36515632 DOI: 10.1111/cup.14379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Affiliation(s)
- César Magalhães
- Department of Dermatology, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Miguel Costa
- Department of Dermatology, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Sérgio Campainha
- Department of Pulmonology, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - André Coelho
- Laboratório de Anatomia Patológica (LAP) - UNILABS, Porto, Portugal
| | - Artur César
- Department of Dermatology, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
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Ortega Beltrá N, Guallart Domenech F, Martínez Ruiz de Apodaca P, Pons Rocher F. Odynophagia as the first manifestation of toxic epidermal necrolysis. BMJ Case Rep 2022; 15:e250305. [PMID: 36423938 PMCID: PMC9693651 DOI: 10.1136/bcr-2022-250305] [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: 11/25/2022] Open
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are infrequent mucocutaneous diseases, rapidly progressive and life-threatening. The clinical aspects and the management of TEN are exposed following a case.A man in his 40s presented to the emergency department with severe odynophagia, poor general condition and fever. His medical history was significant for HIV stage AIDS, and the treatment was discontinued 5 years before the present diagnosis. He was admitted for cerebral toxoplasmosis and discharged the previous 14 days with sulfadiazine. Erythematous-bullous lesions in the oral cavity, diffuse erythematous maculopapular rashes over his neck and chest, acute bilateral conjunctivitis and purulent urethritis was observed. The diagnostic suspicion was SJS/TEN due to sulfadiazine in immunosuppressed patients.This entity is infrequent but is a life-threatening dermatological emergency that requires immediate medical attention. Its diagnosis is mainly clinical, with a new drug history, prodromal symptoms and characteristic cutaneous-mucous lesions. Early diagnosis and rapid withdrawal of the drug improve the prognosis.
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Affiliation(s)
| | | | - Paula Martínez Ruiz de Apodaca
- Otorhinolaryngology, Hospital Universitario Doctor Peset, Valencia, Spain
- Otorhinolaryngology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Francisco Pons Rocher
- Otorhinolaryngology, Hospital Universitario Doctor Peset, Valencia, Spain
- Cirurgia (Otorhinolaryngology), Universitat de Valencia Facultat de Medicina i Odontologia, Valencia, Spain
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Muddebihal A, Khurana A, Kulhari A, Ahuja A. Psoriasiform Drug Eruption to Finasteride: Uncommon Side Effect of a Commonly Used Drug. Int J Trichology 2022; 14:216-217. [PMID: 37034544 PMCID: PMC10075345 DOI: 10.4103/ijt.ijt_42_21] [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: 04/25/2021] [Accepted: 01/25/2022] [Indexed: 03/16/2023] Open
Abstract
Finasteride, a 5-α reductase inhibitor, is generally well tolerated on long-term use and cutaneous adverse events have rarely been observed with the drug. We present the case of a 25-year-old male who developed an extensive psoriasiform eruption within a week of starting finasteride 1 mg for androgenetic alopecia.
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Affiliation(s)
- Aishwarya Muddebihal
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
| | - Anita Kulhari
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. RML Hospital, New Delhi, India
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Shakshouk H, Erickson LA, Johnson EF, Lehman JS. Updates and Proposed Diagnostic Approach to Psoriasiform Dermatoses. Adv Anat Pathol 2022; 29:263-274. [PMID: 35180737 DOI: 10.1097/pap.0000000000000333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psoriasiform dermatoses represent a wide array of skin diseases commonly encountered by clinicians and pathologists. While they may present a diagnostic challenge, thorough observation coupled with proper interpretation of subtle additional clinical or histopathologic features provide clues to the correct diagnosis. In this review, we provide updates on emerging entities and develop a systemic approach to establish the pathologic diagnosis, with emphasis on the importance of clinicopathologic correlation.
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Affiliation(s)
- Hadir Shakshouk
- Departments of Dermatology
- Department of Dermatology, Alexandria University, Alexandria, Egypt
| | - Lori A Erickson
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Emma F Johnson
- Departments of Dermatology
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Julia S Lehman
- Departments of Dermatology
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Ernst M, Lundgren M, Evans MD, Miller D, Giubellino A. The Mixed Spongiotic and Interface Reaction Pattern: A Study of Clinical and Histopathologic Findings. J Cutan Pathol 2022; 49:1051-1059. [PMID: 36445270 PMCID: PMC9709294 DOI: 10.1111/cup.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Categorization of biopsy specimens into inflammatory reaction patterns is central to dermatopathologic assessment. Mixed inflammatory patterns are poorly characterized and may represent clinicopathologic challenges. The purpose of this study was to identify clinical and histopathologic findings associated with the mixed spongiotic-interface dermatitis (SID) histopathologic pattern. METHODS Fifty-one institutional biopsy specimens of SID were identified over a 2-year period by retrospective natural language search. Histopathologic and clinical features were identified. RESULTS The most common histopathologic features associated with SID were mild spongiosis (51%), focal vacuolar interface change (72%), lymphocytic exocytosis (92%), and superficial-dermal lymphocytic infiltrate (94%) with variable eosinophils (61%). Clinically, 80% of subjects presented with a symmetric morbilliform eruption. Polypharmacy (94%), immunosuppression (47%), and history of malignancy (47%) were common. The most common diagnoses were drug reaction (37%), possible drug reaction (12%), and viral exanthem (12%). Drug reaction with eosinophilia and systemic symptoms represented 25% of all confirmed cutaneous adverse drug reactions (CADR). Average time from drug initiation to symptom initiation was 20 days (SD: 22.3, range: 0-90); median disease duration was 25.5 days. Spongiotic vesicles and Langerhans cells were less common in patients with a strong clinicopathologic diagnosis of drug reaction compared to non-drug eruptions (p = 0.04). CONCLUSIONS The mixed SID pattern is commonly encountered in CADR but may represent a more subacute course, implying consideration for inciting medication(s) started before the typical 7- to 14-day window.
