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Del Pozzo-Magaña BR, Liy-Wong C. Drugs and the skin: A concise review of cutaneous adverse drug reactions. Br J Clin Pharmacol 2024; 90:1838-1855. [PMID: 35974692 DOI: 10.1111/bcp.15490] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 01/19/2023] Open
Abstract
Drug-induced skin disease or cutaneous adverse drug reactions (CADRs) are terms that encompass the clinical manifestations of the skin, mucosae and adnexa induced by a drug or its metabolites. The skin is the organ most frequently affected by drug reactions, which may affect up to 10% of hospitalized patients and occur in 1-3% of multimedicated patients. Most CADRs are mild or self-resolving conditions; however, 2-6.7% of could develop into potentially life-threatening conditions. CADRs represent a heterogeneous field and can be diagnostically challenging as they may potentially mimic any dermatosis. Currently, there are between 29-35 different cutaneous drug-reaction patterns reported ranging from mild dermatitis to an extensively burnt patient. The most frequently reported are maculopapular rash, urticaria/angioedema, fixed drug eruption and erythema multiforme. Less common but more severe patterns include erythroderma, drug reaction with eosinophilia and systemic symptoms, and Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum. Almost any drug can induce a CADR, but antibiotics, nonsteroidal anti-inflammatory drugs and antiepileptics are the most frequently involved. Different mechanisms are involved in the pathogenesis of CADRs, although in some cases, these remain still unknown. CADRs could be classified in different ways: (i) type A (augmented) or type B (bizarre); (ii) immediate or delayed; (iii) immune-mediated or nonimmune-mediated; (iv) nonsevere or life-threatening; and (v) by their phenotype, including exanthematous, urticarial, pustular and blistering morphology. Recognizing a specific CADR will mostly depend on the ability of the physician to perform a detailed clinical examination, the proper description of the morphology of the skin lesions and supporting laboratory and/or skin biopsy findings.
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Affiliation(s)
- Blanca R Del Pozzo-Magaña
- Department of Pediatrics, Division of Pediatric Clinical Pharmacology, Children's Hospital of Western Ontario, Western University, London, ON, Canada
| | - Carmen Liy-Wong
- Department of Pediatrics, Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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2
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Ouni NEI, Mokni S, Rouatbi J, Lahouel M, Fathallah N, Tlili T, Ghariani Fetoui N, Ben Kahla M, Ghariani N, Denguezli M. Severe Localized Vitiligo Following Phototoxicity to Hydrochlorothiazide. Dermatitis 2024; 35:181-183. [PMID: 38150560 DOI: 10.1089/derm.2023.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Nour El Imene Ouni
- From the Dermatology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Sana Mokni
- From the Dermatology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Jacem Rouatbi
- From the Dermatology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Maha Lahouel
- From the Dermatology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Neila Fathallah
- Pharmacovigilance Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Taghrid Tlili
- Anatomopathology Department, Farhat Hached Hospital, Sousse, Tunisia
| | | | - Marouen Ben Kahla
- From the Dermatology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Najet Ghariani
- From the Dermatology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Mohamed Denguezli
- From the Dermatology Department, Farhat Hached Hospital, Sousse, Tunisia
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3
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Lejwoda K, Gumieniczek A, Filip A, Naumczuk B. The Study on Timolol and Its Potential Phototoxicity Using Chemical, In Silico and In Vitro Methods. Pharmaceuticals (Basel) 2024; 17:98. [PMID: 38256931 PMCID: PMC10818944 DOI: 10.3390/ph17010098] [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: 12/10/2023] [Revised: 12/30/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Timolol (TIM) is a non-selective ß-adrenergic receptor antagonist used orally for the treatment of hypertension and heart attacks, and topically for treating glaucoma; lately, it has also been used in some specific dermatological problems. In the present study, its photodegradation and potential risk of phototoxicity were examined using chemical, in silico and in vitro methods. The UV/VIS irradiated solutions of TIM at pH 1-13 were subjected to LC-UV and UPLC-HRMS/MS analyses showing pseudo first-order kinetics of degradation and several degradation products. The structures of these photodegradants were elucidated by fragmentation path analysis based on high resolution (HR) fragmentation mass spectra, and then used for toxicity evaluation using OSIRIS Property Explorer and Toxtree. Potential risk of phototoxicity was also studied using chemical tests for detecting ROS under UV/VIS irradiation and in vitro tests on BALB/c 3T3 mouse fibroblasts (MTT, NRU and Live/Dead tests). TIM was shown to be potentially phototoxic because of its UV/VIS absorptive properties and generation ROS during irradiation. As was observed in the MTT and NRU tests, the co-treatment of fibroblasts with TIM and UV/VIS light inhibited cell viability, especially when concentrations of the drug were higher than 50 µg/mL.
