RESUMEN
We present a case of acute generalized exanthematous pustolosis (AGEP) induced by amoxicillin-clavulanate. Clinical diagnosis was confirmed by symptoms presentation and histological features (Euroscar score point compatible with definite diagnosis). Patch testing performer six months later confirmed sensitization to the culprit drug and showed positivity also to other beta-lactam antibiotics (penicillin G and cephalexin). We believe that a T cell delayed response to betalactams common ring could be involved.
Asunto(s)
Pustulosis Exantematosa Generalizada Aguda/etiología , Combinación Amoxicilina-Clavulanato de Potasio/efectos adversos , Antibacterianos/efectos adversos , Inhibidores Enzimáticos/efectos adversos , Pruebas del Parche , Pustulosis Exantematosa Generalizada Aguda/diagnóstico , Adulto , Humanos , MasculinoAsunto(s)
Ectima Contagioso/virología , Eritema Multiforme/virología , Virus del Orf/aislamiento & purificación , Infecciones por Poxviridae/virología , Adulto , Antivirales/uso terapéutico , Ectima Contagioso/tratamiento farmacológico , Ectima Contagioso/patología , Eritema Multiforme/tratamiento farmacológico , Eritema Multiforme/patología , Humanos , Italia , Masculino , Virus del Orf/genética , Infecciones por Poxviridae/tratamiento farmacológico , Infecciones por Poxviridae/patologíaRESUMEN
BACKGROUND/AIM: The guidelines of the British Photodermatology Group for topical treatment with psoralen and ultraviolet light (PUVA) recommend starting UVA doses between 0.2 and 0.5 J/cm(2), according to the phototype. Our purpose was to evaluate the therapeutic efficacy and tolerability of bath PUVA, with 8-methoxypsoralen (8-MOP), by using lower UVA doses, regardless of phototype. METHODS: We compared 2 groups of patients (group 1: n = 10, group 2: n = 20) with chronic plaque-type psoriasis. Group 1 was treated with the usual starting dose and dose progression; group 2 was treated by using a lower first dose, a slower dose progression and reaching a lower maximum dose. The Psoriasis Area and Severity Index (PASI) score was assessed at the initial stages, and every month until the end of the treatment. RESULTS: In group 1, the median baseline PASI score decreased from 15.2 to 4.5 (p < 0.005, Student's paired t test), while in group 2, it fell from 13.7 to 4.1 (p < 0.005). No statistical difference between the groups is detectable. Severe phototoxic reactions were observed only in 2 patients of group 1. Side effects were not observed in group 2. CONCLUSIONS: Our data indicate that an aggressive bath PUVA treatment is not substantially more effective in clearing chronic plaque-type psoriasis than a milder therapeutic approach.