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Affiliation(s)
- Madison Ernst
- University of Minnesota, Department of Laboratory Medicine and Pathology
- University of Minnesota, Department of Dermatology
| | - Mia Lundgren
- University of Minnesota, Department of Laboratory Medicine and Pathology
| | - Michael D. Evans
- University of Minnesota, Clinical and Translational Science Institute
| | | | - Alessio Giubellino
- University of Minnesota, Department of Laboratory Medicine and Pathology
- University of Minnesota, Masonic Cancer Center Minneapolis
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9
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Histopathologic Features of Maculopapular Drug Eruption. Dermatopathology (Basel) 2022; 9:111-121. [PMID: 35466243 PMCID: PMC9036233 DOI: 10.3390/dermatopathology9020014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 12/19/2022] Open
Abstract
Background: Cutaneous adverse drug reaction (CADR) is common in both inpatient and outpatient clinical settings and has been associated with a large variety of medications. Drug reactions represent a significant burden to the healthcare system due to increased hospital stay durations and associated costs. Moreover, some of these reactions may be life-threatening. The most common clinical manifestation of a CADR is a maculopapular drug eruption (MDE). Due to its many clinical mimics and associations with a variety of histopathologic patterns, maculopapular drug eruption is difficult to definitively diagnose from both a clinical and histopathological perspective. Summary: We reviewed the clinical and histopathologic features of 327 cases of MDE from several studies in the literature and summarized characteristic histopathologic findings and their frequencies of occurrence. We found that the most common and suggestive histopathologic features of MDE were epidermal spongiosis, lymphocytic infiltrate, and occasional necrotic keratinocytes; interface change at the DEJ; superficial perivascular and interstitial lymphocytic infiltrate with or without eosinophils and neutrophils in the mid-to-deep dermis and mild papillary dermal edema; and dilation of superficial vessels. The presence of multiple histopathologic patterns within the same tissue specimen is also suggestive of MDE. This review and analysis suggest that a biopsy may improve the diagnostic accuracy by both establishing common and uncommon features associated with MDE and reviewing features that help to exclude other causes of maculopapular eruption. Key Message: Histopathologic criteria for the diagnosis of MDE, while not entirely specific, may aid in establishing a differential that includes a drug eruption. Thus, a biopsy can be a helpful diagnostic tool when MDE is suspected by demonstrating findings suggestive of MDE or by ruling out clinical mimics. However, biopsy results cannot be used in isolation as clinical-pathologic correlation is paramount in MDE.
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Adair K, Meng X, Naisbitt DJ. Drug hapten-specific T-cell activation: Current status and unanswered questions. Proteomics 2021; 21:e2000267. [PMID: 33651918 DOI: 10.1002/pmic.202000267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 11/07/2022]
Abstract
Drug haptens are formed from the irreversible, covalent binding of drugs to nucleophilic moieties on proteins, which can warrant adverse reactions in the body including severe delayed-type, T-cell mediated, drug hypersensitivity reactions (DHRs). While three main pathways exist for the activation of T-cells in DHRs, namely the hapten model, the pharmacological interaction model and the altered peptide repertoire model, the exact antigenic determinants responsible have not yet been defined. In recent years, progress has been made using advanced mass spectrometry-based proteomic methods to identify protein carriers and characterise the structure of drug-haptenated proteins. Since genome-wide association studies discovered a link between human leukocyte antigens (HLA) and an individual's susceptibility to DHRs, much effort has been made to define the drug-associated HLA ligands driving T-cell activation, including the elution of natural HLA peptides from HLA molecules and the generation of HLA-binding peptides. In this review, we discuss our current methodology used to design and synthesise drug-modified HLA ligands to investigate their immunogenicity using T-cell models, and thus their implication in drug hypersensitivity.
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Affiliation(s)
- Kareena Adair
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK
| | - Xiaoli Meng
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK
| | - Dean J Naisbitt
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK
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Rossi G, da Silva Cartell A, Marchiori Bakos R. Dermoscopic Aspects of Cutaneous Adverse Drug Reactions. Dermatol Pract Concept 2021; 11:e2021136. [PMID: 33614215 DOI: 10.5826/dpc.1101a136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 10/31/2022] Open
Abstract
Background Little is known about the dermoscopic evaluation of cutaneous adverse drug reactions (CADRs). Objectives To evaluate the dermoscopic patterns of CADRs and identify those associated with severe cutaneous adverse reactions to drugs (SCARDs). Patients and Methods Patients included in this study from May 2015 to April 2016 had presented with CADRs. CADR presentation and classification were based on standard criteria. SCARDs included Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), overlap SJS/TEN, drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). The dermoscopic features of CADRs were described and compared according to the severity of the reactions. Results Sixty-nine patients were included. Sixteen patients (23.2%) presented SCARDs. The main dermoscopic findings in SJS, overlap SJS/TEN and TEN were black dots or necrotic areas (100%). Erosion [respectively, 4/6 (66.7%), 3/3 (100%) and 1/1 (100%)], necrotic borders [respectively, 4/6 (66.7%), 3/3 (100%) and 1/1, (100%)] and epidermal detachment [respectively, 5/6 (83.3%); 2/3 (66.7%) and 1/1 (100%)] were also common among these reactions. Erythema and purpuric dots were the main dermoscopic findings [respectively, 5/6 (83.3%) and 4/6 (66.7%)] in DRESS. In non-severe reactions, the most prevalent structures were erythema and purpura in exanthema [respectively, 31/33 (93.9%) and 24/33 (72.7%)] and erythema and vascular structures in urticarial reactions [respectively, 6/6 (100%) and 3/6 (50%)]. Black dots or necrotic areas, epidermal detachment, necrotic borders and erosion were highly associated with SCARDs (P < 0.001). Conclusions Dermoscopy improves clinical recognition of SCARDs.
