A case of anti-laminin γ1 (p200) pemphigoid developed after dipeptidyl peptidase-4 inhibitor administration.

A 73-year-old man with diabetes mellitus was referred to our department for ultraviolet treatment for erythematous skin lesions with itching. On dipeptidyl peptidase-4 inhibitor (DPP-4i) sitagliptin (Januvia®) for diabetes mellitus, the erythematous skin lesions appeared and spread to the whole body. At the initial visit, erythema multiforme-like skin lesions with crusts were observed on the trunk and extremities, and the patient was suspected to have drug eruption. Histopathology demonstrated eosinophilic infiltration in the superficial dermis and inflammatory cell infiltration in the epidermis. Sitagliptin was discontinued, and erythematous lesions improved with oral prednisolone. Thereafter the patient was treated with phototherapy and  betamethasone sodium phosphate infusion for residual prurigo. However, blistering skin lesions appeared 5 months later. Histopathological findings were subepidermal blisters with eosinophilic abscess, and bullous pemphigoid was suspected. CLEIAs for autoantibodies to desmoglein 1 (Dsg1), Dsg3 and BP180 were negative. Direct immunofluorescence showed linear depositions of immunoglobulin G (IgG) and C3 at the epidermal basement membrane zone, and indirect immunofluorescence detected IgG anti-epidermal basement membrane zone antibodies, reacting with the dermal side of 1M NaCl-split normal human skin. IgG antibodies reacted with 200 kDa laminin γ1 (p200) by immunoblotting using dermal extracts. These results indicated that this patient was diagnosed with anti-laminin γ1 (p200) pemphigoid developed after DPP-4i administration. Although reports of DPP-4i-related bullous pemphigoid have accumulated, cases of anti-laminin γ1 (p200) pemphigoid developed after DPP-4i administration are rarely reported.

Estudio clínico-histopatológico de las eritrodermias en un hospital universitario: 14 años de experiencia / Clinical-histopathological study of erythroderma in a university hospital: 14 years of experience

INTRODUCCIÓN: La eritrodermia es un síndrome inflamatorio cutáneo infrecuente caracterizado por compromiso eritematoso generalizado y descamación, de más del 90% de superficie cutánea total. OBJETIVO: Caracterizar clínica e histopatológicamente a los pacientes con eritrodermia en un hospital universitario chileno. METODOLOGÍA: Estudio retrospectivo, realizado en el Hospital Clínico Universidad de Chile, basado en revisión de fichas clínicas e informes histopatológicos de pacientes con eritrodermia, entre 2005 y 2018. Se evaluó edad, sexo y variables clínicas (co-morbilidades, síntomas, días de evolución, ingreso hospitalario, informe histopatológico, diagnóstico y evolución). RESULTADOS: Total de 28 pacientes, 18 hombres (64%), edad promedio 59 años. Causa más frecuente de eritrodermia fue dermatosis pre-exis-tentes, con 15 casos (54%), que incluyen: psoriasis 9 (32%), dermatitis de contacto 3 (11%), PRP 2 (7%), dermatitis atópica 1 (4%). A estas le siguen: reacción adversa medicamentosa 6 (21%), idiopática 6 (21%) y Síndrome de Sezary 1 (4%). CONCLUSIÓN: El presente estudio corresponde a la primera serie de eritrodermias realizada en Chile. Destacan las dermatosis preexistentes como la principal causa, lo que se correlaciona con la literatura.