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Affiliation(s)
- Karolina Lejwoda
- Department of Medicinal Chemistry, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Anna Gumieniczek
- Department of Medicinal Chemistry, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Agata Filip
- Department of Cancer Genetics, Cytogenetics Laboratory, Medical University of Lublin, 20-080 Lublin, Poland;
| | - Beata Naumczuk
- Institute of Organic Chemistry Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland;
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4
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Abdelwahab R, Tangalos EG, Matulis J. Differentiation of hydrochlorothiazide-induced dermatitis from stasis dermatitis. Drug Ther Bull 2023; 61:189-191. [PMID: 37399277 DOI: 10.1136/dtb.2023.249884rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
- Rewan Abdelwahab
- Community Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Eric G Tangalos
- Community Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - John Matulis
- Community Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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5
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Berg SZ, Berg J. Melanin: a unifying theory of disease as exemplified by Parkinson's, Alzheimer's, and Lewy body dementia. Front Immunol 2023; 14:1228530. [PMID: 37841274 PMCID: PMC10570809 DOI: 10.3389/fimmu.2023.1228530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Melanin, a ubiquitous dark pigment, plays important roles in the immune system, including scavenging reactive oxygen species formed in response to ultraviolet radiation absorption, absorbing metals, thermal regulation, drug uptake, innate immune system functions, redox, and energy transduction. Many tissue types, including brain, heart, arteries, ovaries, and others, contain melanin. Almost all cells contain precursors to melanin. A growing number of diseases in which there is a loss of melanin and/or neuromelanin are increasingly thought to have infectious etiologies, for example, Alzheimer's disease (AD), Parkinson's disease (PD), Lewy Body Dementia (LBD), and vitiligo. AD, PD, LBD, and vitiligo have been linked with herpesvirus, which enters melanosomes and causes apoptosis, and with gut dysbiosis and inflammation. Herpesvirus is also linked with gut dysbiosis and inflammation. We theorize that under normal healthy states, melanin retains some of the energy it absorbs from electromagnetic radiation, which is then used to fuel cells, and energy from ATP is used to compliment that energy supply. We further theorize that loss of melanin reduces the energy supply of cells, which in the case of AD, PD, and LBD results in an inability to sustain immune system defenses and remove the plaques associated with the disease, which appear to be part of the immune system's attempt to eradicate the pathogens seen in these neurodegenerative diseases. In addition, in an attempt to explain why removing these plaques does not result in improvements in cognition and mood and why cognitions and moods in these individuals have ebbs and flows, we postulate that it is not the plaques that cause the cognitive symptoms but, rather, inflammation in the brain resulting from the immune system's response to pathogens. Our theory that energy retained in melanin fuels cells in an inverse relationship with ATP is supported by studies showing alterations in ATP production in relationship to melanin levels in melanomas, vitiligo, and healthy cells. Therefore, alteration of melanin levels may be at the core of many diseases. We propose regulating melanin levels may offer new avenues for treatment development.
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Affiliation(s)
- Stacie Z. Berg
- Department of Translational Biology, William Edwards LLC, Baltimore, MD, United States
| | - Jonathan Berg
- Department of Translational Biology, William Edwards LLC, Baltimore, MD, United States
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6
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Weidman-Evans E, Rhodes A, Ferrington L. What is the relationship between photosensitizing drugs and skin cancer? JAAPA 2023; 36:8-10. [PMID: 37229580 DOI: 10.1097/01.jaa.0000931448.63999.de] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
ABSTRACT Many medications are associated with phototoxicity or photoallergy, the two types of photosensitivity. Recently, a warning related to increased skin cancer risk was added to the labeling of the popular diuretic hydrochlorothiazide. This article reviews some photosensitizing medications and describes patient education on preventing and recognizing photosensitivity reactions and skin cancer.