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Affiliation(s)
- Gabriela Rossi
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, (UFRGS), Porto Alegre, Brazil
| | - André da Silva Cartell
- Department of Pathology, Hospital de Clínicas de Porto Alegre (HCPA) & Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Renato Marchiori Bakos
- Department of Dermatology, Hospital de Clínicas de Porto Alegre (HCPA) & Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Abstract
Rash is one of the most common adverse events observed with mogamulizumab, an anti-C-C chemokine receptor 4 monoclonal antibody approved for previously treated mycosis fungoides (MF) and Sezary syndrome (SS). Given the nonspecific clinical presentations of this rash, histopathologic distinction from MF/SS is critical for informing clinical management. We performed a comprehensive characterization of the histopathologic findings in mogamulizumab-associated rash (MAR) with the integration of high-throughput sequencing of T-cell receptor (TCR) genes. Fifty-two biopsy specimens from 19 patients were evaluated retrospectively. Three major histologic reaction patterns were identified: spongiotic/psoriasiform dermatitis (33/52), interface dermatitis (11/52), and granulomatous dermatitis (8/52). Almost half of the specimens (21/52) showed at least 2 of these reaction patterns concurrently. Dermal eosinophils were not a consistent feature, being present in only half (27/52) of specimens and prominent in only 3. Features mimicking MF/SS, including lymphocyte exocytosis, lamellar fibroplasia, and adnexal involvement, were commonly seen but tended to be focal and mild. In 38/43 specimens with available immunohistochemistry, intraepidermal lymphocytes demonstrated a CD4:CD8 ratio ≤1 : 1. Low background levels of the patient's previously identified MF/SS-associated TCR sequence(s) were demonstrated in 20/46 specimens analyzed by high-throughput sequencing of TCR. We conclude that MAR may demonstrate diverse histologic features. Findings that may distinguish MAR from MF/SS include the inverted or normalized CD4:CD8 ratio within intraepidermal lymphocytes and demonstration of absent or nondominant levels of disease-associated TCR sequences. Correlation with the clinical findings and immunohistochemical and molecular characterization of the patient's MF/SS before mogamulizumab, when possible, may facilitate recognition of MAR.
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Paredes BE. [Pattern analysis of inflammatory skin diseases according to A. B. Ackerman-always up to date]. DER PATHOLOGE 2020; 41:301-316. [PMID: 32377832 DOI: 10.1007/s00292-020-00789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The exact microscopic diagnosis of inflammatory skin diseases requires the linking of histopathological findings with clinical features. This is not easy when skin biopsies are rarely assessed and the terminology of dermatopathology and dermatology is itself unfamiliar.The infiltrates of almost all inflammatory skin diseases tend to show eight specific patterns in high magnification. By further classifying according to architectural and cytological features, a specific diagnosis can be made in most cases. At the same time, clinically suspected diagnoses are simply excluded or greatly reduced in number. This procedure, starting with the overview magnification and the recognition of clearly defined histomorphological features, corresponds to an algorithm.Another algorithmic approach uses histomorphological changes under high magnification. Here, "nonspecific" findings are added to the pattern analysis as a diagnostic vehicle.Occasionally, inflammatory skin diseases cannot be assessed conclusively with current modern methods. Such pathology reports should be written descriptively and possible differential diagnoses should be mentioned as notes. The report should be written in a language understandable to the clinician.Artificial intelligence, with its ability to transform and integrate extensive clinical as well as image data, will play an important role in the future of decision making, diagnosing, and personalizing medicine. In the field of pathology, it could be seen as a second opinion. It is important that physicians always contribute their opinion where important algorithmic decisions are made, such as in algorithm design, data quality, interpretation, action, and feedback.
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Affiliation(s)
- B E Paredes
- Dermatopathologie Friedrichshafen, Siemensstraße 6/1, 88048, Friedrichshafen, Deutschland.
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14
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Risk Factors for the Development of Psoriasis. Int J Mol Sci 2019; 20:ijms20184347. [PMID: 31491865 PMCID: PMC6769762 DOI: 10.3390/ijms20184347] [Citation(s) in RCA: 257] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022] Open
Abstract
Psoriasis is an immune-mediated genetic skin disease. The underlying pathomechanisms involve complex interaction between the innate and adaptive immune system. T cells interact with dendritic cells, macrophages, and keratinocytes, which can be mediated by their secreted cytokines. In the past decade, biologics targeting tumor necrosis factor-α, interleukin (IL)-23, and IL-17 have been developed and approved for the treatment of psoriasis. These biologics have dramatically changed the treatment and management of psoriasis. In contrast, various triggering factors can elicit the disease in genetically predisposed individuals. Recent studies suggest that the exacerbation of psoriasis can lead to systemic inflammation and cardiovascular comorbidity. In addition, psoriasis may be associated with other auto-inflammatory and auto-immune diseases. In this review, we summarize the risk factors, which can be divided into two groups (namely, extrinsic and intrinsic risk factors), responsible for the onset and exacerbation of psoriasis in order to facilitate its prevention.
