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Pinheiro MM, de Souza LG, Nunes GP, Martin IF, de Oliveira YU, Pinheiro FMM, Costa LN, Caprio M, Della-Morte D, Infante M. The first report of leukocytoclastic vasculitis induced by once-weekly subcutaneous semaglutide. Curr Med Res Opin 2024; 40:1525-1531. [PMID: 39072425 DOI: 10.1080/03007995.2024.2386047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis involving arterioles, capillaries and postcapillary venules. LCV is generally confined to the skin, with extracutaneous manifestations occurring less frequently. LCV has multiple potential etiologies. Indeed, histological LCV can be found in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, immune complex vasculitis, vasculitis associated with systemic diseases (i.e. sarcoidosis, Sjögren's syndrome, rheumatoid arthritis, and systemic lupus erythematosus), or in vasculitis associated with cancer, infections, sepsis and use of certain medications. LCV can also be idiopathic in up to 50% of cases. CASE REPORT Semaglutide is a glucagon-like peptide 1 (GLP-1) receptor agonist used for management of type 2 diabetes mellitus (T2DM), obesity and overweight associated with one or more weight-related comorbidities. A case of drug-induced LCV has already been described with the use of once-daily oral semaglutide. Herein, we describe the first case of skin-limited LCV induced by once-weekly subcutaneous semaglutide in a 73-year-old man with T2DM, who experienced the complete resolution of the skin lesions shortly after the discontinuation of semaglutide therapy. CONCLUSION Future prospective studies, adverse event reporting and post-marketing surveillance will certainly contribute to establishing if LCV represents a less rare than expected side effect of both oral and subcutaneous semaglutide formulations.
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Affiliation(s)
| | | | | | - Isis Franco Martin
- UNIVAG, Centro Universitário de Várzea Grande, Várzea Grande, MT, Brazil
| | | | - Felipe Moura Maia Pinheiro
- Hospital das Clínicas, Faculdade de Medicina de São Paulo, Universidade de São Paulo-USP, São Paulo, SP, Brazil
| | | | - Massimiliano Caprio
- Department of Human Sciences and Promotion of the Quality of Life & Laboratory of Cardiovascular Endocrinology, San Raffaele Open University & San Raffaele Research Institute-IRCCS San Raffaele, Rome, Italy
| | - David Della-Morte
- Department of Biomedicine and Prevention, Section of Clinical Nutrition and Nutrigenomics, University of Rome Tor Vergata, Rome, Italy
| | - Marco Infante
- Section of Diabetes & Metabolic Disorders, UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
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2
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Kowalska J, Wrześniok D. Skin-Related Adverse Reactions Induced by Oral Antidiabetic Drugs-A Review of Literature and Case Reports. Pharmaceuticals (Basel) 2024; 17:847. [PMID: 39065698 PMCID: PMC11280276 DOI: 10.3390/ph17070847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
Type 2 diabetes (T2DM) is a chronic metabolic disease with a steadily increasing prevalence worldwide. Diabetes affects the function of many organs, including the skin. Pharmacotherapy for T2DM is mainly based on oral hypoglycemic drugs. The therapeutic strategy is chosen taking into account the individual patient's characteristics, among other comorbidities. Antidiabetic drugs can induce cutaneous adverse reactions (CADRs) ranging in severity from mild erythema to serious disorders such as DRESS or Stevens-Johnson syndrome. CADRs can result from hypersensitivity to the drug but can also be related to the mechanism of action of the drug or cross-reactivity with drugs of similar structure. This paper reviews CADRs induced by oral antidiabetic drugs, considering their dermatological manifestations and possible pathomechanisms. Particular attention was paid to specific dermatological conditions such as dipeptidylpeptidase 4 inhibitor-associated bullous pemphigoid or Fournier's gangrene associated with sodium-glucose cotransporter 2 inhibitor therapy. Knowledge of the dermatological manifestations of CADRs is important in clinical practice. Recognition of a skin lesion resulting from an adverse drug reaction allows for appropriate management, which in this case is primarily related to drug discontinuation. This is particularly important in the treatment of T2DM since this disease has a high prevalence in the elderly, who are at higher risk of adverse drug reactions.
