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Hong Kong Medical Journal = Xianggang... Apr 2024Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) [hereafter, SJS/TEN] are uncommon but severe mucocutaneous reactions. Although they have been...
INTRODUCTION
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) [hereafter, SJS/TEN] are uncommon but severe mucocutaneous reactions. Although they have been described in many populations worldwide, data from Hong Kong are limited. Here, we explored the epidemiology, disease characteristics, aetiology, morbidity, and mortality of SJS/TEN in Hong Kong.
METHODS
This retrospective cohort study included all hospitalised patients who had been diagnosed with SJS/TEN in Prince of Wales Hospital from 1 January 2004 to 31 December 2020.
RESULTS
There were 125 cases of SJS/TEN during the 17-year study period. The annual incidence was 5.07 cases per million. The mean age at onset was 51.4 years. The mean maximal body surface area of epidermal detachment was 23%. Overall, patients in 32% of cases required burns unit or intensive care unit admission. Half of the cases involved concomitant sepsis, and 23.2% of cases resulted in multiorgan failure or disseminated intravascular coagulation. The mean length of stay was 23.9 days. The cause of SJS/TEN was attributed to a drug in 91.9% of cases, including 84.2% that involved anticonvulsants, allopurinol, antibiotics, or analgesics. In most cases, patients received treatment comprising either best supportive care alone (35.2%) or combined with intravenous immunoglobulin (43.2%). The in-hospital mortality rate was 21.6%. Major causes of death were multiorgan failure and/or fulminant sepsis (81.5%).
CONCLUSION
This study showed that SJS/TEN are uncommon in Hong Kong but can cause substantial morbidity and mortality. Early recognition, prompt withdrawal of offending agents, and multidisciplinary supportive management are essential for improving clinical outcomes.
Topics: Humans; Stevens-Johnson Syndrome; Hong Kong; Middle Aged; Retrospective Studies; Male; Female; Adult; Incidence; Aged; Length of Stay; Allopurinol; Anticonvulsants; Sepsis; Multiple Organ Failure
PubMed: 38531617
DOI: 10.12809/hkmj2210131 -
The Journal of Dermatological Treatment Dec 2024This case study aims to report the efficacy and safety of a Janus kinase (JAK) inhibitor in the treatment of generalized eosinophilic pustular folliculitis (EPF).
AIM
This case study aims to report the efficacy and safety of a Janus kinase (JAK) inhibitor in the treatment of generalized eosinophilic pustular folliculitis (EPF).
METHODS
We present a case of a 16-year-old Chinese patient who had been suffering from EPF for two years and had shown no response to both topical and systemic glucocorticoids. The patient was subsequently treated with oral tofacitinib at a dosage of 5mg daily.
RESULTS
Significant remission of eruption and pruritus was observed in the patient upon treatment with tofacitinib. However, a relapse occurred upon dose reduction. Subsequent switch to the highly selective JAK1 inhibitor upadacitinib resulted in complete recovery, with the patient achieving a symptom-free status after six months.
CONCLUSIONS
JAK inhibitors show promise as a potential treatment option for EPF patients who do not respond to traditional therapies.
Topics: Humans; Adolescent; Janus Kinase Inhibitors; Folliculitis; Eosinophilia; Skin Diseases, Vesiculobullous
PubMed: 38531388
DOI: 10.1080/09546634.2024.2331785 -
Frontiers in Immunology 2024Idiopathic granulomatous mastitis (IGM) is a noncancerous, chronic inflammatory disorder of breast with unknown causes, posing significant challenges to the quality of... (Review)
Review
Idiopathic granulomatous mastitis (IGM) is a noncancerous, chronic inflammatory disorder of breast with unknown causes, posing significant challenges to the quality of life due to its high refractoriness and local aggressiveness. The typical symptoms of this disease involve skin redness, a firm and tender breast mass and mastalgia; others may include swelling, fistula, abscess (often without fever), nipple retraction, and peau d'orange appearance. IGM often mimics breast abscesses or malignancies, particularly inflammatory breast cancer, and is characterized by absent standardized treatment options, inconsistent patient response and unknown mechanism. Definite diagnosis of this disease relies on core needle biopsy and histopathological examination. The prevailing etiological theory suggests that IGM is an autoimmune disease, as some patients respond well to steroid treatment. Additionally, the presence of concurrent erythema nodosum or other autoimmune conditions supports the autoimmune nature of the disease. Based on current knowledge, this review aims to elucidate the autoimmune-favored features of IGM and explore its potential etiologies. Furthermore, we discuss the immune-mediated pathogenesis of IGM using existing research and propose immunotherapeutic strategies for managing this condition.
Topics: Female; Humans; Granulomatous Mastitis; Quality of Life; Fever; Erythema Nodosum; Immunoglobulin M
PubMed: 38529282
DOI: 10.3389/fimmu.2024.1295759 -
Toxicological Research Apr 2024Several patients with cutaneous adverse drug reactions exhibit extracutaneous organ damages, and it becomes severe in a few patients resulting in death due to multiorgan...