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Abate MS, Battle LR, Emerson AN, Gardner JM, Shalin SC. Dermatologic Urgencies and Emergencies: What Every Pathologist Should Know. Arch Pathol Lab Med 2019; 143:919-942. [PMID: 30785787 DOI: 10.5858/arpa.2018-0239-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Fatal dermatologic diseases and ones with high morbidity can occur in the inpatient setting. In such cases, prompt and accurate assessment of a bedside skin biopsy is required. This may be challenging for many pathologists who are not familiar with the complexity of skin pathology and skin terminology within the fields of dermatopathology and dermatology. OBJECTIVE.— To provide the pathologist with a practical, up-to-date, and "must-know" reference guide on dermatologic urgencies and emergencies from a real-world perspective, highlighting diagnostic pearls, diagnostic pitfalls, and commonly encountered practice gaps. This review will focus on key diseases with which every pathologist should be familiar, including angioinvasive fungal infections, Stevens-Johnson syndrome/toxic epidermal necrolysis, staph-scalded-skin syndrome, acute graft-versus-host disease, bullous pemphigoid, calciphylaxis, Sweet syndrome and its histiocytoid variant, pyoderma gangrenosum, and leukocytoclastic vasculitis, as well as those in their clinical and histopathologic differential. DATA SOURCES.— This review is based on peer-reviewed literature and our personal experiences with these diseases at major academic institutions, including one where a large number of stem cell transplants are performed. This review is unique as it represents collaborative expert opinion from both a dermatopathology and a dermatology standpoint. CONCLUSIONS.— This review outlines the critical role that the pathologist plays in the outcomes of patients with dermatologic urgencies and emergencies. Improved patient care will result from prompt and accurate histopathologic diagnoses as well as an open line of communication with the dermatologist.
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Affiliation(s)
- Mallory S Abate
- From the Department of Dermatology, Saint Louis University, St Louis, Missouri (Dr Abate); the Departments of Dermatology (Dr Battle), and Pathology (Drs Gardner and Shalin), University of Arkansas for Medical Sciences, Little Rock; and the Department of Dermatology, University of Mississippi Medical Center, Jackson (Dr Emerson)
| | - Laura R Battle
- From the Department of Dermatology, Saint Louis University, St Louis, Missouri (Dr Abate); the Departments of Dermatology (Dr Battle), and Pathology (Drs Gardner and Shalin), University of Arkansas for Medical Sciences, Little Rock; and the Department of Dermatology, University of Mississippi Medical Center, Jackson (Dr Emerson)
| | - Ashley N Emerson
- From the Department of Dermatology, Saint Louis University, St Louis, Missouri (Dr Abate); the Departments of Dermatology (Dr Battle), and Pathology (Drs Gardner and Shalin), University of Arkansas for Medical Sciences, Little Rock; and the Department of Dermatology, University of Mississippi Medical Center, Jackson (Dr Emerson)
| | - Jerad M Gardner
- From the Department of Dermatology, Saint Louis University, St Louis, Missouri (Dr Abate); the Departments of Dermatology (Dr Battle), and Pathology (Drs Gardner and Shalin), University of Arkansas for Medical Sciences, Little Rock; and the Department of Dermatology, University of Mississippi Medical Center, Jackson (Dr Emerson)
| | - Sara C Shalin
- From the Department of Dermatology, Saint Louis University, St Louis, Missouri (Dr Abate); the Departments of Dermatology (Dr Battle), and Pathology (Drs Gardner and Shalin), University of Arkansas for Medical Sciences, Little Rock; and the Department of Dermatology, University of Mississippi Medical Center, Jackson (Dr Emerson)
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16
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Balak DM, Hajdarbegovic E. Drug-induced psoriasis: clinical perspectives. PSORIASIS-TARGETS AND THERAPY 2017; 7:87-94. [PMID: 29387611 PMCID: PMC5774610 DOI: 10.2147/ptt.s126727] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Exposure to certain drugs can elicit an induction or exacerbation of psoriasis. Although well-conducted systematic studies on drug-related psoriasis are mostly lacking, traditionally strong associations have been documented for beta-blockers, lithium, antimalarial drugs such as (hydroxy)chloroquine, interferons, imiquimod, and terbinafine. More recently, new associations have been reported for monoclonal antibody- and small-molecule-based targeted therapies used for oncological and immunological indications, such as tumor necrosis factor-alpha antagonists and anti-programmed cell death protein 1 immune checkpoint inhibitors. Recognizing potential drug-related psoriasis is of clinical relevance to allow an optimal management of psoriasis. However, in clinical practice, identifying medication-related exacerbations and induction of psoriasis can be challenging. The clinical and histopathological features of drug-provoked psoriasis may differ little from that of “classical” nondrug-related forms of psoriasis. In addition, the latency period between start of the medication and onset of psoriasis can be significantly long for some drugs. Assessment of the Naranjo adverse drug reaction probability scale could be used as a practical tool to better differentiate drug-related psoriasis. The first step in the management of drug-related psoriasis is cessation and replacement of the offending drug when deemed clinically possible. However, the induced psoriasis skin lesions may persist after treatment withdrawal. Additional skin-directed treatment options for drug-related psoriasis follows the conventional psoriasis treatment guidelines and includes topical steroids and vitamin D analogs, ultraviolet phototherapy, systemic treatments, such as acitretin, methotrexate, and fumaric acid esters, and biological treatments.