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Affiliation(s)
- Justyna Kowalska
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Jagiellońska 4, 41-200 Sosnowiec, Poland;
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3
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Yazdani AN, Abdi A, Velpuri P, Patel P, DeMarco N, Agrawal DK, Rai V. A Review of Hematological Complications and Treatment in COVID-19. Hematol Rep 2023; 15:562-577. [PMID: 37873794 PMCID: PMC10594461 DOI: 10.3390/hematolrep15040059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/30/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
COVID-19, caused by SARS-CoV-2, and its variants have spread rapidly across the globe in the past few years, resulting in millions of deaths worldwide. Hematological diseases and complications associated with COVID-19 severely impact the mortality and morbidity rates of patients; therefore, there is a need for oversight on what pharmaceutical therapies are prescribed to hematologically at-risk patients. Thrombocytopenia, hemoglobinemia, leukopenia, and leukocytosis are all seen at increased rates in patients infected with COVID-19 and become more prominent in patients with severe COVID-19. Further, COVID-19 therapeutics may be associated with hematological complications, and this became more important in immunocompromised patients with hematological conditions as they are at higher risk of hematological complications after treatment. Thus, it is important to understand and treat COVID-19 patients with underlying hematological conditions with caution. Hematological changes during COVID-19 infection and treatment are important because they may serve as biomarkers as well as to evaluate the treatment response, which will help in changing treatment strategies. In this literature review, we discuss the hematological complications associated with COVID-19, the mechanisms, treatment groups, and adverse effects of commonly used COVID-19 therapies, followed by the hematological adverse events that could arise due to therapeutic agents used in COVID-19.
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Affiliation(s)
- Armand N. Yazdani
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Arian Abdi
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Prathosh Velpuri
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Parth Patel
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Nathaniel DeMarco
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Devendra K. Agrawal
- Department of Translational Research, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Vikrant Rai
- Department of Translational Research, Western University of Health Sciences, Pomona, CA 91766, USA
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4
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Drug-induced cutaneous vasculitis: A case series of 31 cases. REVUE FRANÇAISE D'ALLERGOLOGIE 2023. [DOI: 10.1016/j.reval.2023.103618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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5
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Abtahi-Naeini B, Momen T, Amiri R, Rajabi P, Rastegarnasab F. Metformin-Induced Generalized Bullous Fixed-Drug Eruption with a Positive Dechallenge-Rechallenge Test: A Case Report and Literature Review. Case Rep Dermatol Med 2023; 2023:6353919. [PMID: 37034844 PMCID: PMC10081908 DOI: 10.1155/2023/6353919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/25/2022] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Metformin is a commonly used medication in diabetic patients. It can cause different complications including cutaneous adverse reactions. Metformin-induced fixed-drug eruption (FDE) has been reported in limited cases. Due to the popularity of metformin, clinicians need to be aware of uncommon drug reactions for proper diagnosis and treatment. Herein, we report a 43-year-old man with generalized bullous lesions with a positive dechallenge-rechallenge test diagnosed as metformin-induced generalized bullous fixed-drug eruption. Metformin dosage was stopped and lesions were treated with topical clobetasol propionate and oral prednisolone and cyclosporine-A. After a 6-month follow-up, he was well without any relapsing episodes.
