RESUMO
Tumor necrosis factor (TNF) inhibitors may paradoxically induce pustular eruptions, most of which are classified as pustular psoriasis. Amicrobial pustulosis of the folds (APF) is a much rarer entity that was recently recognized to occur in the setting of chronic anti-TNF therapy and inflammatory bowel disease, with 12 existing cases in the literature. Amicrobial pustulosis of the folds is a neutrophilic dermatosis characterized by aseptic pustules involving the major and minor skin folds, genital regions, and scalp. Herein, we report an additional case of paradoxical APF induced by chronic infliximab therapy in a patient with Crohn disease.
Assuntos
Doença de Crohn , Infliximab , Humanos , Infliximab/efeitos adversos , Infliximab/uso terapêutico , Doença de Crohn/tratamento farmacológico , Doença de Crohn/complicações , Adulto , Dermatopatias Vesiculobolhosas/induzido quimicamente , Dermatopatias Vesiculobolhosas/patologia , Masculino , Feminino , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
Generalized pustular rashes have various etiologies and can be challenging to diagnose and manage at first presentation. The authors provide an in-depth analysis of common pustular skin eruptions including generalized pustular psoriasis (GPP) and acute generalized exanthematous pustulosis, focusing on their pathophysiology, triggers, clinical presentation, diagnostic challenges, and management strategies. The article also highlights recent advances in genetic research and biologic therapies for GPP and the future directions in personalized medicine and prevention strategies.
Assuntos
Pustulose Exantematosa Aguda Generalizada , Psoríase , Dermatopatias Vesiculobolhosas , Humanos , Pustulose Exantematosa Aguda Generalizada/diagnóstico , Pustulose Exantematosa Aguda Generalizada/etiologia , Pustulose Exantematosa Aguda Generalizada/terapia , Psoríase/diagnóstico , Psoríase/terapia , Pele , Dermatopatias Vesiculobolhosas/induzido quimicamente , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/terapia , Doença Aguda , Doença CrônicaRESUMO
Rituximab has been the mainstay treatment for autoimmune bullous diseases (AIBDs). Among the side effects of rituximab, rituximab-induced thrombocytopenia (RIT) is a rare but critical complication. However, there have been no reports or identification of risk factors for RIT in patients with AIBD. In our retrospective study, we compared rituximab-treated AIBD in patients with and without thrombocytopenia to explore the risk factors. In addition, we compared two different rituximab protocols (rheumatoid arthritis [RA] and lymphoma) in terms of the incidence and severity of thrombocytopenia. A total of 222 patients were enrolled, and 46 patients (20.7%) developed RIT. Multivariate logistic regression analysis identified age and chronic kidney disease (CKD) as significant factors for RIT. We also found that patients treated with the lymphoma protocol demonstrated a significantly higher mean post-rituximab platelet count compared with those on the RA protocol. This was the first analysis, to our knowledge, of risk factors for RIT in patients with AIBD. Individuals aged 70 or older and those with multiple comorbidities, particularly CKD, should be closely monitored for thrombocytopenia. For patients with CKD, it may be safer to use the lymphoma protocol for rituximab administration as it results in a lesser reduction in post-rituximab platelet count.
Assuntos
Artrite Reumatoide , Doenças Autoimunes , Linfoma Folicular , Insuficiência Renal Crônica , Dermatopatias Vesiculobolhosas , Trombocitopenia , Humanos , Rituximab/efeitos adversos , Estudos Retrospectivos , Trombocitopenia/induzido quimicamente , Trombocitopenia/epidemiologia , Linfoma Folicular/tratamento farmacológico , Doenças Autoimunes/complicações , Doenças Autoimunes/tratamento farmacológico , Artrite Reumatoide/tratamento farmacológico , Fatores de Risco , Dermatopatias Vesiculobolhosas/induzido quimicamenteRESUMO
Bullous hemorrhagic dermatosis is a rare cutaneous reaction of heparin, a commonly used anticoagulant. Exact etiopathogenesis remains elusive but immune related mechanisms as well as dose dependent relationship have been proposed. Clinically, it is characterized by asymptomatic, tense hemorrhagic bullae on extremities or abdomen occurring 5-21 days after initiation of therapy. We report bilateral symmetrically grouped lesions, in a previously unreported distribution of this entity in both the forearms in a 50-year-old male admitted with acute coronary syndrome on oral ecosprin, oral clopidogrel and subcutaneous enoxaparin. The condition is self-resolving and discontinuation of drug is not required.