INTRODUCTION: Erythroderma is an infrequent cutaneous inflammatory disorder characterized by generalized erythematous compromise and desquamation, of more than 90% of total cutaneous surface. OBJECTIVE: Clinical and histopathological cha-racterization of patients with erythroderma in a Chilean university hospital. METHODOLOGY: Retrospective study, performed at the University of Chile Clinical Hospital, based on review of clinical records and histopatho-logical reports of patients with erythroderma, between 2005 and 2018. Age, sex and clinical variables were evaluated (co-morbidities, symp-toms, days of evolution, hospital admission, histopathological report, diagnosis and evolu-tion). RESULTS: A total of 28 patients, 18 were men (64%), average age 59 years. Most frequent cause of erythroderma was pre-existing dermatosis, with 13 cases (52%), which included: psoriasis 9 (32%), contact dermatitis 3 (11%), PRP 2 (7%), atopic dermatitis 1 (4%). These are followed by adverse drug eruption 6 (21%), idiopathic 6 (21%) and Sezary syndrome 1 (4%). CONCLUSION: The present study corresponds to the first series of erythrodermas performed in Chile. The pre-existing dermatoses were the main cause of erythroderma, which coincides with other reports.

Factores predictores de respuesta y revisión de la toxicidad cutánea de cetuximab y panitumumab en 116 pacientes / Predictors of Tumor Response to Cetuximab and Panitumumab in 116 Patients and a Review of Approaches to Managing Skin Toxicity

INTRODUCCIÓN Y OBJETIVOS: Cetuximab y panitumumab son anticuerpos anti-factor de crecimiento epidérmico (anti-EGFR) usados para el cáncer colorrectal metastásico. La mayoría de los pacientes desarrollan una erupción papulopustulosa que podría predecir la respuesta tumoral. Además, producen otros efectos adversos cutáneos, por lo que hemos estudiado si estos también podrían ser predictores clínicos de respuesta. Así mismo, hemos realizado una revisión del tratamiento de la erupción papulopustulosa, ya que no existen directrices basadas en la evidencia. MATERIAL Y MÉTODOS: Estudio retrospectivo de 116 pacientes. Se incluyeron pacientes afectos de cáncer colorrectal metastásico en tratamiento con los anticuerpos anti-EGFR, cetuximab o panitumumab, en el Hospital Universitario Donostia. RESULTADOS: El 81,9% de los pacientes desarrolló la erupción papulopustulosa, siendo el riesgo mayor y de mayor intensidad cuantos más ciclos de anti-EGFR se administraban (p = 0,03). Todos los pacientes que obtuvieron una respuesta tumoral completa desarrollaron la erupción. Cuanto peor era la respuesta tumoral, menor era la frecuencia de la erupción (p = 0,03). También se encontró una asociación entre la xerosis y la respuesta tumoral (el 53,4% de los que obtuvieron respuesta tumoral desarrollaron xerosis, p = 0,002). El manejo de la erupción papulopustulosa se llevó a cabo mediante un algoritmo desarrollado por nuestro servicio. CONCLUSIONES: En la práctica clínica la erupción papulopustulosa grave y la xerosis pueden ser predictores clínicos de buena respuesta al tratamiento anti-EGFR. Los pacientes con esta erupción deben tratarse precozmente, ya que el tratamiento subóptimo de estos efectos secundarios puede conllevar un retraso en la dosis o su interrupción

INTRODUCTION AND OBJECTIVES: Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR) in the treatment of metastatic colorectal cancer. Most patients develop a papulopustular rash, which may predict tumor response. We studied whether the other adverse cutaneous effects associated with these monoclonal antibodies are also clinical predictors of response. We also reviewed publications describing approaches to treating the papulopustular rash since no evidence-based guidelines have yet been published. MATERIAL AND METHODS: We performed a retrospective study of 116 patients with metastatic colorectal cancer receiving anti-EGRF therapy with cetuximab or panitumumab at Hospital Universitario Donostia. RESULTS: In total, 81.9% of the patients developed a papulopustular rash. Patients who received the most cycles of treatment with the EGFR inhibitor were at the highest risk of developing the rash, and these patients also had the most severe rash reactions (P = .03). All of the patients who exhibited a complete tumor response had the rash, and the incidence of rash was lower in patients with poor tumor response (P = .03). We also observed an association between tumor response and xerosis (53.4% of the patients who developed xerosis also exhibited tumor response, P = .002). The papulopustular rash was managed according to an algorithm developed by our department. CONCLUSIONS: Severe papulopustular rash and xerosis may be clinical predictors of good response to anti-EGFR therapy. Patients who develop a papulopustular rash should be treated promptly because suboptimal treatment of this and other adverse effects can lead to delays in taking the prescribed anti-EGFR dose or to interruption of therapy