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Affiliation(s)
- Bahareh Abtahi-Naeini
- Pediatric Dermatology Division of Department of Pediatrics, Imam Hossein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tooba Momen
- Department of Asthma, Allergy and Clinical Immunology, Child Growth and Development Research Center, Research Institute of Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rezvan Amiri
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Rajabi
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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6
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Fenn K, Maurer M, Lee SM, Crew KD, Trivedi MS, Accordino MK, Hershman DL, Kalinsky K. Phase 1 Study of Erlotinib and Metformin in Metastatic Triple-Negative Breast Cancer. Clin Breast Cancer 2019; 20:80-86. [PMID: 31570268 DOI: 10.1016/j.clbc.2019.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) is frequently overexpressed in metastatic triple-negative breast cancer (mTNBC). One strategy for overcoming resistance to EGFR inhibition is concomitant inhibition of downstream signaling. The antidiabetic drug metformin inhibits both MAPK and PI3K/mTOR pathway signaling. We evaluated the combination of erlotinib and metformin in a phase 1 study of patients with mTNBC. PATIENTS AND METHODS Patients with mTNBC who had received at least one prior line of therapy for metastatic disease were eligible. Erlotinib dose was fixed at 150 mg daily. Metformin dose escalation was planned according to a 3 + 3 design. Dose-limiting toxicities (DLT) were assessed during the first 5 weeks of therapy. The primary objective was to determine the maximum tolerated dose of metformin with fixed-dose erlotinib. Secondary endpoints were response rate, stable disease rate, and progression-free survival. RESULTS Eight patients were enrolled. The median number of prior therapies for metastatic disease was 2.5 (range, 1-6). No DLT events were reported during the DLT assessment period. Most adverse events were grade 1/2. Grade 3 diarrhea despite maximum supportive care required dose reduction of metformin in one patient. Grade 3 rash led to study withdrawal in one patient. No grade 4 adverse events were reported. The best observed response was stable disease in 2 patients (25%). Median progression-free survival was 60 days (range, 36-61 days). CONCLUSION Erlotinib and metformin were well tolerated in a population of pretreated mTNBC patients but did not demonstrate efficacy in this population.
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Affiliation(s)
- Kathleen Fenn
- Department of Medicine, Columbia University Irving Medical Center, New York NY
| | | | - Shing M Lee
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Katherine D Crew
- Department of Medicine, Columbia University Irving Medical Center, New York NY
| | - Meghna S Trivedi
- Department of Medicine, Columbia University Irving Medical Center, New York NY
| | - Melissa K Accordino
- Department of Medicine, Columbia University Irving Medical Center, New York NY
| | - Dawn L Hershman
- Department of Medicine, Columbia University Irving Medical Center, New York NY
| | - Kevin Kalinsky
- Department of Medicine, Columbia University Irving Medical Center, New York NY.
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7
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Garg Y, Jain S, Kumar A. A rare case of clomiphene-induced leukocytoclastic vasculitis. J Basic Clin Physiol Pharmacol 2019; 30:jbcpp-2018-0183. [PMID: 31343980 DOI: 10.1515/jbcpp-2018-0183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/04/2019] [Indexed: 01/22/2023]
Abstract
Clomiphene citrate is a first-line drug for the induction of ovulation in infertility cases. Leukocytoclastic vasculitis (LCV) is an extremely rare serious adverse drug reaction to clomiphene. We report here the case of a 30-year-old Indian female patient who presented with generalized petechiae and palpable purpura without fever and sparing the mucosa, temporally related to clomiphene intake and consistent with LCV histologically. Clomiphene was stopped and the patient was treated symptomatically with prednisolone 40 mg/day, oral levocetirizine 5 mg twice daily, and emollients and calamine lotion topically. The patient improved over 3-4 weeks. The prednisolone dose was tapered weekly and withdrawn gradually. To date, drug-induced LCV has not been previously reported with clomiphene. Although rare, clomiphene could be considered a potential cause of drug-induced cutaneous LCV in the differential diagnosis of erythematosus rash with non-blanching petechiae and purpura.