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Affiliation(s)
- Deepak Mw Balak
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Enes Hajdarbegovic
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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17
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Helm TN, Liu‐Helm AY. Immunomodulation, alemtuzumab associated dermatitis and the histology of drug‐induced exanthems. J Cutan Pathol 2017; 44:405-406. [DOI: 10.1111/cup.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas N. Helm
- Departments of Dermatology and AllergyBuffalo Medical Group Williamsville New York
| | - Aries Y. Liu‐Helm
- Departments of Dermatology and AllergyBuffalo Medical Group Williamsville New York
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Dodiuk-Gad RP, Chung WH, Shear NH. Adverse Medication Reactions. CLINICAL AND BASIC IMMUNODERMATOLOGY 2017. [PMCID: PMC7123512 DOI: 10.1007/978-3-319-29785-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cutaneous adverse drug reactions (ADRs) are among the most frequent adverse reactions in patients receiving drug therapy. They have a broad spectrum of clinical manifestations, are caused by various drugs, and result from different pathophysiological mechanisms. Hence, their diagnosis and management is challenging. Severe cutaneous ADRs comprise a group of diseases with major morbidity and mortality, reaching 30 % mortality rate in cases of Toxic Epidermal Necrolysis. This chapter covers the terminology, epidemiology, pathogenesis and classification of cutaneous ADR, describes the severe cutaneous ADRs and the clinical and laboratory approach to the patient with cutaneous ADR and presents the translation of laboratory-based discoveries on the genetic predisposition and pathogenesis of cutaneous ADRs to clinical management guidelines.
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Abstract
Granulomas of the skin may be classified in several ways. They are either infectious or non-infectious in character, and they contain areas of necrobiosis or necrosis, or not. Responsible infectious agents may be mycobacterial, fungal, treponemal, or parasitic organisms, and each case of granulomatous dermatitis should be assessed histochemically for those microbes. In the non-infectious group, examples of necrobiotic or necrotizing granulomas include granuloma annulare; necrobiosis lipoidica; rheumatoid nodule; and lupus miliaris disseminates faciei. Non-necrobiotic/necrotizing and non-infectious lesions are exemplified by sarcoidosis; foreign-body reactions; Melkersson-Rosenthal syndrome; Blau syndrome; elastolytic granuloma; lichenoid and granulomatous dermatitis; interstitial granulomatous dermatitis; cutaneous involvement by Crohn disease; granulomatous rosacea; and granulomatous pigmented purpura. Histiocytic dermatitides that do not feature granuloma formation are peculiar reactions to infection, such as cutaneous malakoplakia; leishmaniasis; histoplasmosis; lepromatous leprosy; rhinoscleroma; lymphogranuloma venereum; and granuloma inguinale.
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Affiliation(s)
- Mark R Wick
- Section of Dermatopathology, Division of Surgical & Cytological Pathology, University of Virginia Medical Center, Charlottesville, VA, USA.
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Affiliation(s)
- Brian Scott
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heather Wickless
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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22
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Abstract
Granuloma formation is usually regarded as a means of defending the host from persistent irritants of either exogenous or endogenous origin. Noninfectious granulomatous disorders of the skin encompass a challenging group of diseases owing to their clinical and histologic overlap. Drug reactions characterized by a granulomatous reaction pattern are rare, and defined by a predominance of histiocytes in the inflammatory infiltrate. This review summarizes current knowledge on the various types of granulomatous drug eruptions, focusing on the 4 major types: interstitial granulomatous drug reaction, drug-induced accelerated rheumatoid nodulosis, drug-induced granuloma annulare, and drug-induced sarcoidosis.
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Affiliation(s)
- Roni P Dodiuk-Gad
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M1-737, Toronto, ON M4N 3M5, Canada; Department of Dermatology, Ha'emek Medical Center, Afula 18101, Israel
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room M1-737, Toronto, ON M4N 3M5, Canada; Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room M1-737, Toronto, Ontario M4N 3M5, Canada.
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23
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Gavazzoni-Dias MFR, Rochael M, Vilar E, Tanus A, Tosti A. Eczema-Like Psoriasiform Skin Reaction due to Brazilian Keratin Treatment. Skin Appendage Disord 2016; 1:156-62. [PMID: 27172059 DOI: 10.1159/000442529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The use of formaldehyde and formaldehyde releasers in hair-straightening formulations started in Rio de Janeiro in 2003. The technique is known as BKT, Brazilian keratin treatment. The aim of this study was to analyze the types of skin reactions presented by patients due to BKT. We describe 7 patients with severe erythema and scurf on the scalp which developed shortly after BKT. The lesions were eczema-like psoriasiform, located mainly on the scalp. Some patients also developed eczema-like lesions and pustules on the face, neck, upper arms, and upper trunk. Dermatoscopic findings included erythema, perifollicular and interfollicular scurf. The peripilar desquamation resembled the outer skin of an onion bulb. Scalp biopsies revealed psoriasiform and spongiotic psoriasiform patterns, one of them similar to anti-TNFα biologic drug psoriasiform alopecia. The possible consequences of the absorption of formaldehyde by hairdressers or clients are still to be verified by the scientific community; however, the skin and scalp reactions observed in our cases suggest a drug reaction phenomenon and not only eczemas of irritant or allergic origin.
