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Trimeche K, Lahouel I, Ben Salah N, Mansour K, Soua Y, Bellalah A, Chadly Z, Belhadjali H, Zili J. Terbinafine induced bullous pemphigoid. Therapie 2024:S0040-5957(24)00004-0. [PMID: 38290917 DOI: 10.1016/j.therap.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/10/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Khaoula Trimeche
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Monastir, 5000 Monastir, Tunisia.
| | - Ines Lahouel
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Monastir, 5000 Monastir, Tunisia
| | - Nesrine Ben Salah
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Monastir, 5000 Monastir, Tunisia
| | - Khadija Mansour
- Pharmacology Department, Fattouma Bourguiba Hospital, University of Monastir, 5000 Monastir, Tunisia
| | - Yosra Soua
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Monastir, 5000 Monastir, Tunisia
| | - Ahlem Bellalah
- Anatomopathology Department, Fattouma Bourguiba Hospital, University of Monastir, 5000 Monastir, Tunisia
| | - Zohra Chadly
- Pharmacology Department, Fattouma Bourguiba Hospital, University of Monastir, 5000 Monastir, Tunisia
| | - Hichem Belhadjali
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Monastir, 5000 Monastir, Tunisia
| | - Jameleddine Zili
- Department of Dermatology, Fattouma Bourguiba Hospital, University of Monastir, 5000 Monastir, Tunisia
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Abstract
Palbociclib is an FDA-approved cyclin-dependent kinase inhibitor to treat hormone-positive, HER2-negative metastatic breast cancer. Severe skin toxicities are rare but important adverse events associated with these agents. Early detection of severe forms of skin lesions is crucial to permit the immediate discontinuation of palbociclib in order to avoid unacceptable risk level in the form of severe cutaneous toxicities like Steven-Johnson Syndrome. In such cases, palbociclib should be abruptly discontinued and an early aggressive support should be initiated. We here present a case of 50-year-old Caucasian female, who developed acute onset blistering skin lesions one to two weeks after she was started on palbociclib. We sought to report this case given the unusual toxicity and to emphasize the importance of identifying the acute onset of blistering skin lesions, regardless of their extension, should prompt awareness of their potential severity.
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Affiliation(s)
- Noman Ahmed Jang Khan
- Hematology and Medical Oncology, Joan C. Edwards School of Medicine at Marshall University, Huntington, USA
| | - Mohamed Alsharedi
- Hematology and Medical Oncology, Joan C. Edwards School of Medicine at Marshall University, Huntington, USA
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Cheraghlou S, Levy LL. Fixed drug eruptions, bullous drug eruptions, and lichenoid drug eruptions. Clin Dermatol 2020; 38:679-692. [PMID: 33341201 DOI: 10.1016/j.clindermatol.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Drug reactions are among the most common reasons for inpatient dermatology consultation. These reactions are important to identify because discontinuation of the offending agent may lead to disease remission. With the rising use of immunomodulatory and targeted therapeutics in cancer care and the increased incidence in associated reactions to these drugs, the need for accurate identification and treatment of such eruptions has led to the development of the "oncodermatology" subspecialty of dermatology. Immunobullous drug reactions are a dermatologic urgency, with patients often losing a significant proportion of their epithelial barrier; early diagnosis is critical in these cases to prevent complications and worsening disease. Lichenoid drug reactions have myriad causes and can take several months to occur, often leading to difficulties identifying the offending drug. Fixed drug eruptions can often mimic other systemic eruptions, such as immunobullous disease and Stevens-Johnson syndrome, and must be differentiated from them for effective therapy to be initiated. We review the clinical features, pathogenesis, and treatment of immunobullous, fixed, and lichenoid drug reactions with attention to key clinical features and differential diagnosis.
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Affiliation(s)
| | - Lauren L Levy
- Private Practice, New York, New York, USA; Private Practice, Westport, Connecticut, USA.
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Stavropoulos PG, Soura E, Antoniou C. Drug-induced pemphigoid: a review of the literature. J Eur Acad Dermatol Venereol 2014; 28:1133-40. [PMID: 24404939 DOI: 10.1111/jdv.12366] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/11/2013] [Indexed: 01/03/2023]
Abstract
Bullous pemphigoid is an acquired autoimmune disease that is characterized by subepidermal blistering and affects mainly the elderly. The pathogenesis of the condition has not yet been fully elucidated, but it is widely accepted that a strong correlation with various medications may exist. In reality, more than 50 different drugs have been associated with the appearance of bullous pemphigoid and as new therapies emerge, this number is very likely to increase. A number of pathogenetic mechanisms have been proposed in the past. It is true that a delicate immunological balance is disturbed in all patients with the disease. The variable effects that may be exhibited by the use of biological drugs could shed some light in this complex immunological behaviour. At the same time, drug-induced bullous pemphigoid is difficult to differentially diagnose from its idiopathic counterpart, as the clinical picture and histopathological findings in both conditions may only have subtle differences. Patients who present with bullous pemphigoid and receive multiple regimens should always be suspected of suffering from the drug-induced variant of the condition. This possibility must be considered, as after the withdrawal of the suspect medication most patients respond rapidly to treatment and do not experience relapses.
