RESUMO
There are few reports of chemotherapy-induced eccrine squamous syringometaplasia in children. We report the first case of an infant developing this condition after treatment with busulfan, fludarabine, and antithymocyte globulin in preparation for bone marrow transplantation. Twenty-eight days after transplantation, the infant developed faintly erythematous papules and plaques on the bilateral axillae, inguinal folds, and sites of adhesives. Punch biopsy revealed eccrine glands with dyskeratotic cells and focal squamous metaplasia consistent with chemotherapy-induced eccrine squamous syringometaplasia.
Assuntos
Toxidermias/diagnóstico , Glândulas Écrinas/patologia , Imunossupressores/efeitos adversos , Doenças das Glândulas Sudoríparas/patologia , Transplante de Medula Óssea/efeitos adversos , Humanos , Lactente , Masculino , Metaplasia , Pele/patologia , Doenças das Glândulas Sudoríparas/induzido quimicamenteRESUMO
Penicillamine-induced skin changes are rare and include: hypersensitivity reactions, autoimmune reactions, and cutaneous elastoses. We report a case of a 73-year-old man with cystinuria taking penicillamine for over 50 years who presented with penicillamine-induced cutis laxa and milia en plaque. A brief review of penicillamine induced skin changes, specifically cutis laxa and milia en plaque, is presented.
Assuntos
Quelantes/efeitos adversos , Cútis Laxa/induzido quimicamente , Cistinúria/tratamento farmacológico , Penicilamina/efeitos adversos , Doenças das Glândulas Sudoríparas/induzido quimicamente , Idoso , Humanos , MasculinoAssuntos
Antibacterianos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Antineoplásicos Alquilantes/efeitos adversos , Toxidermias/etiologia , Exantema/induzido quimicamente , Doenças das Glândulas Sudoríparas/induzido quimicamente , Axila , Toxidermias/patologia , Quimioterapia Combinada/efeitos adversos , Exantema/patologia , Feminino , Virilha , Humanos , Masculino , Metaplasia/induzido quimicamente , Metaplasia/patologia , Pessoa de Meia-Idade , Doenças das Glândulas Sudoríparas/patologiaAssuntos
Calcinose/induzido quimicamente , Gluconato de Cálcio/efeitos adversos , Toxidermias/etiologia , Glândulas Écrinas , Doenças das Glândulas Sudoríparas/induzido quimicamente , Gluconato de Cálcio/administração & dosagem , Humanos , Hipocalcemia/tratamento farmacológico , Infusões Intravenosas , Masculino , Calcificação Vascular/induzido quimicamente , Adulto JovemRESUMO
BACKGROUND: Eccrine squamous syringometaplasia (ESS) has been associated with characteristic clinical eruption in patients receiving chemotherapy. It has been suggested as a diagnostic clue in the diagnosis of chemotherapy-induced reactions vs acute graft-vs-host disease, as well as other drug reactions. We identified 10 cases of ESS in patients in whom a distinctive clinical eruption developed during or after a pretransplantation conditioning regimen with high-dose chemotherapy. A complete clinical and histologic evaluation was performed in all patients. OBSERVATIONS: All patients developed erythematous and edematous plaques or confluent erythematous macular areas in the axillae and/or groin, with painful areas of well-defined erythema and edema on palms and/or soles in 5 patients. Some discrete papular lesions on the trunk or extremities could also be observed in most patients. The histologic hallmark of the eruption was ESS, with a variable degree of cornification and apoptosis. A vacuolar interface dermatitis and a variable degree of cellular atypica were also consistent findings. CONCLUSIONS: Chemotherapy-induced ESS may be associated with a distinctive clinical eruption and should be considered in the differential diagnosis of erythematous eruptions during or after a pretransplantation conditioning regimen with high-dose chemotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Toxidermias/etiologia , Glândulas Écrinas/patologia , Transplante de Células-Tronco Hematopoéticas , Adulto , Apoptose , Transplante de Medula Óssea , Dermatite/etiologia , Dermatite/patologia , Diagnóstico Diferencial , Toxidermias/diagnóstico , Glândulas Écrinas/efeitos dos fármacos , Edema/induzido quimicamente , Edema/patologia , Epitélio/efeitos dos fármacos , Epitélio/patologia , Eritema/induzido quimicamente , Eritema/patologia , Feminino , Dermatoses do Pé/induzido quimicamente , Dermatoses do Pé/patologia , Doença Enxerto-Hospedeiro/diagnóstico , Dermatoses da Mão/induzido quimicamente , Dermatoses da Mão/patologia , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Doenças das Glândulas Sudoríparas/induzido quimicamente , Doenças das Glândulas Sudoríparas/patologia , Vacúolos/ultraestruturaRESUMO
This chapter represents the first effort to characterize the cutaneous histologic changes that occur in response to chemotherapy. In preparing this chapter it became increasingly evident that there are significant gaps in our knowledge and that many of the known clinical reactions have not had careful histologic study. The readers of this chapter are encouraged to report adverse reactions they have encountered and include complete histologic descriptions of biopsied material.
