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Acta Dermatovenerologica Alpina,... Mar 2020Patients with multiple actinic keratoses are frequently treated with topical agents such as imiquimod, an immune-response modifying agent. Adverse effects associated...
Patients with multiple actinic keratoses are frequently treated with topical agents such as imiquimod, an immune-response modifying agent. Adverse effects associated with imiquimod therapy are mainly limited to the application site and include erythema, crusting, scaling and ulceration. Systemic adverse reactions, such as erythema multiforme are rare. Here we report a case of a 77- years old patient that developed erythema multiforme after treatment of actinic keratoses with imiquimod. Cessation of imiquimod and treatment with local corticosteroids led to rapid regression of erythema multiforme lesions. Residual actinic keratoses were treated with cryotherapy.
Topics: Aged; Drug Eruptions; Erythema Multiforme; Humans; Imiquimod; Male
PubMed: 32206824
DOI: No ID Found -
British Journal of Clinical Pharmacology May 2011Cutaneous adverse drug reactions range from mild to severe and from those localized only to skin to those associated with systemic disease. It is important to... (Review)
Review
Cutaneous adverse drug reactions range from mild to severe and from those localized only to skin to those associated with systemic disease. It is important to distinguish features of cutaneous drug reactions which help classify the underlying mechanism and likely prognosis as both of these influence management decisions, some of which necessarily have to be taken rapidly. Severe cutaneous reactions are generally T cell-mediated, yet this immunological process is frequently poorly understood and principles for identification of the culprit drug are different to those of IgE mediated allergic reactions. Furthermore, intervention in severe skin manifestations of drug allergy is frequently necessary. However, a substantial literature reports on success or otherwise of glucocorticoids, cyclophsphamide, ciclosporin, intravenous immunoglobulin and anti-tumour necrosis factor therapy for the treatment of toxic epidermal necrolysis without clear consensus. As well as reviewing the recommended supportive measures and evidence base for interventions, this review aims to provide a mechanistic overview relating to a proposed clinical classification to assist the assessment and management of these complex patients.
Topics: Drug Eruptions; Exanthema; Humans; Stevens-Johnson Syndrome; T-Lymphocytes
PubMed: 21480947
DOI: 10.1111/j.1365-2125.2010.03703.x -
Critical Care (London, England) Apr 2003Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. Red man syndrome has often been associated with rapid infusion of the...
Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. Red man syndrome has often been associated with rapid infusion of the first dose of the drug and was initially attributed to impurities found in vancomycin preparations. Even after improvement in vancomycin's purity, however, reports of the syndrome persist. Other antibiotics (e.g. ciprofloxacin, amphotericinB, rifampicin and teicoplanin) or other drugs that stimulate histamine release can result in red man syndrome. Discontinuation of the vancomycin infusion and administration of diphenhydramine can abort most of the reactions. Slow intravenous administration of vancomycin should minimize the risk of infusion-related adverse effects.
Topics: Anti-Bacterial Agents; Drug Eruptions; Humans; Infusions, Intravenous; Syndrome; Vancomycin
PubMed: 12720556
DOI: 10.1186/cc1871 -
The Journal of Investigative Dermatology Nov 2022Cutaneous immune-related adverse events (cirAEs) are the most prevalent complication to arise from immunotherapy and cause significant morbidity. We aimed to determine... (Observational Study)
Observational Study
Cutaneous immune-related adverse events (cirAEs) are the most prevalent complication to arise from immunotherapy and cause significant morbidity. We aimed to determine the spectrum, timing, clinical features, and outcomes of cirAEs by conducting an observational pharmacovigilance study using VigiBase, the World Health Organization's global database of individual case safety reports from over 130 member countries (ClinicalTrials.gov, number NCT04898751). We compared adverse event reporting in patients who received immune checkpoint inhibitors (91,323 adverse events) with those of the full reporting database (18,919,358 adverse events). There were 10,933 cases of cirAEs within 51 distinct dermatologic types, with 27 specific eruptions with disproportionate signal represented (information component [IC] > 0). Of these 27 eruptions, there were eight cirAEs with n > 100 reports, including vitiligo (IC = 4.87), bullous pemphigoid (IC = 4.08), lichenoid dermatitis (IC = 3.69), erythema multiforme (IC = 1.03), toxic epidermal necrolysis (IC = 0.95), Stevens‒Johnson syndrome (IC = 0.41), drug eruption (IC = 0.11), and eczematous dermatitis (IC = 0.11). There were differences in time to onset after immune checkpoint inhibitor initiation, with a median of approximately 1 month (erythema multiforme, Stevens‒Johnson syndrome, and toxic epidermal necrolysis), 2 months (drug eruption and eczematous dermatitis), 4 months (lichenoid dermatitis), and 5‒6 months (bullous pemphigoid and vitiligo). CirAEs are diverse, dependent on cancer type, and have distinct and different onset times that are linked to the cirAE subtype.