A retrospective study on sequential desensitization-rechallenge for antituberculosis drug allergy

BACKGROUND: Antituberculosis (anti-TB) drug allergy often involves multiple concurrently administered drugs which subsequently need to be reinitiated as no better alternatives exist. OBJECTIVE: To describe the results of tailored sequential desensitization-rechallenge (D-R) for anti-TB drug allergy. METHODS: Consecutive patients who had undergone D-R to anti-TB drugs between 1 September 1997 and 31 January 2012 were recruited. Following resolution of the acute reaction, anti-TB drug was restarted at 1:6,000 to 1:3 of the final daily dose (FDD), with gradual single or multiple step daily dose escalation to the FDD. Subsequent drugs were sequentially added ≥3 days later when the preceding drug was tolerated. Full blood count and liver function tests were monitored prior to addition of each new drug. RESULTS: There were 11 patients of whom 10 were male, predominantly Chinese (8 patients). Regimens comprised at least 3 drugs: isoniazid (INH), rifampicin (RIF), ethambutol (EMB), pyrazinamide (PZA), or streptomycin. All patients had nonimmediate reactions, with cutaneous eruptions, where maculopapular exanthema (MPE) was the most common (8 patients). Drug-induced hypersensitivity syndrome (DIHS) occurred in 6 patients, and Stevens Johnson syndrome (SJS) in 2 patients. D-R to INH was successful in 7/9 patients (77.8%) and to RIF/EMB/PZA/streptomycin in all. Of the 2 patients who failed INH D-R, 1 developed fever and MPE on day 3, the other MPE on day 8. D-R with INH and RIF respectively was successful in 2 patients with SJS. Among DIHS patients, 1 failed D-R with INH (fever and MPE on day 3). There were 23/25 (92%) successful D-R among the 11 patients. All patients completed TB treatment of ≥5 months' duration with no cases of drug-resistant TB. CONCLUSION: Tailored sequential TB drug D-R is successful where no better alternative therapies are available, with careful dose escalation and close monitoring, and after a careful risk-benefit assessment.

Wound healing effect of flavonoid rich fraction and luteolin isolated from Martynia annua Linn. on streptozotocin induced diabetic rats

OBJECTIVE@#To evaluate wound healing potential of flavonoid fractions of Martynia annua (M. annua) Linn. leaves in diabetic rats on the basis of folkloric information and preliminary study.@*METHODS@#The flavonoid compound luteolin and apigenin were isolated from dried leaves of plant by column chromatography. The two concentrations (0.2% and 0.5% w/w) of luteolin and flavonoid fraction were selected for topically applied as ointment on diabetic wound. The Povidone Iodine Ointment USP was used as a reference. On 18th days, protein content, hydroxyproline and antioxidants (SOD, CAT and GSH) level in granuloma tissues were determined.@*RESULTS@#The results showed that, percent wound contraction were observed significantly (P<0.01) greater in MAF fraction and 0.5% w/w of luteolin treatment groups. Presence of matured collagen fibres and fibroblasts with better angiogenesis were observed in histopathological studies.@*CONCLUSIONS@#In conclusion, our findings suggest that flavonoid fraction (MAF) and luteolin (0.5% w/w) may have potential benefit in enhancing wound healing in diabetic condition, possibly due to free-radical scavenging activity of plant.