Assuntos
Antineoplásicos/efeitos adversos , Toxidermias/etiologia , Relação Dose-Resposta a Droga , Doenças do Cabelo/induzido quimicamente , Doenças do Cabelo/patologia , Humanos , Necrose , Transtornos da Pigmentação/induzido quimicamente , Esclerose , Dermatopatias/induzido quimicamente , Dermatopatias/patologia , Doenças das Glândulas Sudoríparas/induzido quimicamenteRESUMO
Docetaxel-induced skin reactions include hypersensitivity, edema, skin toxicity with erythrodysesthesia syndrome, infusion site reactions, alopecia, nail onycholysis, nail pigmentation, photosensitivity, scleroderma, and others, for example, stomatitis and paresthesias. However, of all reported effects, the acral erythrodysesthesia syndrome has only rarely been described in the literature. We report on two female patients with breast cancer who on treatment with docetaxel developed acral erythrodysesthesia syndrome. It presented as bizarrely shaped, burning skin reactions at their hands and feet. Histology of skin biopsies revealed microscopic damages to the eccrine sweat glands in both patients. Skin patch testing with docetaxel was negative. None of the reports dealing with side effects of docetaxel chemotherapy has described acral erythrodysesthesia syndrome with the histologic features of syringo-squamous metaplasia and eccrine neutrophilic hidradenitis. We propose here that these characteristic histologic features are essential in the differentiation from fixed drug eruption and localized graft-versus-host disease.
Assuntos
Antineoplásicos/efeitos adversos , Paclitaxel/análogos & derivados , Paclitaxel/efeitos adversos , Dermatopatias/induzido quimicamente , Taxoides , Neoplasias da Mama/tratamento farmacológico , Docetaxel , Toxidermias/etiologia , Toxidermias/patologia , Eritema/induzido quimicamente , Eritema/patologia , Feminino , Pé , Mãos , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Dermatopatias/patologia , Doenças das Glândulas Sudoríparas/induzido quimicamente , Doenças das Glândulas Sudoríparas/patologia , SíndromeAssuntos
Anticonvulsivantes/efeitos adversos , Frutose/análogos & derivados , Transtornos da Pigmentação/induzido quimicamente , Pigmentação da Pele/efeitos dos fármacos , Doenças das Glândulas Sudoríparas/induzido quimicamente , Adulto , Feminino , Frutose/efeitos adversos , Humanos , Transtornos da Pigmentação/patologia , Doenças das Glândulas Sudoríparas/patologia , TopiramatoAssuntos
Antineoplásicos/efeitos adversos , Toxidermias/patologia , Glândulas Écrinas/patologia , Piperazinas/efeitos adversos , Pirimidinas/efeitos adversos , Doenças das Glândulas Sudoríparas/induzido quimicamente , Benzamidas , Feminino , Humanos , Mesilato de Imatinib , Metaplasia , Pessoa de Meia-Idade , Doenças das Glândulas Sudoríparas/patologiaAssuntos
Vesícula/induzido quimicamente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Doenças das Glândulas Sudoríparas/induzido quimicamente , Glândulas Sudoríparas/efeitos dos fármacos , Glândulas Sudoríparas/patologia , Doença Aguda , Adulto , Antibióticos Antineoplásicos/efeitos adversos , Antimetabólitos Antineoplásicos/efeitos adversos , Citarabina/efeitos adversos , Toxidermias/etiologia , Humanos , Idarubicina/efeitos adversos , Leucemia Mieloide/terapia , Masculino , Necrose , Indução de RemissãoAssuntos
Bisacodil/efeitos adversos , Catárticos/efeitos adversos , Toxidermias/diagnóstico , Transtornos da Pigmentação/diagnóstico , Doenças das Glândulas Sudoríparas/diagnóstico , Bisacodil/uso terapêutico , Catárticos/uso terapêutico , Doença Crônica , Corantes/efeitos adversos , Constipação Intestinal/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Pigmentação/induzido quimicamente , Doenças das Glândulas Sudoríparas/induzido quimicamente , Tartrazina/efeitos adversosRESUMO
Eccrine squamous syringometaplasia is a rare entity that occurs in patients who have received chemotherapy treatment. It also occurs in association with chronic ulcers, skin tumors, and after the ingestion of drugs, exposure to toxic agents and inflammatory processes. We present the case of a 47-year-old male diagnosed with microcytic lung carcinoma and superior vena cava syndrome. After receiving the third cycle of chemotherapy, and after accidental extravasation, he presented with an erythematous plaque. The histopathological study revealed eccrine squamous syringometaplasia together with interphase dermatitis and epidermal changes that may be responsible for the epidermal necrosis.