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Affiliation(s)
- Emily Weidman-Evans
- Emily Weidman-Evans is a professor in the PA program at Louisiana State University Health Sciences Center in Shreveport, La. Andrea Rhodes practices at Eating Recovery Center/Pathlight Mood & Anxiety Center in San Antonio, Tex. Lindsay Ferrington is an assistant professor in the PA program at Louisiana State University. The authors have disclosed no potential conflicts of interest, financial or otherwise
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7
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Stump TK, Fastner S, Jo Y, Chipman J, Haaland B, Nagelhout ES, Wankier AP, Lensink R, Zhu A, Parsons B, Grossman D, Wu YP. Objectively-Assessed Ultraviolet Radiation Exposure and Sunburn Occurrence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5234. [PMID: 37047850 PMCID: PMC10094127 DOI: 10.3390/ijerph20075234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Ultraviolet radiation (UVR) exposure is the primary modifiable risk factor for melanoma. Wearable UVR sensors provide a means of quantifying UVR exposure objectively and with a lower burden than self-report measures used in most research. The purpose of this study was to evaluate the relationship between detected UVR exposure and reported sunburn occurrence. In this study, a UVR monitoring device was worn by 97 parent-child dyads during waking hours for 14 days to measure instantaneous and accumulated UVR exposure. The results showed that the participants' total UVR exposure was associated with reported sunburn after adjusting for Fitzpatrick skin type and geographic location. It was observed that one standard erythemal dose (SED) increase in the participants' daily total UVR exposure was associated with reported sunburn (an odds ratio (OR) of 1.26 with a 95% CI of 1.13 and 1.41, and p < 0.001 for parents and an OR of 1.28 with a 95% CI of 1.12 and 1.47, and p < 0.001 for children). A one-SED increase in the participants' UVR exposure from 10 am to 4 pm was also associated with reported sunburn (an OR of 1.31 with a 95% CI of 1.15 and 1.49, and p < 0.001 for parents and an OR of 1.33 with a 95% CI of 1.12 and 1.59, and p = 0.001 for children). We found that elevated UVR exposure recordings measured by the UVR sensor were associated with reported sunburn occurrence. Future directions for wearable UVR sensors may include their use as an intervention tool to support in-the-moment sunburn prevention.
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Affiliation(s)
- Tammy K. Stump
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Suzanne Fastner
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Yeonjung Jo
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA
| | - Jonathan Chipman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA
| | - Elizabeth S. Nagelhout
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah, Salt Lake City, UT 84108, USA
| | - Ali P. Wankier
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Riley Lensink
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Angela Zhu
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84113, USA
| | - Bridget Parsons
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Douglas Grossman
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Yelena P. Wu
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
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8
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Semyachkina-Glushkovskaya O, Bragin D, Bragina O, Socolovski S, Shirokov A, Fedosov I, Ageev V, Blokhina I, Dubrovsky A, Telnova V, Terskov A, Khorovodov A, Elovenko D, Evsukova A, Zhoy M, Agranovich I, Vodovozova E, Alekseeva A, Kurths J, Rafailov E. Low-Level Laser Treatment Induces the Blood-Brain Barrier Opening and the Brain Drainage System Activation: Delivery of Liposomes into Mouse Glioblastoma. Pharmaceutics 2023; 15:567. [PMID: 36839889 PMCID: PMC9966329 DOI: 10.3390/pharmaceutics15020567] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
The progress in brain diseases treatment is limited by the blood-brain barrier (BBB), which prevents delivery of the vast majority of drugs from the blood into the brain. In this study, we discover unknown phenomenon of opening of the BBBB (BBBO) by low-level laser treatment (LLLT, 1268 nm) in the mouse cortex. LLLT-BBBO is accompanied by activation of the brain drainage system contributing effective delivery of liposomes into glioblastoma (GBM). The LLLT induces the generation of singlet oxygen without photosensitizers (PSs) in the blood endothelial cells and astrocytes, which can be a trigger mechanism of BBBO. LLLT-BBBO causes activation of the ABC-transport system with a temporal decrease in the expression of tight junction proteins. The BBB recovery is accompanied by activation of neuronal metabolic activity and stabilization of the BBB permeability. LLLT-BBBO can be used as a new opportunity of interstitial PS-free photodynamic therapy (PDT) for modulation of brain tumor immunity and improvement of immuno-therapy for GBM in infants in whom PDT with PSs, radio- and chemotherapy are strongly limited, as well as in adults with a high allergic reaction to PSs.