Assuntos
Heparina , Dermatopatias Vesiculobolhosas , Masculino , Humanos , Pessoa de Meia-Idade , Heparina/efeitos adversos , Hemorragia/induzido quimicamente , Anticoagulantes/efeitos adversos , Dermatopatias Vesiculobolhosas/induzido quimicamente , Dermatopatias Vesiculobolhosas/patologia , ClopidogrelRESUMO
Glucocorticoid use in patients with autoimmune bullous disease is associated with significant morbidity, and in some cases, excess mortality. The hyperglycaemic complications arising from glucocorticoid use have been well-documented and range from mild hyperglycaemia to diabetic ketoacidosis. Patients with pre-existing glucose intolerance or type 2 diabetes mellitus are at increased risk of developing complications. Several other factors have been investigated for their association with steroid-induced hyperglycaemia, including patient age, sex, family history, dose, regimen and duration of therapy. Findings in the current literature, however, are largely conflicting and evidence is limited by methodological weaknesses. Glucocorticoids should be used with caution, and patients using steroids should be closely monitored for adverse effects.
Assuntos
Doenças Autoimunes , Diabetes Mellitus Tipo 2 , Hiperglicemia , Dermatopatias Vesiculobolhosas , Humanos , Glucocorticoides/efeitos adversos , Diabetes Mellitus Tipo 2/induzido quimicamente , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Prevalência , Hiperglicemia/induzido quimicamente , Doenças Autoimunes/induzido quimicamente , Doenças Autoimunes/complicações , Dermatopatias Vesiculobolhosas/induzido quimicamenteRESUMO
This review finds that topical corticosteroids and systemic corticosteroids are the mainstays of initial treatment for bullous pemphigoid and pemphigus diseases. Additional immunomodulatory therapies such as methotrexate, azathioprine and mycophenolatmofetil should be added early during treatment to minimize the adverse effects of chronic corticosteroid therapy and to augment improvement in the disease. Rituximab is a first-line immunomodulatory treatment for moderate to severe pemphigus disease.
Assuntos
Doenças Autoimunes , Pênfigo , Dermatopatias Vesiculobolhosas , Azatioprina/efeitos adversos , Glucocorticoides , Humanos , Metotrexato/efeitos adversos , Pênfigo/induzido quimicamente , Pênfigo/tratamento farmacológico , Rituximab/uso terapêutico , Dermatopatias Vesiculobolhosas/induzido quimicamenteRESUMO
Background: Intravenous immunoglobulin (IVIG), a pooled blood product acquired from multiple healthy donors, is an effective treatment for various types of autoimmune diseases, haematological disorders, and infectious diseases. Adverse haematological events such as throm-bocytopenia are rarely caused by IVIG. Objectives: To investigate the phenomenon of IVIG-induced thrombocytopenia. Materials & Methods: A case study and a review of the previous literature based on a search using MEDLINE (PubMed) and ICHUSHI (for Japanese literature) electronic databases. Results: The present case of dermatomyositis exhibited two episodes of IVIG-induced thrombocytopenia, which occurred a few days after initiating IVIG and was significant within two weeks without haemorrhagic symptoms. Spontaneous remission of thrombocytopenia was repeatedly observed. Based on a review of five cases, the underlying disorders were autoimmune bullous diseases in three of the five cases. Polyethylene glycol-treated human immunoglobulin products were used in three of the five cases. The clinical course of IVIG-induced thrombocytopenia was similar to that in our present case. Conclusion: Because of the rarity of severe haemorrhagic symptoms and spontaneous remission of IVIG-induced thrombocytopenia, discontinuation of IVIG due to thrombocytopenia is not straightforward.
Assuntos
Doenças Autoimunes , Dermatopatias Vesiculobolhosas , Trombocitopenia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Remissão Espontânea , Dermatopatias Vesiculobolhosas/induzido quimicamente , Trombocitopenia/induzido quimicamente , Trombocitopenia/tratamento farmacológicoAssuntos
Exantema , Dermatoses do Couro Cabeludo , Dermatopatias Vesiculobolhosas , Humanos , Panitumumabe/efeitos adversos , Couro Cabeludo , Dermatoses do Couro Cabeludo/induzido quimicamente , Dermatoses do Couro Cabeludo/tratamento farmacológico , Dermatopatias Vesiculobolhosas/induzido quimicamente , Dermatopatias Vesiculobolhosas/tratamento farmacológicoRESUMO
We present seven new cases of patients with Crohn disease who developed lesions clinically compatible with amicrobial pustulosis of the flexures during their treatment with anti-tumour necrosis factor therapy.