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Affiliation(s)
- Yashika Garg
- ESIC Dental College and Hospital, Department of Pharmacology, New Delhi, India.,Vardhman Mahavir Medical College and Safdarjung Hospital, Department of Pharmacology, New Delhi, India.,Apartment No. 174, Agroha Kunj Apartments, Rohini Sector 13New Delhi 110085, India
| | - Sourabh Jain
- All India Institute of Medical Sciences (AIIMS), Department of Dermatology, Bhopal, India.,Vardhman Mahavir Medical College and Safdarjung Hospital, Department of Dermatology, New Delhi, India
| | - Arun Kumar
- Vardhman Mahavir Medical College and Safdarjung Hospital, Department of Pharmacology, New Delhi, India
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8
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Fathallah N, Ouni B, Mokni S, Baccouche K, Atig A, Ghariani N, Azzabi A, Denguezli M, Slim R, Ben Salem C. [Drug-induced vasculitis]. Therapie 2018; 74:347-354. [PMID: 30173896 DOI: 10.1016/j.therap.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/12/2018] [Accepted: 07/17/2018] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Drug-induced vasculitis is reported in almost 10-20 % of vasculitis. Several drugs may be incriminated in their occurrence. Our study aimed to study the epidemiological, clinical, histopathological and evolutionary characteristics of drug-indced vasculitis from a series of cases and to specify the different drugs involved. METHODS We conducted a retrospective study during the period from January 2006 to December 2015 from the cases notified to the regional pharmacovigilance center of Sousse, Tunisia. The diagnosis was established according to the criteria proposed by the group of the American college of rheumatology (ACR). RESULTS Our study included thirteen cases of drug-induced vasculitis over a ten-year period, with an mean incidence of 1.3 new cases per year. Mean age of patients was 40.84 years. The mean delay from the treatment onset was 14.46 days with extremes ranging from 5 days to six weeks. Most patients had pure skin involvement. Association with other extracutaneous complaints was present in five cases. Cutaneous biopsy was performed in all patients showing a pathological pattern of leukocytoclastic vasculitis, associated with fibrinoid necrosis, extravasation of red blood cells and allergic capillaritis. The outcome was favorable for all patients. The offending drugs in our series were amoxicillin, pristinamycin, rifampicin, fluconazole, metformin, glimepiride, phenobarbital, gabapentin, fenofibrate, ibuprofen, allopurinol, rituximab and tinzaparin. CONCLUSION Anamnestic, clinical, biological and histopathological findings allow the early recognition of drug-induced vasculitis. Adequate treatment prevents systemic spreading and a worse prognosis.
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Affiliation(s)
- Neila Fathallah
- Département de pharmacologie, faculté de médecine de Sousse, université de Sousse, avenue Md Karoui, 4002 Sousse, Tunisie.
| | - Bouraoui Ouni
- Département de pharmacologie, faculté de médecine de Sousse, université de Sousse, avenue Md Karoui, 4002 Sousse, Tunisie
| | - Sana Mokni
- Département de dermatologie, CHU Farhat Hached, 4002 Sousse, Tunisie
| | - Khadija Baccouche
- Département de rhumatologie, CHU Farhat Hached, 4002 Sousse, Tunisie
| | - Amira Atig
- Département de médecine Interne, CHU Farhat Hached, 4002 Sousse, Tunisie
| | - Najat Ghariani
- Département de dermatologie, CHU Farhat Hached, 4002 Sousse, Tunisie
| | - Awatef Azzabi
- Département de néphrologie, CHU Sahloul, 4002 Sousse, Tunisie
| | - Mohamed Denguezli
- Département de dermatologie, CHU Farhat Hached, 4002 Sousse, Tunisie
| | - Raoudha Slim
- Département de pharmacologie, faculté de médecine de Sousse, université de Sousse, avenue Md Karoui, 4002 Sousse, Tunisie
| | - Chaker Ben Salem
- Département de pharmacologie, faculté de médecine de Sousse, université de Sousse, avenue Md Karoui, 4002 Sousse, Tunisie
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9
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Ladhari C, Aounallah A, Slim R, Fathallah N, Sriha B, Chati S, Denguezli M, Ben Salem C. Pristinamycin-induced leukocytoclastic vasculitis: First report of a case in Tunisia. Therapie 2017; 73:295-297. [PMID: 29174956 DOI: 10.1016/j.therap.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/28/2017] [Accepted: 10/12/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Chayma Ladhari
- Department of pharmacovigilance, Sousse university, faculty of medicine, avenue Mohamed Karoui, 4002 Sousse, Tunisia.