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Affiliation(s)
- Oxana Semyachkina-Glushkovskaya
- Institute of Physics, Humboldt University, Newtonstrasse 15, 12489 Berlin, Germany
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Denis Bragin
- Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Olga Bragina
- Lovelace Biomedical Research Institute, Albuquerque, NM 87108, USA
| | - Sergey Socolovski
- Optoelectronics and Biomedical Photonics Group, Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK
| | - Alexander Shirokov
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
- Institute of Biochemistry and Physiology of Plants and Microorganisms, Russian Academy of Sciences, Prospekt Entuziastov 13, 410049 Saratov, Russia
| | - Ivan Fedosov
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Vasily Ageev
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Inna Blokhina
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Alexander Dubrovsky
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Valeria Telnova
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Andrey Terskov
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Alexander Khorovodov
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Daria Elovenko
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Arina Evsukova
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Maria Zhoy
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Ilana Agranovich
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
| | - Elena Vodovozova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia
| | - Anna Alekseeva
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Miklukho-Maklaya 16/10, 117997 Moscow, Russia
| | - Jürgen Kurths
- Institute of Physics, Humboldt University, Newtonstrasse 15, 12489 Berlin, Germany
- Department of Biology, Saratov State University, Astrakhanskaya 82, 410012 Saratov, Russia
- Potsdam Institute for Climate Impact Research, Department of Complexity Science, Telegrafenberg A31, 14473 Potsdam, Germany
| | - Edik Rafailov
- Optoelectronics and Biomedical Photonics Group, Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK
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9
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Abdelwahab R, Tangalos EG, Matulis J. Differentiation of hydrochlorothiazide-induced dermatitis from stasis dermatitis. BMJ Case Rep 2022; 15:e249884. [PMID: 36127034 PMCID: PMC9490582 DOI: 10.1136/bcr-2022-249884] [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: 11/04/2022] Open
Abstract
A woman in her 60s with a history of hypertension and stasis dermatitis presented to a primary care clinic with a bilateral, erythematous rash on the legs, stomach, and chest. Photosensitive rash and dermatitis may be caused by many conditions. Hydrochlorothiazide-induced dermatitis is a rare side effect of thiazide diuretics. Early identification of sulfa-sensitivity and photoallergic or phototoxic reaction is essential to accurate diagnosis and treatment of photosensitive dermatitis. Soliciting a targeted history is essential to delineating drug-induced dermatitis from stasis dermatitis. A thorough skin examination can elucidate the focal or extensive nature of the rash and is essential to making an accurate diagnosis. Immediate cessation of hydrochlorothiazide and switching drugs classes for hypertension management typically leads to resolution of symptoms.
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Affiliation(s)
- Rewan Abdelwahab
- Community Internal Medicine, Mayo Medical School, Rochester, Minnesota, USA
| | - Eric G Tangalos
- Community Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - John Matulis
- Community Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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10
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Merin KA, Shaji M, Kameswaran R. A Review on Sun Exposure and Skin Diseases. Indian J Dermatol 2022; 67:625. [PMID: 36865856 PMCID: PMC9971785 DOI: 10.4103/ijd.ijd_1092_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Skin is the thin layer of tissue forming the natural integumentary system of the body that acts as a barrier to protect it from exogenous and endogenous factors that induce undesirable biological responses in the body. Among these risk factors, skin damage triggered by solar ultraviolet radiation (UVR) is an escalating problem in dermatology with an increased incidence of acute and chronic cutaneous reactions. Several epidemiological studies have provided evidence for both beneficial and harmful effects of sunlight, particularly the solar UVR exposure of human beings. Due to overexposure to solar UVR on the earth's surface, outdoor professionals such as farmers, rural workers, builders and road workers are most vulnerable to developing occupational skin diseases. Indoor tanning is also associated with increased risks for various dermatological diseases. Sunburn is described as the erythematic acute cutaneous response in addition to increased melanin and apoptosis of keratinocytes to prevent skin carcinoma. Alterations in molecular, pigmentary and morphological characteristics cause carcinogenic progression in skin malignancies and premature ageing of the skin. Solar UV damage leads to immunosuppressive skin diseases such as phototoxic and photoallergic reactions. UV-induced pigmentation persists for a longer time, called long-lasting pigmentation. Sunscreen is the most mentioned skin protective behaviour and it is the most promoted part of the sun smart message along with other effective skin protection strategies such as clothing, that is, long sleeves, hats and sunglasses.