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Affiliation(s)
- P G Stavropoulos
- 1st Department of Dermatology/University Clinic, "Andreas Sygros" Hospital, Athens, Greece
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Galgóczy L, Papp T, Pócsi I, Hegedus N, Vágvölgyi C. In vitro activity of Penicillium chrysogenum antifungal protein (PAF) and its combination with fluconazole against different dermatophytes. Antonie van Leeuwenhoek 2008; 94:463-70. [PMID: 18574706 DOI: 10.1007/s10482-008-9263-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 06/06/2008] [Indexed: 12/01/2022]
Abstract
Strains of five dermatophyte species (Microsporum canis, Microsporum gypseum, Trichophyton mentagrophytes, Trichophyton rubrum and Trichophyton tonsurans) were selected for testing against Penicillium chrysogenum antifungal protein (PAF) and its combination with fluconazole (FCZ). Inhibition of microconidia germination and growth was detected with MICs of PAF ranging from 1.56 to 200 microg ml(-1) when it was used alone, or at constant concentration (100 microg ml(-1)) in combination with FCZ at from 0.25 to 32 microg ml(-1). The MICs for FCZ were found to be between 0.25 and 128 microg ml(-1). PAF caused a fungicidal effect at 200 microg ml(-1) and reduced growth at between 50 and 200 microg ml(-1). Total growth inhibition with fungistatic activity was detected at 64 microg ml(-1) of FCZ for M. gypseum, T. mentagrophytes, and T. tonsurans, and at 32 microg ml(-1) FCZ for M. canis and T. rubrum. PAF and FCZ acted synergistically and/or additively on all of the tested fungi except M. gypseum, where no interactions were detected.
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Affiliation(s)
- László Galgóczy
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52., Szeged, Hungary.
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Abstract
Bullous pemphigoid is an autoimmune skin blistering disorder that can present with several different degrees of severity. The treatment modality employed by the treating physician varies from localised topical therapy and anti-inflammatory treatments with minimal side effects to immunosuppressive agents associated with significant adverse reactions. Deciding which therapy to use with a particular patient can be a challenge, and the treating physician must take into account the severity of disease, the overall medical condition of the patient and potential drug interactions. This article provides a comprehensive review of current medical therapies, as well as an overall approach to the patient with bullous pemphigoid.
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Affiliation(s)
- Timothy Patton
- Department of Dermatology, University of Pittsburgh, 145 Lothrop Hall, 190 Lothrop Street, Pittsburgh, PA 15213, USA.
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Farhi D, Viguier M, Cosnes A, Reygagne P, Dubertret L, Revuz J, Roujeau JC, Bachelez H. Terbinafine-Induced Subacute Cutaneous Lupus Erythematosus. Dermatology 2006; 212:59-65. [PMID: 16319476 DOI: 10.1159/000089024] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2005] [Accepted: 07/06/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nearly 10% of lupus erythematosus (LE) are drug induced. More than 60 different drugs are involved in iatrogenic LE. We report herein 3 cases of terbinafine-induced LE. OBSERVATIONS Three patients receiving terbinafine for a suspected dermatophytic infection developed a subacute cutaneous LE, within 7 weeks following terbinafine introduction. The patients' medical history included sicca syndrome, lung carcinoma and Kikuchi disease, respectively. Clinical remission occurred within 15 weeks following terbinafine withdrawal. DISCUSSION Sixteen cases of terbinafine-induced LE have been previously reported, including 13 women. The median age was 54 years. Prior autoimmunity was reported in 10 cases, including 5 pre-existing LE. The median delay between terbinafine introduction and LE onset was 5 weeks. The median time until clinical recovery following terbinafine withdrawal was 8 weeks. CONCLUSION Terbinafine should be prescribed only in patients with proven dermatophytosis. We recommend cautious monitoring in patients with pre-existing autoimmunity. The diagnosis of terbinafine-induced LE should lead to the immediate and definitive withdrawal of the drug.
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Affiliation(s)
- David Farhi
- Department of Dermatology 1, Saint Louis Hospital, Paris, France
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Fernandez-Obregon AC, Rohrback J, Reichel MA, Willis C. Current use of anti-infectives in dermatology. Expert Rev Anti Infect Ther 2005; 3:557-91. [PMID: 16107197 DOI: 10.1586/14787210.3.4.557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dermatologic diseases encompass a broad category of pathologic situations. Infection remains a significant aspect of the pathology faced in patient encounters, and it is natural to expect that anti-infectives play a major element in the armamentarium utilized by dermatologists. Aside from the treatment of the classic bacterial and fungal infections, there are now new uses for antiviral agents to help suppress recurrent disease, such as herpes simplex. There is also the novel approach of using anti-infectives, or agents that have been thought to have antimicrobial activity, to treat inflammatory diseases. This review describes anti-infectives, beginning with common antibiotics used to treat bacterial infections. The discussion will then cover the current use of antivirals. Finally, the description of antifungals will be separated, starting with the oral agents and ending with the topical antimycotics. The use of anti-infectives in tropical dermatology has been purposefully left out, and perhaps should be the subject of a separate review. Cutaneous bacterial infections consist chiefly of those microorganisms that colonize the skin, such as species of staphylococcus and streptococcus. Propionibacterium acnes and certain other anaerobes can be involved in folliculitis, pyodermas and in chronic conditions such as hidradenitis suppurativa.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2004. [DOI: 10.1002/pds.916] [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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