| | - Amina Aounallah
- Department of dermatology, Farhat-Hached university hospital, 4002 Sousse, Tunisia
| | - Raoudha Slim
- Department of pharmacovigilance, Sousse university, faculty of medicine, avenue Mohamed Karoui, 4002 Sousse, Tunisia
| | - Neila Fathallah
- Department of pharmacovigilance, Sousse university, faculty of medicine, avenue Mohamed Karoui, 4002 Sousse, Tunisia
| | - Badreddine Sriha
- Anatomo-cytopathology department, Farhat-Hached university hospital, 4002 Sousse, Tunisia
| | - Souheil Chati
- Occupational department, Farhat-Hached university hospital, 4002 Sousse, Tunisia
| | - Mohamed Denguezli
- Department of dermatology, Farhat-Hached university hospital, 4002 Sousse, Tunisia
| | - Chaker Ben Salem
- Department of pharmacovigilance, Sousse university, faculty of medicine, avenue Mohamed Karoui, 4002 Sousse, Tunisia
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Abstract
Diabetes mellitus is a widespread endocrine disease with severe impact on health systems worldwide. Increased serum glucose causes damage to a wide range of cell types, including endothelial cells, neurons, and renal cells, but also keratinocytes and fibroblasts. Skin disorders can be found in about one third of all people with diabetes and frequently occur before the diagnosis, thus playing an important role in the initial recognition of underlying disease. Noninfectious as well as infectious diseases have been described as dermatologic manifestations of diabetes mellitus. Moreover, diabetic neuropathy and angiopathy may also affect the skin. Pruritus, necrobiosis lipoidica, scleredema adultorum of Buschke, and granuloma annulare are examples of frequent noninfectious skin diseases. Bacterial and fungal skin infections are more frequent in people with diabetes. Diabetic neuropathy and angiopathy are responsible for diabetic foot syndrome and diabetic dermopathy. Furthermore, antidiabetic therapies may provoke dermatologic adverse events. Treatment with insulin may evoke local reactions like lipohypertrophy, lipoatrophy and both instant and delayed type allergy. Erythema multiforme, leukocytoclastic vasculitis, drug eruptions, and photosensitivity have been described as adverse reactions to oral antidiabetics. The identification of lesions may be crucial for the first diagnosis and for proper therapy of diabetes.
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11
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Metformin-Induced Generalized Fixed Drug Eruption With Cutaneous Hemophagocytosis. Am J Dermatopathol 2017; 39:471-475. [DOI: 10.1097/dad.0000000000000800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Fathallah N, Ladhari C, Slim R, Ghariani N, Sriha B, Ben Salem C. Vasculitis induced by phenobarbital with cross-reactivity to carbamazepine. Therapie 2016; 72:387-389. [PMID: 27717500 DOI: 10.1016/j.therap.2016.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/20/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Neila Fathallah
- Sousse university, Faculty of medicine, Department of pharmacovigilance, avenue Mohamed-Karoui, 4002 Soussse, Tunisia.
| | - Chayma Ladhari
- Sousse university, Faculty of medicine, Department of pharmacovigilance, avenue Mohamed-Karoui, 4002 Soussse, Tunisia
| | - Raoudha Slim
- Sousse university, Faculty of medicine, Department of pharmacovigilance, avenue Mohamed-Karoui, 4002 Soussse, Tunisia
| | - Najet Ghariani
- Farhat-Hached University Hospital, Department of dermatology, 4002 Sousse, Tunisia
| | - Badreddine Sriha
- Farhat-Hached University Hospital, Anatomo-cytopathology department, Sousse, Tunisia
| | - Chaker Ben Salem
- Sousse university, Faculty of medicine, Department of pharmacovigilance, avenue Mohamed-Karoui, 4002 Soussse, Tunisia
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Makrantonaki E, Jiang D, Hossini AM, Nikolakis G, Wlaschek M, Scharffetter-Kochanek K, Zouboulis CC. Diabetes mellitus and the skin. Rev Endocr Metab Disord 2016; 17:269-282. [PMID: 27432328 DOI: 10.1007/s11154-016-9373-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diabetes is a debilitating, life-threatening disease accounting in 2015 for the death of 5 million people worldwide. According to new estimations, 415 million adults currently suffer from the disease, and this number is expected to rise to 642 million by 2040. High glucose blood levels also affect the skin among systemic organs, and skin disorders can often predict the onset of this metabolic disorder. In this review, we address the pathomechanistic effects of diabetes on the skin and give an overview on the most common skin diseases associated with diabetes.