Topics: Humans; Pharmacovigilance; Immune Checkpoint Inhibitors; Stevens-Johnson Syndrome; Pemphigoid, Bullous; Vitiligo; Drug Eruptions; Erythema Multiforme; Eczema
PubMed: 35605659
DOI: 10.1016/j.jid.2022.04.020 -
Asian Pacific Journal of Allergy and... Jun 2014Drug hypersensitivity reactions affect many patients leading to a variety of clinical manifestations, mainly the cutaneous adverse reactions ranging from milder skin... (Review)
Review
Drug hypersensitivity reactions affect many patients leading to a variety of clinical manifestations, mainly the cutaneous adverse reactions ranging from milder skin reactions to severe cutaneous adverse reactions (SCARs). Hypersensitivity reactions are unpredictable and are thought to have an underlying genetic etiology, as suggested by case reports. With the scientific knowledge of pharmacogenomics and the evidence based on the genomic testing, it is possible to identify genetic predisposing factors for these serious adverse reactions and personalize drug therapy. The most significant genetic associations have been identified in the major histocompatibility complex (MHC) genes encoded for human leukocyte antigens (HLA) alleles. Drugs associated with hypersensitivity reactions with strong genetic predisposing factors include abacavir, nevirapine, carbamazepine, and allopurinol. In this review, strong genetic associations of drug-induced SCARs are highlighted so as to improve drug safety and help to select optimal drugs for individual patients. Further investigation, however, is essential for the characterization of other genes involved in the hypersensitivity reactions with the use of several genetic strategies and technologies.
Topics: Alleles; Drug Eruptions; Female; Genetic Predisposition to Disease; HLA Antigens; Humans; Male; Pharmacogenetics; Skin
PubMed: 25003724
DOI: No ID Found -
Indian Journal of Dermatology,... 2014
Topics: Adolescent; Coconut Oil; Drug Eruptions; Female; Humans; Hyperpigmentation; Medicine, Ayurvedic; Neck; Plant Oils
PubMed: 24823405
DOI: 10.4103/0378-6323.132255 -
The Pan African Medical Journal 2018
Topics: Allopurinol; Drug Eruptions; Female; Gout Suppressants; Humans; Middle Aged
PubMed: 31065326
DOI: 10.11604/pamj.2018.31.188.16608 -
The Turkish Journal of Gastroenterology... Mar 2019Fixed drug eruption (FDE) is a type of drug reaction characterized by localized erythema, hyperpigmentation, and bullous at the same site(s), generally observed... (Review)
Review
Fixed drug eruption (FDE) is a type of drug reaction characterized by localized erythema, hyperpigmentation, and bullous at the same site(s), generally observed following every intake of a causative drug. Delayed-type cellular hypersensitivity (Type IVC) is considered to play a role in FDE etiology. Several antibiotics, barbiturates, oral contraceptives, nonsteroidal anti-inflammatory drugs, laxative-containing phenolphthalein, metronidazole, and quinine are known to be the primary drugs responsible for FDE. Bullous FDE, on the other hand, is a relatively rare form of FDE. Hepatitis B is a significant worldwide health problem, and entecavir is a common nucleoside (deoxyguanosine) analog used for treating hepatitis B; however, it has various side effects, such as lactic acidosis, myalgia, azotemia, hypophosphatemia, headache, diarrhea, pancreatitis, and neuropathy, and, in rare cases, cutaneous drug eruption. Our aim is to present a case of entecavir-associated bullous drug reaction, which has not been reported in the literature. Furthermore, we performed a review of literature to compile previously reported entecavir-associated drug reactions.