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Affiliation(s)
| | - Mayra Rochael
- Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Enoï Vilar
- Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Aline Tanus
- Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, Brazil
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami L. Miller School of Medicine, Miami, Fla., USA
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24
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Keeling BH, Gavino ACP, Gavino ACP. Skin Biopsy, the Allergists' Tool: How to Interpret a Report. Curr Allergy Asthma Rep 2015; 15:62. [PMID: 26310278 DOI: 10.1007/s11882-015-0560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inflammatory dermatoses are frequently encountered by the allergist, and histologic evaluation achieved through skin biopsy can be of tremendous value clinically. There is no substitute for a thorough history and physical exam; however, the skin biopsy is a simple, in-office procedure with little risk of complication that can provide invaluable information when a diagnosis is uncertain. Histopathologically, many inflammatory eruptions can look similar or overlap, but information provided by the dermatopathologist can help the clinician render or refine the clinical diagnosis and guide management. This review will discuss descriptive elements contained in the pathology report to provide a framework that can be used by the allergist to comfortably and confidently diagnose inflammatory dermatologic conditions.
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Affiliation(s)
- Brett H Keeling
- Department of Dermatology, Dell Medical School, The University of Texas at Austin, 601 E. 15th Street, Austin, TX, 78701, USA,
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25
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Abstract
Cutaneous drug reactions are common adverse effects that occur in about 2-3% of the hospitalized patients. They have both immunologic and non-immunologic underlying mechanisms. These reactions are clinically and histologically similar to dermatoses. Their significant clinical indicators include: history of drug intake, atypical clinical features and improvement after cessation of the offending drugs. Their diagnostic histological clues include the presence of mixed histological patterns, apoptotic keratinocytes, eosinophils (dermis and epidermis), papillary dermal edema and extravasations of erythrocytes. However, no single clinical or histological feature is specific of drug eruptions. This work attempts to classify the histomorphologic reactions to various drugs in defined categories for assistance in morphologic diagnosis.
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Levetiracetam induced psoriasiform drug eruption: a rare case report. Saudi Pharm J 2015; 23:720-2. [PMID: 26702269 PMCID: PMC4669462 DOI: 10.1016/j.jsps.2015.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/20/2015] [Indexed: 01/07/2023] Open
Abstract
Levetiracetam (LEV) is an established second generation anti-epileptic drug and LEV associated severe cutaneous reactions are rare. Here we report the case of psoriasiform drug eruption in a patient with newly diagnosed epilepsy who had been treated with levetiracetam. To our knowledge this is the first report of a patient with a psoriasiform eruption that appeared after the administration of LEV.
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27
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Farshchian M, Ansar A, Zamanian A, Rahmatpour-Rokni G, Kimyai-Asadi A, Farshchian M. Drug-induced skin reactions: a 2-year study. Clin Cosmet Investig Dermatol 2015; 8:53-6. [PMID: 25709487 PMCID: PMC4330003 DOI: 10.2147/ccid.s75849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The aim of this study was to analyze the clinical characteristics of patients with adverse cutaneous drug reactions, which occur when a medicinal product results in cutaneous morbidity. Methods The study included 308 patients who were diagnosed as having an adverse cutaneous drug reaction during the study period (2007–2009). In 84 cases, histopathologic examination of skin biopsies were also performed. Results Patients with drug reactions were found to be more commonly female (63%) than male (37%). Beta-lactam antibiotics were found to be the most frequent cause of adverse cutaneous drug reactions (42.7%), followed by non-steroidal anti-inflammatory drugs (16.5%). Acute urticaria was the most common clinical presentation (59.2%) followed by fixed drug eruptions (18.5%), and maculopapular eruptions (14.9%). Conclusion Adverse cutaneous drug reactions in our study population were mainly induced by beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The most common forms of cutaneous adverse drug reactions were found to be acute urticaria, fixed drug eruptions, and maculopapular rashes.