UNLABELLED
Several patients with cutaneous adverse drug reactions exhibit extracutaneous organ damages, and it becomes severe in a few patients resulting in death due to multiorgan failure. Understanding the sequential changes in various organs in patients with cutaneous eruption following drug administration will help understand disease onset and progression, aiding the development of prevention strategies and interventions. Therefore, we aimed to understand the effects of abacavir (ABC) on various organs in patients with ABC-induced eruptions by evaluating its effects in a mouse model. We found pathological changes in various organs of HLA-B*57:01 transgenic mice (B*57:01-Tg) following oral administration of ABC (20 mg/body/day). B*57:01-Tg exhibited a significant body weight decrease from day 1 of ABC administration, and reddening of the auricle was observed from day 5, and approximately 2/3 mice died by day 7. Histopathological examination revealed severe thymic atrophy after day 3, infiltration of inflammatory cells, predominantly lymphocytes with neutrophils, not only in the skin but also in the liver, kidney, and lung after day 5, and an increased number of lymphocytes with enlarged nuclei and granulocytic hematopoiesis were observed in the spleen after day 5. Blood chemistry revealed that albumin/globulin ratio was below 1.0 on day 5, reflecting a systemic inflammatory response, and the aspartate aminotransferase concentration rose to 193 ± 93.0 U/L on day 7, suggesting that cell damage may have occurred in various organs including liver accompanying inflammatory cell infiltration. These examinations of a mouse model of ABC-induced skin eruption show that disorders in various organs other than the skin should be considered and provide insights into the unexpected early systemic responses dependent on HLA-B*57:01.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s43188-023-00220-1.
PubMed: 38525129
DOI: 10.1007/s43188-023-00220-1 -
Case Reports in Dermatological Medicine 2024A fixed drug eruption (FDE) is an immunological cutaneous adverse reaction, classified as a cutaneous adverse drug reaction (CADR) and characterized by well-defined...
BACKGROUND
A fixed drug eruption (FDE) is an immunological cutaneous adverse reaction, classified as a cutaneous adverse drug reaction (CADR) and characterized by well-defined lichenoid lesions that occur at the same site each time. Ceftriaxone is a third-generation antibiotic of cephalosporin antibiotics of the beta-lactam antibiotic family, which has typical activity against many Gram-negative aerobic bacteria. This is the first clinical case from Saudi Arabia and the fifth in the world to document a woman's experience with recurrent FDE after repeated ceftriaxone use. . A 25-year-old Saudi woman with a known case of sickle cell anemia (SCA) with a history of avascular necrosis of the right hip after replacement was hospitalized with a pain crisis triggered by an upper respiratory tract infection. The patient denied having a history of allergy previously. Due to fever, leukocytosis, and active follicular tonsillitis, ceftriaxone was started. However, a few hours later she developed lip edema and a fixed drug eruption measuring 7 × 11 cm on the left side of her back. The lesion reformed over a hyperpigmented lesion (4 × 8 cm) that the patient did not report upon initial examination. It turned out that this was due to the intravenous administration of ceftriaxone, a year ago in another hospital. An allergy to ceftriaxone was considered, and steroids and antihistamines were started. The case was labeled as ceftriaxone induced FDE.
CONCLUSION
Ceftriaxone induced FDE is an uncommon type of allergic reaction that has been reported infrequently. Understanding this condition and the mechanism by which FDE becomes recurrent with the same previous fixed lesion is of great importance for both academic and future research purposes.
PubMed: 38523830
DOI: 10.1155/2024/9975455 -
Clinical Diabetes and Endocrinology Mar 2024Dipeptidyl peptidase-4 (DPP-4) inhibitors are a class of drugs that enhance the incretin-insulin pathway and offer effective glycemic control in type 2 diabetes... (Review)
Review
Dipeptidyl peptidase-4 (DPP-4) inhibitors are a class of drugs that enhance the incretin-insulin pathway and offer effective glycemic control in type 2 diabetes mellitus. However, these drugs may be associated with various dermatological side effects, ranging from mild to severe. This review article summarizes the current literature on the dermatological side effects of DPP-4 inhibitors, including bullous pemphigoid, severe cutaneous adverse drug reactions, fixed drug eruptions, and other mucocutaneous reactions. The review also discusses the possible mechanisms, risk factors, diagnosis, and management of these side effects. This review aims to increase the awareness and vigilance of healthcare providers in recognizing and managing the dermatological side effects of DPP-4 inhibitors and to emphasize the need for further research and surveillance to optimize diabetes care and patient safety.