Research of xuebijing injection combined with glucocorticoid in treating dermatitis medicamentosa like of trichloroethylene with systemic inflammatory response syndrome / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the better efficacy of clinic treatment for dermatitis medicamentosa like of trichloroethylene (DMLT) and observe the clinic efficacy of Xuebejing injection for DMLT patients with systemic inflammatory response syndrome (SIRS).</p><p><b>METHODS</b>16 DMLT patients with SIRS were randomly divided into control group (conventional therapy) and xuebijing group (conventional therapy plus xuebijing). We evaluated all the patients with APACHE II before treatment and checked the TNF-alpha in blood at the different time (before treatment and the 7th day of treatment). The total usages, first dosage of medrol and the time of therapy for each group were counted.</p><p><b>RESULTS</b>All patients were cured, there was no significant difference according to APACHE II and TNF-alpha before treatment in two groups . The level of TNF-alpha of all the patients were decreased markedly, but more significantly in xuebijing group (P < 0.01). Moreover, the treatment group patients were given relatively less total usages, first dosage of medrol and time of therapy (P < 0.01).</p><p><b>CONCLUSION</b>Xuebejing injection combined glucocorticoids can cure DMLT patients with SIRS effectively, and reduce the total usages, first dosage of medrol and time of therapy.</p>

Problemas relacionados con la medicación que causan ingresos hospitalarios / Drug related problems and hospital admissions

ObjetivoLos problemas relacionados con los medicamentos (PRM) están vinculados al tratamiento farmacológico del paciente e interfieren o pueden interferir con los resultados esperados en su salud. El presente estudio tiene como objetivo determinar la prevalencia de los PRM en los pacientes de un centro de salud urbano que son causa de ingreso en su hospital de referencia, y su evitabilidad.DiseñoEs un estudio observacional de tipo descriptivo y retrospectivo.EmplazamientoCENTRO de Salud Les Corts, que es un centro de salud urbano y docente con una población asignada de 32.318 habitantes.ParticipantesUsuarios del CS Les Corts ingresados en el Hospital Clínico de Barcelona desde agosto de 2005 a enero de 2006.Resultados y mediciones principalesUna pareja de un farmacéutico y un médico de familia analizan las historias clínicas y determinan la presencia o no de PRM. El 13,4% de todas las altas presentan PRM, que en su mayoría están implicados en el ingreso hospitalario (12%). Un 57,3% del total de altas con un PRM como causa del ingreso hospitalario se ha considerado evitable. Los ingresos por PRM se concentran en los servicios de medicina interna, cardiología y neumología. Los problemas de salud motivo de ingreso hospitalario por PRM son mayoritariamente circulatorios (38,5%) y respiratorios (11,5%).ConclusionesEl número de ingresos debidos a problemas relacionados con la medicación es elevado y evitable(AU)

ObjectiveDrug related problems (DRP) are health problems associated with the pharmacological treatment of patients and interfere or can interfere with the expected results on their health. The aim of this study is to determine the prevalence of DRP in patients from an urban health centre that lead to hospitalisation, and its prevention.DesignIt is a retrospective, observational and descriptive study.SettingLes Corts Health Centre (HC), which is an urban health and teaching centre with a reference population of 32,318 inhabitants.ParticipantsUsers of the les Corts HC admitted to the Barcelona Hospital Clinic from August 2005 to January 2006.Results and main outcome measurementsA pharmacist and a family doctor analysed the clinical histories and determined whether or not there was a DRP. A DRP was present in 13.4% of all hospital discharges, and 12% were implicated in the hospital admission. It was considered that 57.3% of all the discharges with a DRP as the causing factor in the hospital admission were avoidable. Admissions due to DRP were mainly in internal medicine, cardiology and pneumology. The health problems that lead to hospital admission due to DRP are mainly circulatory (38.5%) and respiratory (11.5%).ConclusionsThe number of hospital admissions due to drug related problems is avoidably high(AU)