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Affiliation(s)
- Mahmood Farshchian
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Akram Ansar
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Abbas Zamanian
- Department of Dermatology, Iran University of Medical Sciences, Tehran, Iran
| | - Ghasem Rahmatpour-Rokni
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamedan, Iran
| | | | - Mehdi Farshchian
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamedan, Iran ; Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland
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28
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Kwan Z, Che Ismail RB, Wong SM, Tan LL, Robinson S, Lim KS. Sodium valproate-aggravated psoriasiform eruption. Int J Dermatol 2014; 53:e477-9. [DOI: 10.1111/ijd.12579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Zhenli Kwan
- Dermatology Unit; Department of Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Rokiah Binti Che Ismail
- Dermatology Unit; Department of Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Su-Ming Wong
- Dermatology Unit; Department of Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Leng Leng Tan
- Dermatology Unit; Department of Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Suganthy Robinson
- Dermatology Unit; Department of Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Kheng Seang Lim
- Division of Neurology; Department of Medicine; Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
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29
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Lichenoid Eruption Associated With Antituberculous Drug; An Unusual Oral and Follicular Involvement. Am J Dermatopathol 2014; 36:684-5. [DOI: 10.1097/dad.0b013e3182919e3a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Cicek D, Cobanoglu B, Inci R, Dertlioglu SB, Kokcam I, Elkiran T. A very rare side effect of mitomycin-C: psoriasiform drug eruption. Int J Dermatol 2013; 52:1572-4. [PMID: 24261729 DOI: 10.1111/j.1365-4632.2011.05306.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Demet Cicek
- Firat University Faculty of Medicine Department of Dermatology Elazig, TurkeyFirat University Faculty of Medicine Department of Pathology Elazig, TurkeyHarran University Faculty of Medicine Department of Dermatology Sanliurfa, TurkeyFirat University Faculty of Medicine Department of Oncology Elazig, Turkey
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31
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Drug-induced exanthems: Correlation of allergy testing with histologic diagnosis. J Am Acad Dermatol 2013; 69:721-728. [DOI: 10.1016/j.jaad.2013.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 11/20/2022]
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Abstract
Cutaneous drug eruptions can range from an asymptomatic rash to a life-threatening emergency. Because of the high frequency, morbidity, and potential mortality associated with drug eruptions, patients with possible drug reactions should promptly be recognized, worked up, and treated. Drug reactions are common in the elderly population due to age-related alterations in metabolism, excretion of medications, and polypharmacy. This review discusses the epidemiology, pathogenesis, clinical presentation, diagnosis, and management of drug eruptions that providers commonly encounter in the care of the geriatric population. An algorithm for an approach to patients with a suspected drug eruption is presented.
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Affiliation(s)
- Ammar M Ahmed
- Department of Dermatology, University of Texas-Southwestern Medical Center-Austin Campus, University Medical Center Brackenridge, Seton Healthcare Family, 601 East 15th Street, CEC C2.443, Austin, TX 78701, USA.
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34
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Sarantopoulos GP, Palla B, Said J, Kinney MC, Swerdlow SM, Willemze R, Binder SW. Mimics of cutaneous lymphoma: report of the 2011 Society for Hematopathology/European Association for Haematopathology workshop. Am J Clin Pathol 2013; 139:536-51. [PMID: 23525620 DOI: 10.1309/ajcpx4bxtp2qbrko] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The Society for Hematopathology and European Association for Haematopathology workshop, from October 27 to 29, 2011, in Los Angeles, CA, exhibited many exemplary skin biopsy specimens with interesting inflammatory changes mimicking features of cutaneous lymphoma. This article reviews features observed in cutaneous lymphoid hyperplasia, cutaneous drug reactions, lupus-associated panniculitis, pityriasis lichenoides, hypereosinophilic syndrome, histiocytic necrotizing lymphadenitis, traumatic ulcerative granuloma with stromal eosinophils, and pigmented purpuric dermatosis, as well as a brief review of the pertinent literature and discussion of submitted conference cases. For the pathologist, it is important to be aware of diagnostic pitfalls as well as the limitations of ancillary testing (eg, clonality studies). Finally, correlation with total clinical information, good communication with clinical colleagues, close clinical follow-up with rebiopsy, and prudent use of laboratory studies are vital and will likely offer the best path toward a correct diagnosis.
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Affiliation(s)
| | - Beth Palla
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, CA
| | - Jonathan Said
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, CA
| | | | - Steven M. Swerdlow
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Scott W. Binder
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, CA
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35
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Histopathological features of cutaneous drug reactions to vemurafenib: a report of two cases. Pathology 2012; 44:661-4. [DOI: 10.1097/pat.0b013e328359d5e2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Fessa C, Lim P, Kossard S, Richards S, Peñas PF. Lichen planus-like drug eruptions due to β-blockers: a case report and literature review. Am J Clin Dermatol 2012; 13:417-21. [PMID: 22809321 DOI: 10.2165/11634590-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Lichen planus-like drug eruptions (LDE) can appear similar or identical to idiopathic lichen planus. We present a 45-year-old man with a widespread, violaceous, papular, generalized exanthema with histologic features of a lichenoid reaction, which subsequently resolved with the cessation of labetatol. We found 29 cases of previously reported β-adrenoceptor antagonist (β-blocker)-associated LDE. This is a relatively rare complication that may present as classic lichenoid papules indistinguishable from lichen planus and has a predilection for the limbs, chest, back, and oral mucosa. Histologically, there is a lichenoid infiltrate often with eosinophils. LDE may be due to drug cross-reactivity or as a result of a suppressed skin adrenergic system. Multiple potential medications in case studies and the inability to differentiate LDE from idiopathic lichen planus in cross-sectional association studies make any conclusive analysis difficult.
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Affiliation(s)
- Chris Fessa
- Department of Dermatology, Westmead Hospital, Westmead, NSW, Australia.
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37
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Abstract
Adverse drug reactions are a difficult problem faced by clinicians in everyday practice. The mechanisms of drug hypersensitivity are not well understood. This is reflected by difficulties in their classification, which is mainly based upon the current knowledge of immunologic and nonimmunologic mechanisms, onset of symptoms (immediate or nonimmediate) and morphology. For the individual patient, the correct diagnosis and classification is important because strict avoidance of the offending drug might be of vital importance. Considerable experience is required to guide management, to interpret results of investigations and to undertake drug challenges. This article summarizes the current knowledge regarding definitions and mechanisms. However, the field of drug hypersensitivity is rapidly expanding. Modern drugs such as biological agents bare hypersensitivity risks that are potentially mediated by, so far, unknown mechanisms.