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Affiliation(s)
- E Makrantonaki
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany.
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany.
| | - D Jiang
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - A M Hossini
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
| | - G Nikolakis
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
| | - M Wlaschek
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - K Scharffetter-Kochanek
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - C C Zouboulis
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
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Steber CJ, Perkins SL, Harris KB. Metformin-Induced Fixed-Drug Eruption Confirmed by Multiple Exposures. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:231-4. [PMID: 27056044 PMCID: PMC4827516 DOI: 10.12659/ajcr.896424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Female, 56 Final Diagnosis: Fixed-drug eruption Symptoms: — Medication: Metformin Clinical Procedure: Discontinued metformin Specialty: Family Medicine
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Affiliation(s)
- Carolyn J Steber
- Levine College of Health Sciences, Wingate University, Wingate, NC, USA
| | - Scott L Perkins
- College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, USA
| | - Kira B Harris
- Levine College of Health Sciences, Wingate University, Wingate, NC, USA
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Mumoli L, Gambardella A, Labate A, Succurro E, De Sarro G, Arturi F, Gallelli L. Rosacea-like facial rash related to metformin administration in a young woman. BMC Pharmacol Toxicol 2014; 15:3. [PMID: 24507578 PMCID: PMC3923099 DOI: 10.1186/2050-6511-15-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/04/2014] [Indexed: 11/17/2022] Open
Abstract
Background Since the skin represents a common site of adverse drug reactions, few data are reported at this time regarding the development of skin rash during the treatment with antidiabetic drugs. Case presentation We report a 29-year old woman that developed a facial skin rash during the treatment with metformin. Clinical and laboratory findings excluded the presence of systemic diseases, but several diagnosis and many drugs were administered without clinical improvement. The self-dismission of metformin induced an improvement of symptoms, while the re-challenge documented an impairments of skin rash. The Naranjo probability scale suggested a probable association between metformin and skin rash and metformin was definitively dismissed. Conclusion We report for the first time a non vasculitis facial skin manifestation related to metformin in a young woman. However, this case may emphasizes the need to consider the ADRs as a differential diagnosis in order to reduce medical errors and the related medical costs.
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Affiliation(s)
| | | | | | | | | | - Franco Arturi
- Department of Medical and Surgical Science, Division of Internal Medicine, University "Magna Graecia"- Mater Domini Hospital of Catanzaro, Catanzaro, Italy.
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16
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Badr D, Kurban M, Abbas O. Metformin in dermatology: an overview. J Eur Acad Dermatol Venereol 2013; 27:1329-35. [PMID: 23437788 DOI: 10.1111/jdv.12116] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 01/21/2013] [Indexed: 11/26/2022]
Abstract
For several decades, metformin has been used as an oral hypoglycaemic agent, where it is the first line of treatment in overweight and obese type 2 diabetic patients. This is because it decreases the hepatic glucose output and acts as an insulin sensitizer by increasing the glucose utilization by muscles and adipocytes. As a result of the improvement in glycaemic control, serum insulin concentrations decline slightly, thus improving hyperinsulinaemia and its signs. In addition, it has been shown that metformin has platelet anti-aggregating and antioxidant effects. These pharmacological properties have allowed metformin to be effective in non-diabetic situations including cutaneous conditions. This is an evidence-based review on the use of metformin in the treatment of skin disorders such as hirsutism, acne, hidradenitis suppurativa, acanthosis nigricans, psoriasis, skin cancer, among others. In addition, cutaneous side-effects such as leukocytoclastic vasculitis, bullous pemphigoid, psoriasiform drug eruption, lichen planus and acute alopecia have been associated with metformin use and are discussed in the article.