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Affiliation(s)
- KA Merin
- From the Doctor of Pharmacy, Department of Pharmacy Practice, J. K. K Nattraja College of Pharmacy, Kumarapalayam, Tamil Nadu, India
| | - Merin Shaji
- From the Doctor of Pharmacy, Department of Pharmacy Practice, J. K. K Nattraja College of Pharmacy, Kumarapalayam, Tamil Nadu, India
| | - R Kameswaran
- Department of Pharmacy Practice, J. K. K Nattraja College of Pharmacy, Kumarapalayam, Tamil Nadu, India
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11
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Aggarwal M, Chikwana E, Corvaro M. A proposed NAM-based tiered phototoxicity testing and human risk assessment framework for agrochemicals. Regul Toxicol Pharmacol 2022; 135:105250. [PMID: 36007800 DOI: 10.1016/j.yrtph.2022.105250] [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: 04/14/2022] [Revised: 06/18/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
Abstract
Phototoxicity testing is required by European regulations for agrochemicals with UV/visible molar extinction/absorption coefficient (MEC) higher than 10 L x mol-1 x cm-1 in the 290-700 nm wavelength range. Furthermore, regulations identify a need of considering human exposure in case of positive results. While in vitro OECD test guidelines are available for hazard characterisation, there is no guidance on how to utilise positive results in human exposure risk assessments. Our goal was to take a first step towards developing a NAM based tiered testing approach and a framework for non-dietary acute human dermal risk assessment for phototoxicity to agrochemicals. The proposed framework can be divided into a few steps: 1) use the OECD updated MEC values of 1000 L x mol-1 x cm-1 as trigger for phototoxicity testing; 2) establish a reference concentration (RfC) from in vitro phototoxicity studies using BMC approach, 3) estimate potential exposure to skin, target organ for phototoxicity, using EFSA exposure models, product specific labels and skin penetration values, and 4) phototoxicity risk assessment; 5) refinement to RfC and/or exposure estimates can be considered. Finally, case studies of a nematicide and an herbicide active substance are provided to illustrate the proposed framework.
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Affiliation(s)
- Manoj Aggarwal
- Corteva Agriscience LLC, 1090 Elkton Road, Newark, DE, 19711, USA.
| | - Edward Chikwana
- Corteva Agriscience LLC, 9330 Zionsville Road, Indianapolis, IN, 46268, USA
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12
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Kahremany S, Hofmann L, Gruzman A, Dinkova-Kostova AT, Cohen G. NRF2 in dermatological disorders: Pharmacological activation for protection against cutaneous photodamage and photodermatosis. Free Radic Biol Med 2022; 188:262-276. [PMID: 35753587 PMCID: PMC9350913 DOI: 10.1016/j.freeradbiomed.2022.06.238] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 01/27/2023]
Abstract
The skin barrier and its endogenous protective mechanisms cope daily with exogenous stressors, of which ultraviolet radiation (UVR) poses an imminent danger. Although the skin is able to reduce the potential damage, there is a need for comprehensive strategies for protection. This is particularly important when developing pharmacological approaches to protect against photocarcinogenesis. Activation of NRF2 has the potential to provide comprehensive and long-lasting protection due to the upregulation of numerous cytoprotective downstream effector proteins that can counteract the damaging effects of UVR. This is also applicable to photodermatosis conditions that exacerbate the damage caused by UVR. This review describes the alterations caused by UVR in normal skin and photosensitive disorders, and provides evidence to support the development of NRF2 activators as pharmacological treatments. Key natural and synthetic activators with photoprotective properties are summarized. Lastly, the gap in knowledge in research associated with photodermatosis conditions is highlighted.
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Affiliation(s)
- Shirin Kahremany
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan, 5290002, Israel; The Skin Research Institute, The Dead Sea and Arava Science Center, Masada, 86910, Israel
| | - Lukas Hofmann
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Arie Gruzman
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Albena T Dinkova-Kostova
- Jacqui Wood Cancer Centre, Division of Cellular Medicine, School of Medicine, University of Dundee, Dundee, UK; Department of Pharmacology and Molecular Sciences and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Guy Cohen
- The Skin Research Institute, The Dead Sea and Arava Science Center, Masada, 86910, Israel; Ben-Gurion University of the Negev, Eilat Campus, Eilat, 8855630, Israel.