Assuntos
Antineoplásicos/efeitos adversos , Toxidermias/etiologia , Glândulas Écrinas/patologia , Doenças das Glândulas Sudoríparas/induzido quimicamente , Humanos , Masculino , Metaplasia/induzido quimicamente , Pessoa de Meia-IdadeRESUMO
Neutrophilic eccrine hidradenitis (NEH) is a recently recognized dermatosis occurring in patients receiving chemotherapy for a variety of malignancies. We report the second pediatric case. An 11-year-old boy with non-Hodgkin's lymphoma developed widespread erythematous papulopustules beginning two days after receiving high-dose cytarabine (Ara-C) in preparation for a bone marrow transplant. The lesions spontaneously regressed in two weeks. Histologic examination revealed a neutrophilic infiltrate around and within the eccrine ducts and secretory coils. Bacterial, fungal, and viral cultures were negative. These findings are characteristic of NEH. The condition should be differentiated from infectious dermatoses that may require treatment.
Assuntos
Citarabina/efeitos adversos , Doenças das Glândulas Sudoríparas/induzido quimicamente , Criança , Glândulas Écrinas , Humanos , Inflamação/induzido quimicamente , MasculinoRESUMO
Two cases of chemotherapy-associated eccrine hidradenitis are presented. Previous cases have been labeled "neutrophilic eccrine hidradenitis" (NEH). Both cases reported herein involve neutropenic patients and are notable for the absence of neutrophils on histologic examination. Oncologists need to be aware of this newly described process, and this rash must be added to the differential diagnosis of the neutropenic oncology patient. The role of neutrophils in this disorder is discussed, and a new term, "chemotherapy-associated eccrine hidradenitis," is suggested for this unusual process.
Assuntos
Antineoplásicos/efeitos adversos , Doenças das Glândulas Sudoríparas/induzido quimicamente , Pré-Escolar , Feminino , Humanos , Inflamação/induzido quimicamente , Inflamação/patologia , Pessoa de Meia-Idade , Necrose , Doenças das Glândulas Sudoríparas/patologiaRESUMO
The clinical spectrum of sweating disorders includes sudomotor excess and deficiency. Hyperhidrosis is characterized by sweating beyond that required to maintain a constant internal body temperature. Hypohidrosis and anhidrosis are distinguished by a reduced or absent ability to generate sweat for the purpose of evaporative heat dissipation. Whereas hyperhidrosis is usually benign, anhidrosis may predispose to hyperthermia. Either hyperhidrosis or anhidrosis may accompany a more serious underlying disorder. Correct diagnosis depends on determining the anatomical pattern of sweating and localizing the lesion within the autonomic nervous system. Sudomotor deficits may involve the frontal operculum, hypothalamus, brain stem, spinal cord, sympathetic chain ganglia, peripheral nerve, or eccrine sweat glands. Treatments for hyperhidrosis include topical aluminum chloride, oral anticholinergic agents, intradermal botulinum toxin for some localized syndromes, and thoracic ganglionic sympathotomy or sympathectomy for refractory palmar hyperhidrosis.
Assuntos
Doenças das Glândulas Sudoríparas/fisiopatologia , Sudorese/fisiologia , Animais , Antagonistas Colinérgicos/efeitos adversos , Humanos , Doenças das Glândulas Sudoríparas/induzido quimicamente , Doenças das Glândulas Sudoríparas/classificação , Sudorese/efeitos dos fármacosRESUMO
We describe the dermatological consequences of treatment with a beta-adrenergic antagonist, atenolol, in a patient with pheochromocytoma. There were acral skin lesions, histologically characterized by epidermal and sweat-gland necrosis. It is believed that the combined action of severe local ischaemia and profuse sweating produced these lesions, which resembled histologically the changes found in patients comatose as the result of carbon monoxide or drug poisoning. The importance of such lesions in diagnosis is discussed.
Assuntos
Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Atenolol/efeitos adversos , Feocromocitoma/tratamento farmacológico , Doenças das Glândulas Sudoríparas/induzido quimicamente , Adulto , Feminino , Humanos , Necrose , Doenças das Glândulas Sudoríparas/patologia , Glândulas Sudoríparas/patologiaRESUMO
We report three new cases of neutrophilic eccrine hidradenitis associated with induction chemotherapy which resolves two major points. First, because two of our patients had testicular carcinoma; this firmly establishes that NEH is not exclusively seen in patients with acute myelogenous leukemia or Hodgkin's lymphoma as previously reported. Second, because two of our patients did not receive cytarabine which has previously been suspected of being the causative agent, it is apparent that this disorder may be produced by more than one chemotherapeutic agent or combination of agents. The histologic features with a discussion of the spectrum of changes which may be seen are presented.