A rare and severe cutaneous adverse effect of telaprevir: drug rash with eosinophilia and systemic symptoms.

Telaprevir is a specific inhibitor of the hepatitis C (HCV) serine protease 3. Cutaneous side effects have been reported with telaprevir. Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare yet severe adverse drug-induced reaction characterized by exfoliative dermatitis and maculopapular rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and myriad internal organ involvement. We report a case of DRESS due to telaprevir. A 64-year-old Caucasian man with chronic hepatitis C developed a progressive diffuse, painful maculopapular exanthema with fever, facial edema, lymphadenopathy at week 11 of chronic hepatitis C therapy with telaprevir, Peg-Interferon alfa-2a, and ribavirin. He had no exposures to any other medications. He presented an eosinophilia (up to 6.29 X 109 cells/L), skin biopsy was consistent with a drug reaction. The HCV treatment was stopped and methylprednisolone 0.75 mg/kg/day was started. Cutaneous and systemic symptoms had a rapid resolution in few days. Telaprevir can activate severe skin reactions that can mimic an infectious disease, therefore early diagnosis and discontinuation of chronic hepatitis C treatment is mandatory.

Gabapentin-induced aquagenic wrinkling of the palms.

Aquagenic keratoderma (AK) or aquagenic wrinklingis a rare palmoplantar skin disease. It is sporadic orhereditary condition. It appears in childhood or youngadulthood and it is seen as multiple asymptomaticsmall shiny papules on the peripheral margin ofpalms and/or soles after submersion in water. Thepathogenesis and etiology of ASA remains unclear.Drugs sometimes trigger AK. Herein, we present thecase of a 29-year-old man who had begun treatmentwith gabapentin three weeks before the onset of hiscutaneous symptoms.

Sex hormones in male psoriasis patients and their correlation with the Psoriasis Area and Severity Index.

Modulation of psoriasis severity by estradiol during pregnancy, menstruation and menopause has been investigated previously. The correlation between sex hormones and Psoriasis Area Severity Index (PASI) has not been studied in male psoriasis patients. We investigated serum sex hormones in male psoriasis patients compared with healthy controls and correlated these findings with PASI. Estradiol, testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured in 47 male patients with psoriasis and 20 healthy controls. Patients with psoriasis showed higher body mass index and higher serum levels of FSH and LH relative to healthy controls, although this difference was not statistically significant. However, serum levels of testosterone and estradiol were significantly different between patients with psoriasis and healthy controls. Testosterone was significantly increased in control patients and estradiol was significantly increased among psoriatic patients. A significant inverse correlation was found between estradiol and PASI. Although the role of sex hormones in the pathogenesis of psoriasis has not been demonstrated, this is the first report of an inverse correlation between estradiol and PASI in male patients.