Topics: Antiviral Agents; Drug Eruptions; Female; Guanine; Hepatitis B; Hepatitis B virus; Humans; Middle Aged
PubMed: 30459136
DOI: 10.5152/tjg.2018.17887 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Aug 2017To explore the clinical characteristics of various types of severe drug eruption and common sensitized drugs, and to provide clinical references for reducing the...
To explore the clinical characteristics of various types of severe drug eruption and common sensitized drugs, and to provide clinical references for reducing the incidence of severe drug eruption. Methods: The clinical data regarding 126 cases of severe drug eruption were analyzed retrospectively from June 2009 to May 2017 in Xiangya Hospital, Central South University. Results: In the 126 cases of severe drug eruption, the distribution of men and women ratio was 1:1.38. The length of stay was (12.7±9.8) d. The most common type was Steven-Johnson syndrome; the most dangerous type was drug-induced bullosa epidermolysis. The most common sensitized drug category in these patients was antibiotics; the most common single sensitizing drug was carbamazepine, following by allopurinol. Conclusion: Severe drug eruption occurs mostly in young and middle-aged people. Steven-Johnson syndrome is the most common type; drug hypersensitive syndrome has the longest length of hospital course. Mortality rate of drug-induced bullosa epidermolysis is the highest. Timely stop using of allergens, early using glucocorticoids, and timely combination of non-glucocorticoids treatment (such as intravenous immunogloblin, plasma exchange and hemodialysis), can improve the efficacy and reduce the complications and mortality. .
Topics: Allopurinol; Drug Eruptions; Female; Humans; Male; Prognosis; Retrospective Studies; Stevens-Johnson Syndrome
PubMed: 28872088
DOI: 10.11817/j.issn.1672-7347.2017.08.013 -
Archives of Dermatology Feb 2009Palifermin is a recombinant human keratinocyte growth factor that is used to reduce the duration and severity of oral mucositis in patients undergoing hematopoietic stem...
BACKGROUND
Palifermin is a recombinant human keratinocyte growth factor that is used to reduce the duration and severity of oral mucositis in patients undergoing hematopoietic stem cell transplantation after myelotoxic therapy. Cutaneous adverse reactions associated with keratinocyte growth factor are reported to be rash, pruritus, and erythema.
OBSERVATIONS
After receiving palifermin following autologous hematopoietic stem cell transplantation and treatment with melphalan, a patient developed erythema and lichenoid papules that were distributed primarily in intertriginous areas. A biopsy specimen of the papules showed a striking resemblance to verrucae, but in situ hybridization studies were negative for human papillomavirus. Immunohistochemical staining with antibodies to Ki-67 and cytokeratin 5/6 showed increased keratinocyte proliferation in lesional skin.
CONCLUSIONS
After treatment with palifermin, a papular eruption clinically resembling lichen planus or plane warts, with histologic features of verruca plana, and intertriginous erythema may occur. In this case, neither eruption required treatment, and spontaneous resolution was observed over days to weeks. Histopathologic staining patterns of Ki-67 and cytokeratin 5/6 may be useful in identifying adverse reactions to palifermin therapy.
Topics: Aged; Drug Eruptions; Fibroblast Growth Factor 7; Hematopoietic Stem Cell Transplantation; Humans; Male; Multiple Myeloma; Recombinant Proteins; Stomatitis
PubMed: 19221263
DOI: 10.1001/archdermatol.2008.548