Assuntos
Adalimumab/efeitos adversos , Doença de Crohn/tratamento farmacológico , Infliximab/efeitos adversos , Dermatopatias Vesiculobolhosas/induzido quimicamente , Inibidores do Fator de Necrose Tumoral/efeitos adversos , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Doença de Crohn/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias Vesiculobolhosas/patologiaAssuntos
Vacina BNT162/efeitos adversos , Toxidermias/etiologia , Dermatopatias Vesiculobolhosas/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , COVID-19/prevenção & controle , Toxidermias/metabolismo , Toxidermias/patologia , Humanos , Masculino , Dermatopatias Vesiculobolhosas/metabolismo , Dermatopatias Vesiculobolhosas/patologiaAssuntos
Complemento C3/análise , Toxidermias/etiologia , Toxidermias/imunologia , Medicamentos de Ervas Chinesas/efeitos adversos , Dermatopatias Vesiculobolhosas/induzido quimicamente , Dermatopatias Vesiculobolhosas/imunologia , Idoso , Toxidermias/patologia , Feminino , Imunofluorescência , Humanos , Dermatopatias Vesiculobolhosas/patologiaAssuntos
Dermatose Linear Bolhosa por IgA , Dermatopatias Vesiculobolhosas , Cefixima/efeitos adversos , Humanos , Imunoglobulina A , Dermatose Linear Bolhosa por IgA/induzido quimicamente , Dermatose Linear Bolhosa por IgA/diagnóstico , Diálise Renal/efeitos adversos , Dermatopatias Vesiculobolhosas/induzido quimicamente , Dermatopatias Vesiculobolhosas/diagnósticoRESUMO
Vaccination is a well-known trigger for mast cell degranulation in subjects affected by mastocytosis. Nevertheless, there is no exact standardized protocol to prevent a possible reaction after a vaccine injection, especially for patients who have already presented a previous vaccine-related adverse event, considering that these patients frequently tolerate future vaccine doses. For this reason, we aim to share our experience at Meyer Children's University Hospital in Florence to raise awareness on the potential risk for future vaccinations and to discuss the valuable therapeutic strategies intended to prevent them, taking into account what is proposed by experts in literature. We describe the case of an 18-month-old female affected by a polymorphic variant of maculopapular cutaneous mastocytosis that presented an extensive bullous cutaneous reaction 24 hours after the second dose (booster dose) of inactivated-tetravalent influenza vaccine, treated with a single dose of oral corticosteroid therapy with betamethasone (0.1 mg/kg) and an oral antihistamine therapy with oxatomide (1 mg/kg/daily) for a week, until resolution. To the best of our knowledge, in the literature, no documented case of reaction to influenza vaccine in maculopapular cutaneous mastocytosis is described. Subsequently, the patient started a background therapy with ketotifen daily (0.05 mg/kg twice daily), a non-competitive H1-antihistamine, and a mast cell stabilizer (dual activity). A non-standardized pharmacological premedication protocol with an H1-receptor antagonist (oxatomide, 0.5 mg/kg) administered 12 hours before the immunizations, and a single dose of betamethasone (0.05 mg/kg) together with another dose of oxatomide (0.5 mg/kg) administered 2 hours before the injections was followed to make it possible for the patient to continue with the scheduled vaccinations. Indeed, no reactions were subsequently reported. Thus, in our experience, a background therapy with ketotifen associated with a premedication protocol made by two doses of oxatomide and a single dose of betamethasone was helpful to make possible the execution of the other vaccines. We suggest how in these children, it could be considered the idea of taking precaution when vaccination is planned, regardless of the kind of vaccine and if a dose of the same vaccine was previously received. However, international consensus needs to be reached to manage vaccinations in children with mastocytosis and previous adverse reactions to vaccines.
Assuntos
Degranulação Celular , Liberação de Histamina , Imunização Secundária/efeitos adversos , Vacinas contra Influenza/efeitos adversos , Mastócitos/imunologia , Dermatopatias Vesiculobolhosas/induzido quimicamente , Urticaria Pigmentosa/imunologia , Vacinas Combinadas/efeitos adversos , Adolescente , Corticosteroides/administração & dosagem , Degranulação Celular/efeitos dos fármacos , Feminino , Antagonistas dos Receptores Histamínicos H1/administração & dosagem , Liberação de Histamina/efeitos dos fármacos , Humanos , Esquemas de Imunização , Vacinas contra Influenza/administração & dosagem , Mastócitos/efeitos dos fármacos , Pré-Medicação , Fatores de Risco , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/imunologia , Dermatopatias Vesiculobolhosas/prevenção & controle , Resultado do Tratamento , Urticaria Pigmentosa/diagnóstico , Vacinas Combinadas/administração & dosagemRESUMO
Acute generalized exanthematous pustulosis (AGEP) is an uncommon inflammatory subcorneal pustular dermatosis typically caused by exposure to a medication. Several viral infections have also been implicated in its development. We describe herein a rare case of AGEP associated with acute Epstein-Barr virus (EBV) infection in a neonate.