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13
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Significance of stressor media on the stability of statins: a critical assessment. CHEMICAL PAPERS 2022. [DOI: 10.1007/s11696-022-02306-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Phiske M, Kalathil A, Someshwar S. Photoallergic reaction to cephalosporin: Hitherto unreported. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2022. [DOI: 10.4103/ijdd.ijdd_13_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Glombicki SE, Cohen PR. Sofosbuvir-Velpatasvir (Epclusa)-Associated Photosensitivity in a Hepatitis C Patient: Case Report and Review of Photosensitivity to Hepatitis C Antiviral Agents. Cureus 2021; 13:e16496. [PMID: 34430111 PMCID: PMC8373598 DOI: 10.7759/cureus.16496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Hepatitis C is a ribonucleic acid (RNA) virus, and its presence in individuals was previously considered to be a chronic condition. However, recent therapeutic advances with virus-directed treatment have resulted in a significant increase in cure rates as demonstrated by an absence of virus on repeat testing. Currently, several individual and combination antiviral therapies are available for the treatment of hepatitis C virus infection. However, each of the hepatitis C antiviral agents is associated with potential adverse skin effects whose incidence varies depending on the agent used for treatment. The cutaneous reactions, including photosensitivity, usually resolve once the antiviral treatment is completed. In this report, we discuss the case of a chronic hepatitis C patient who developed sofosbuvir-velpatasvir (Epclusa)-associated toxicity, while receiving the antiviral therapy. The 57-year-old man developed cutaneous phototoxicity when he started treatment with the drug. The adverse skin reaction promptly resolved once the treatment was completed. Clinicians who manage patients being treated with antiviral agents for hepatitis C infection should consider counseling these individuals regarding photoprotection including avoidance of sun exposure, daily sunscreen use, and wearing photoprotective clothing.
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Affiliation(s)
- Stephen E Glombicki
- McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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Demirdag HG, Tugrul B. Evaluation of relationship between antihypertensive drug usage and dermatoscopic features in patients with keratinizing skin cancer. Dermatol Ther 2021; 34:e14957. [PMID: 33843141 DOI: 10.1111/dth.14957] [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] [Received: 12/24/2020] [Revised: 02/10/2021] [Accepted: 04/09/2021] [Indexed: 12/20/2022]
Abstract
Keratinizing skin cancers including actinic keratoses (AK), in situ squamous cell carcinoma/Bowen's disease/intraepidermal carcinoma (IEC), invasive cutaneous squamous cell carcinoma (cSCC) and keratoacanthoma share similar dermatoscopic features and also reveal different patterns that assist in their diagnosis. Recently epidemiological studies reveal the association between antihypertensive drugs and skin cancer risk, especially cSCC. This study aims to determine the dermatoscopic features of keratinizing skin cancer in patients using antihypertensive drug and compare with non-users. A total of 46 patients with 64 keratinizing skin cancer lesions were included in the study. The demographic, clinical characteristic of patients, the number, duration, localization and dermatoscopic features from each lesion were collected. First, we evaluated the dermatoscopic features according to the histopathologic diagnosis. Then, all patients were divided into two groups as users of antihypertensive drugs and non-users. The dermatoscopic features were compared in terms of antihypertensive drug usage and histopathologic diagnosis in antihypertensive drug users and non-users, separately. The users of anti-hypertensive drugs were 22 (47,8%) and non-users 24 (52,2%). Of the total 64 lesions including 47 AK, 5 IEC, 10 cSCC, and 2 keratoacanthoma were evaluated. White structureless area was found statistically significant in cSCC lesions of patients using antihypertensive drugs (P = .004). This finding in cSCC may be a clue for antihypertensive drug usage and these drugs may be a predisposan factor for dermal fibrosis. Regardless of histopathology, dermatoscopic features show no statistically difference between antihypertensive drug users and non-users (P > .05). Clearer results can be obtained by conducting more detailed and long-term studies.
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Affiliation(s)
| | - Burcu Tugrul
- Department of Dermatology, Health Science University, Ankara Oncology Training and Research Hospital, Ankara, Turkey
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