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Affiliation(s)
- Bettina Wedi
- Allergy Division, Department of Dermatology and Allergy, Hannover Medical School, Ricklinger Str. 5, D-30449 Hannover, Germany.
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38
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Andreu-Barasoain M, Gómez de la Fuente E, Pinedo F, Nuño A, López-Estebaranz JL. Intravesical mitomycin C-induced generalized pustular folliculitis. J Am Acad Dermatol 2012; 67:e142-3. [PMID: 22980268 DOI: 10.1016/j.jaad.2011.11.932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 10/30/2011] [Accepted: 11/06/2011] [Indexed: 11/29/2022]
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39
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Christel Bolte M. Reacciones medicamentosas severas en piel. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70488-6] [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] Open
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40
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Histopathologic Features of Exanthematous Drug Eruptions of the Macular and Papular Type. Am J Dermatopathol 2011; 33:695-704. [DOI: 10.1097/dad.0b013e31820a285d] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Mas-Vidal A, Santos-Juanes J, Esteve-Martinez A, Caminal-Montero L, Coto-Segura P. Psoriasiform eruption triggered by a dipeptidyl peptidase IV inhibitor. Australas J Dermatol 2011; 53:70-2. [PMID: 22309337 DOI: 10.1111/j.1440-0960.2011.00783.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psoriatic patients have a higher prevalence of diabetes mellitus type 2 (DM). Since dipeptidyl peptidase IV (DPP-IV) dysregulation is present in DM and psoriasis, DPP-IV inhibitors have been proposed as therapeutic agents for both conditions. We report a psoriasiform eruption induced by sitagliptin, a DPP-IV inhibitor. The role of DPP-IV in the pathogenesis of DM is well established; however data on psoriatic patients is contradictory. More studies are required to elucidate the effect of DPP-IV inhibitors and their relationship with DM and psoriasis.
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Affiliation(s)
- Albert Mas-Vidal
- Department of Dermatology, University Hospital of Asturias, Oviedo, Spain.
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42
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Weyers W, Metze D. Histopathology of drug eruptions - general criteria, common patterns, and differential diagnosis. Dermatol Pract Concept 2011; 1:33-47. [PMID: 24396718 PMCID: PMC3881081 DOI: 10.5826/dpc.0101a09] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/18/2011] [Indexed: 02/06/2023] Open
Abstract
Drug eruptions are among the most common inflammatory diseases of the skin and also among those biopsied most often. Yet, the value of histopathologic examination of drug eruptions has often been disputed. One reason is that the spectrum of histopathologic changes in drug eruptions is broad. Nevertheless, each histopathologic pattern assumed by drug eruptions has a limited number of differential diagnoses, and numerous criteria and clues are available to distinguish drug eruptions from other diseases associated with those patterns. By recognition of common patterns, consideration of differential diagnoses, and attention to distinct clues, a histopathologic diagnosis of drug eruption can usually be made with confidence.
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Affiliation(s)
| | - Dieter Metze
- Department of Dermatology, University of Münster, Münster, Germany
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43
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Sezer E, Luzar B, Calonje E. Secondary syphilis with an interstitial granuloma annulare-like histopathologic pattern. J Cutan Pathol 2011; 38:439-42. [DOI: 10.1111/j.1600-0560.2010.01657.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shinjo T, Okada M. Palmar Petechiae (Black Spots on Palms) in Terminally Ill Patients with Cancer: A Sign of Impending Death. J Palliat Med 2010; 13:615-8. [DOI: 10.1089/jpm.2009.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takuya Shinjo
- Palliative Care Unit, Shakaihoken Kobe Central Hospital, Kobe, Japan
| | - Masakuni Okada
- Palliative Care Unit, Shakaihoken Kobe Central Hospital, Kobe, Japan
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Kim JH, Moon JI, Kim JE, Choi GS, Park HS, Ye YM, Yim H. Cutaneous leukocytoclastic vasculitis due to anti-tuberculosis medications, rifampin and pyrazinamide. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2009; 2:55-8. [PMID: 20224679 PMCID: PMC2831607 DOI: 10.4168/aair.2010.2.1.55] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 11/26/2009] [Indexed: 01/10/2023]
Abstract
Anti-tuberculosis drugs frequently result in cutaneous adverse reactions, including pruritus, maculopapular exanthems, and urticaria. However, anti-tuberculosis drug-associated cutaneous leukocytoclastic vasculitis (CLV) has been rarely reported. We describe a case of CLV induced by rifampin and pyrazinamide. A 38-year-old male had been diagnosed with pulmonary tuberculosis two months ago and then he started standard anti-tuberculosis therapy with isoniazid, rifampin, ethambutol, and pyrazinamide. Purpuric lesions developed in the extremities after 1.5 months of anti-tuberculosis medication; the lesions progressively spread over the entire body. Histopathology of the purpuric skin lesion was consistent with leukocytoclastic vasculitis. The skin lesion improved after cessation of anti-tuberculosis medications and treatment with oral corticosteroids and antihistamines. Anti-tuberculosis drugs were rechallenged one at a time over 3 days. Purpura recurred on the right forearm and forehead after taking 300 mg of rifampin. The skin lesion disappeared after taking oral prednisolone. Finally, 1,500 mg of pyrazinamide was readministrated, and then purpuric lesions recurred on both forearms. This report describes a case of leukocytoclastic vasculitis secondary to rifampin and pyrazinamide therapy.
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Affiliation(s)
- Joo-Hee Kim
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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