Toxicodermia por Rhizoma coptidis / Toxicoderma due to Rhizoma coptidis

No disponible

No disponible

Clinical analysis on 162 cases of drug eruption induced by Chinese patent medicine / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To analyze the pathogenesis and characteristics of drug eruption induced by Chinese patent medicine for providing some referential materials on prevention and treatment of drug eruption.</p><p><b>METHODS</b>Clinical data of 162 patients suffered from drug eruption were analyzed retrospectively.</p><p><b>RESULTS</b>Most the drug eruption (161 times/case, accounting for 99.4%) belonged to the mild type; injection was the dominating dosage-form for inducing drug eruptions (87 times/case, 53.7%); most of the cases occurred when drugs were used in combination (106 times/case, 65.4%); and few of the patients (14 times/case, 8.6%) had drug eruption for the first time.</p><p><b>CONCLUSION</b>Prevention of drug eruption could be realized by way of learning more relevant knowledge, cautiousl accepting the Chinese herbal injection, avoiding drug combination, as well as inquiry for the history of drug application of patients in detail.</p>

Herb Medicine-induced Adverse Effects in Dermatological Field

Herb or folk medicine has readily been assumed to have a little or no adverse effects because people have taken or applied it for a long time. However, such an assumption can be dangerous. Generally herb medicine has a shorter time of action both in terms of its pharmacological efficacy and toxic effects than occidental medicine because its ingredient is less potent. Therefore herb medicine does not induce adverse reactions in a short time, but the frequency of its side effects increases along with the accumulation of medicinal substances when taken for a long time. Many doctors of Oriental medicine claim that the development of skin eruption is not a side effect of herb medicine. Rather they argue that it is a result of emission of heat or toxic materials from inside the body. Sometimes the author experience patients who suffer from drug eruptions caused by herb medicine, but usually the patients have little idea what herb medicine they have taken. This article will introduce some cases of herb medicine-induced adverse effects reported in dermatology journals, written in Korean or in English. Most cases are systemic contact dermatitis caused by ingestion of chicken boiled with lacquer, which has been used as a folk medicine and a healthy food. I will introduce what the Rhus lacquer is and discuss its adverse reactions. Lastly, I will report the cases of contact dermatitis caused either by applying crushed insect and medicinal herbs such as buttercup, fig leaf, garlic, pasqueflower, aloe and herbal ointment or by practicing bee sting therapy for treatment of neuralgia, arthralgia, tinea pedis, facial paralysis, pruritus and paresthesia.

Síndrome de hipersensibilidad cruzado entre antiepilépticos: a propósito de un caso / Cross-hypersensivity syndrome between antiepileptic drugs: report of a case

El síndrome de hipersensibilidad a antiepilépticos (SHA) es un síndrome raro (1/1.000 a 1/10.000 nuevos casos) que potencialmente amenaza la vida del paciente y ocurre tras exposición a un antiepiléptico, más frecuentemente un aromático como fenitoína, carbamazepina o fenobarbital. Las características clínicas del síndrome son reacciones cutáneas, fiebre, linfadenopatías, eosinofilia, y afectación sistémica (principalmente el hígado pero también el riñón, el sistema nervioso central y el corazón o el pulmón).Se describe un caso de una mujer de 61 años en tratamiento con fenobarbital que sufrió una erupción cutánea atribuida al tratamiento con este fármaco. Se cambió a fenitoína y después de 17 días la paciente desarrolló erupción cutánea, eosinofilia y aumento en las transaminasas. La alta tasa de reactividad cruzada entre antiepilépticos aromáticos (40-80 por ciento) sugiere la relación entre la reacción a la fenitoína y la anterior a fenobarbital (AU)

No disponible

Contribution to study on the form of the medicament named "Coix seed from China"

Item 'y di bac' on the market is not the grain of Coix lachryma-Jobi L. In comparison with the different references, item 'y di bac' has characters conforming to the standards of Sorghum vulgare Pers. - the commonest one of those items having often been faked as 'y di bac'

O simillimum em farmacodermias com hipersensibilidade aos analgesicos / The simillimum in dermatitis medicamentosa with drug hypersensivity

4 casos de farmacodermia com fator desencadeante e concomitante representado por analgesicos, sao tratados segundo a lei do semelhante, sem considerar a etiologia na prescricao