Subject(s)
Carboxymethylcellulose Sodium/adverse effects , Dermatitis, Allergic Contact/etiology , Gelatin/adverse effects , Pectins/adverse effects , Polyenes/adverse effects , Aged, 80 and over , Dermatitis, Allergic Contact/diagnosis , Drug Combinations , Humans , Male , Patch Tests , Surgical StomasSubject(s)
Adhesives/adverse effects , Carboxymethylcellulose Sodium/adverse effects , Dermatitis, Allergic Contact/etiology , Gelatin/adverse effects , Pectins/adverse effects , Polyenes/adverse effects , Polyethylenes/adverse effects , Skin Ulcer/chemically induced , Aged, 80 and over , Drug Combinations , Humans , Male , OstomyABSTRACT
Invasive fungal infections pose major management problems for clinicians caring for hematopoietic cell transplant patients. Two major fungal genera, Candida and Aspergillus, account for most fungal infections. Rates of systemic Candida infection range from 15% to 25%, mostly in the pre-engraftment period. Prophylaxis by fluconazole has dramatically reduced the frequency of early Candida infections. Caspofungin has recently been shown to offer an excellent alternative to amphotericin B (with less toxicity) or fluconazole (with a broader spectrum) for therapy of systemic Candida infections. Aspergillus infections occur in 15% to 20% of allogeneic hematopoietic cell transplant patients, most frequently in the post-engraftment period; they are associated with a severe diminution of cell-mediated immune responses by graft-versus-host disease and prolonged corticosteroid use. Voriconazole, a recently introduced broad-spectrum azole, has excellent activity against Aspergillus and is generally well tolerated. Voriconazole currently offers the best prospect for success and tolerance as a first-line treatment for aspergillosis. Second-line therapies include lipid formulations of amphotericin B, caspofungin, or intravenous itraconazole. Unfortunately, early initiation of therapy for aspergillosis is frequently not possible because of inaccurate diagnostics. One new diagnostic, the galactomannan assay, has recently been approved, and others are in development; these offer promise for earlier diagnosis without the need for invasive procedures. It is hoped that these new therapies and new diagnostics will usher in a new era of antifungal therapy.
Subject(s)
Antifungal Agents/therapeutic use , Fungal Proteins , Peptides, Cyclic , Antifungal Agents/classification , Antifungal Agents/pharmacokinetics , Azoles/adverse effects , Azoles/pharmacokinetics , Azoles/therapeutic use , Echinocandins , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Mycoses/diagnosis , Mycoses/drug therapy , Mycoses/etiology , Nucleosides/adverse effects , Nucleosides/pharmacokinetics , Nucleosides/therapeutic use , Peptides/adverse effects , Peptides/pharmacokinetics , Peptides/therapeutic use , Polyenes/adverse effects , Polyenes/pharmacokinetics , Polyenes/therapeutic useABSTRACT
We report a case of severe peristomal dermatitis that was refractory to conventional treatments. Patch testing revealed positive allergies to myroxylon perulase (balsam of Peru), propylene glycol, Stomahesive paste, and Gantrez. This is the second reported case of patch-test-positive peristomal allergy to Gantrez.
Subject(s)
Carboxymethylcellulose Sodium/adverse effects , Colostomy , Dermatitis, Allergic Contact/etiology , Dermatologic Agents/adverse effects , Gelatin/adverse effects , Maleates/adverse effects , Pectins/adverse effects , Polyenes/adverse effects , Polyvinyls/adverse effects , Tissue Adhesives/adverse effects , Adolescent , Dermatitis, Allergic Contact/diagnosis , Drug Combinations , Female , Humans , Ointments , Patch TestsABSTRACT
A woman developed dermatitis from Stomadhesive paste used to secure her colostomy appliance. Patch testing revealed that she was allergic to Gantrez (N-butylmonoester of polymethyl vinyl ether maleic acid in an ethanol solution), a water soluble copolymer with stabilizing properties used in the production of Stomadhesive.