PubMed: 38523307
DOI: 10.1186/s40842-024-00165-w -
Psoriasis (Auckland, N.Z.) 2024Generalized pustular psoriasis (GPP) is a rare, chronic, and severe skin disorder characterized by the eruption of non-infectious pustules on an erythematous background... (Review)
Review
Generalized pustular psoriasis (GPP) is a rare, chronic, and severe skin disorder characterized by the eruption of non-infectious pustules on an erythematous background often associated with systemic symptoms. It may appear in association with plaque psoriasis or occur in previously healthy individuals. It differs from psoriasis vulgaris in clinical presentation, immunopathogenesis, histology, and therapeutic strategies. Overexpression of interleukin 36 (IL-36) or a loss-of-function mutation of IL-36 receptor antagonist (IL-36RA) are thought to play a pivotal role in the pathogenesis of this disease. There are currently no globally approved guidelines for the treatment of GPP, and the therapies used so far, with variable results, have given unsatisfactory results. Spesolimab, a selective humanized antibody against the IL-36 receptor that blocks its activation, is the first biologic drug approved in Europe in December 2022 for the treatment of GPP flares. It represents a promising therapy, demonstrating efficacy in reducing disease severity and improving patient outcomes. In our review, we have analyzed the latest advancements and findings regarding the efficacy and safety of spesolimab in the context of GPP management.
PubMed: 38505140
DOI: 10.2147/PTT.S393978 -
Cureus Feb 2024Azithromycin, an azolide antibiotic with structural and functional similarities to macrolides, possesses distinct features such as its effects persisting for seven...
Azithromycin, an azolide antibiotic with structural and functional similarities to macrolides, possesses distinct features such as its effects persisting for seven days, an extended half-life by administering it once daily for three days, and strong antimicrobial activity. Notably, vomiting and diarrhea are recognized as the primary adverse events related to azithromycin. In this particular case, we present a unique case describing a purpuric-type drug eruption associated with azithromycin, which represents an uncommon cutaneous manifestation. A 64-year-old female developed a purpuric eruption on her trunk and lower extremities seven days after receiving daily intravenous azithromycin for upper bronchitis. A previous occurrence of punctate purpuric eruption following azithromycin administration was documented in her medical history. The diagnosis of azithromycin-induced skin eruption was confirmed based on the clinical progression and the recurrence of the eruption upon re-administration of the drug. In response to this diagnosis, the patient underwent treatment involving the discontinuation of azithromycin and the application of topical betamethasone butyrate propionate ointment. Remarkably, her eruption significantly improved within two weeks, although residual pigmentation persisted post-treatment. Additionally, we offer a comprehensive review of the literature, examining cases of drug eruptions related to azithromycin.
PubMed: 38496201
DOI: 10.7759/cureus.54214 -
Cureus Feb 2024We present a rare case of Grover's disease (GD) associated with letrozole therapy in a 66-year-old female with stage IV breast cancer. GD is a dermatological condition...
We present a rare case of Grover's disease (GD) associated with letrozole therapy in a 66-year-old female with stage IV breast cancer. GD is a dermatological condition characterized by papulovesicular lesions typically found on the chest and trunk. While GD is linked to chemotherapeutic agents, its association with letrozole is not well documented. The patient presented with a pruritic rash on her neck, right arm, and trunk, initially misdiagnosed as contact dermatitis. Despite treatment with triamcinolone acetonide, the rash persisted. A subsequent punch biopsy confirmed acantholytic dyskeratosis consistent with GD. Discontinuation of letrozole and treatment with augmented betamethasone dipropionate resulted in significant improvement within four weeks. This case underscores the importance of considering drug-induced dermatological conditions in patients undergoing chemotherapy. While hypersensitivity drug eruptions typically present as morbilliform-patterned cutaneous eruptions, GD should be considered, especially in older patients with multiple medications. The incidence of GD following letrozole therapy is not well studied, making this case a valuable addition to the limited literature. In summary, recognizing and managing drug-induced skin conditions in cancer patients are crucial. This report contributes to our understanding of the potential association between letrozole and GD, emphasizing the need for further research in this area.
PubMed: 38496082
DOI: 10.7759/cureus.54262 -
Annals of Clinical and Translational... Apr 2024Nicolau syndrome is a rare, iatrogenic skin reaction after parental drug administration, characterized by severe pain at an injection site, followed by hemorrhage,...
Nicolau syndrome is a rare, iatrogenic skin reaction after parental drug administration, characterized by severe pain at an injection site, followed by hemorrhage, ulceration, and often necrosis. We present a case of a patient on glatiramer acetate for many years (initially Copaxone then Glatopa) who developed Nicolau syndrome, the second reported case after generic glatiramer acetate. All reported cases of Nicolau syndrome after glatiramer acetate are reviewed. The case highlights the importance of prompt recognition of this skin reaction by neurologists and raises awareness of the risks of skin reactions even in low-risk injectable DMTs.
Topics: Humans; Glatiramer Acetate; Multiple Sclerosis; Immunosuppressive Agents; Nicolau Syndrome
PubMed: 38483009
DOI: 10.1002/acn3.52044