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Affiliation(s)
- D Badr
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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Angioedema after the first dose of metformin. Am J Emerg Med 2013; 31:634.e5. [PMID: 23380117 DOI: 10.1016/j.ajem.2012.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 10/08/2012] [Accepted: 10/10/2012] [Indexed: 11/24/2022] Open
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18
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Nakatani K, Kurose T, Hyo T, Watanabe K, Yabe D, Kawamoto T, Seino Y. Drug-induced generalized skin eruption in a diabetes mellitus patient receiving a dipeptidyl peptidase-4 inhibitor plus metformin. Diabetes Ther 2012; 3:14. [PMID: 23129260 PMCID: PMC3508117 DOI: 10.1007/s13300-012-0014-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Indexed: 12/04/2022] Open
Abstract
A generalized skin eruption with strong itching was induced by sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, in a patient almost 6 months after initiation of the drug. Physical examination revealed a spread of skin rash from chest to back, and abdomen and thigh. Discontinuation of the drug eliminated the skin rash immediately. The emergence of new rash ended, and the rash itself withered after 1 week. The spread of the rash gradually shrank and the skin lesions subsided, leaving pigmentation 1 month later. Two months after cessation of sitagliptin, the skin eruption had subsided and oral steroid medication was stopped, but some small eczematous eruptions continued to appear intermittently. Although a drug-induced lymphocyte stimulation test was negative for sitagliptin, nonspecific radioimmunosorbent test for immunoglobulin E was increased to 532 IU/mL, with a percentage of eosinophil of 7.4%. Sitagliptin has a phenyl ring, carbonyl group, and an absorption spectrum showing three absorption peaks (199.9, 265.0, 400.1 nm), and its photosensitive mechanism could have been responsible for the itchy edematous plaque. In the present case, the initial generalized skin eruption may have been induced by an allergic reaction to sitagliptin. Close attention should be paid to patients receiving this drug with a history of urticaria, and to the development of photosensitivity.
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Affiliation(s)
- Kaori Nakatani
- Division of Diabetes, Clinical Nutrition and Endocrinology, Department of Internal Medicine, Kasai Electric Power Hospital, 2-1-7 Fukushima, Fukushima Ward, Osaka City, 553-0003, Japan
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Abstract
Diabetes mellitus is the most common endocrine disorder with continuously increasing prevalence. Blood vessels, nerves, eyes, kidneys and skin are affected, which causes both an enormous financial burden and a reduced quality of life of the affected patients. Long-standing diabetes may impair skin homeostasis resulting in skin manifestations in at least one third of all diabetics. The skin involvement may be the first presenting sign of diabetes, thus the respective skin signs should lead to diabetes focused diagnostic. Besides, the skin signs may be considered as a marker for the course of the disease or for the success of therapeutic interventions.
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Affiliation(s)
- B Behm
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
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Czarnowicki T, Ramot Y, Ingber A, Maly A, Horev L. Metformin-induced leukocytoclastic vasculitis: a case report. Am J Clin Dermatol 2012; 13:61-3. [PMID: 21846159 DOI: 10.2165/11593230-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Wiwanitkit V. Metformin allergy. Indian J Pharmacol 2011; 43:216-7. [PMID: 21572665 PMCID: PMC3081469 DOI: 10.4103/0253-7613.77379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 10/30/2010] [Accepted: 01/07/2011] [Indexed: 11/23/2022] Open
Abstract
Metformin is an important antidiabetic agent that is widely used for diabetic patients. Here, a case of metformin allergy, presenting with skin lesions, is reported.
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Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol 2011; 105:259-273. [PMID: 20934625 DOI: 10.1016/j.anai.2010.08.002] [Citation(s) in RCA: 663] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/02/2010] [Indexed: 01/17/2023]
Abstract
Adverse drug reactions (ADRs) result in major health problems in the United States in both the inpatient and outpatient setting. ADRs are broadly categorized into predictable (type A and unpredictable (type B) reactions. Predictable reactions are usually dose dependent, are related to the known pharmacologic actions of the drug, and occur in otherwise healthy individuals, They are estimated to comprise approximately 80% of all ADRs. Unpredictable are generally dose independent, are unrelated to the pharmacologic actions of the drug, and occur only in susceptible individuals. Unpredictable reactions are subdivided into drug intolerance, drug idiosyncrasy, drug allergy, and pseudoallergic reactions. Both type A and B reactions may be influenced by genetic predisposition of the patient
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Current World Literature. Curr Opin Rheumatol 2008; 20:111-20. [DOI: 10.1097/bor.0b013e3282f408ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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