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Dermatitis Alérgica por Contacto , Dermatitis Profesional , Humanos , Femenino , Alérgenos , Resinas Epoxi , Pruebas del ParcheAsunto(s)
Fibrilación Atrial , Dermatología , Accidente Cerebrovascular , Administración Oral , Anticoagulantes/efectos adversos , Fibrilación Atrial/inducido químicamente , Fibrilación Atrial/tratamiento farmacológico , Humanos , Piridonas/uso terapéutico , Accidente Cerebrovascular/inducido químicamente , Accidente Cerebrovascular/tratamiento farmacológicoRESUMEN
BACKGROUND: Permethrin is a synthetic pyrethroid used as a chemical insecticide that obtained an MA in the management of human scabies in 2014. We report a case of severe immediate hypersensitivity (IH) reaction with generalized contact urticaria secondary to the cutaneous application of 5% permethrin cream (Topiscab®). OBSERVATION: A 44-year-old woman with no personal history of atopy was treated with oral ivermectin, Topiscab® and levocetirizine for suspected scabies. Eight hours after taking a levocetirizine tablet and five hours after the application of a tube of Topiscab® together with oral ivermectin, she presented generalized urticaria, nausea and diarrhoea, followed by loss of consciousness. Skin prick-tests for ivermectin and levocetirizine were negative. We noticed non-significant erythema with permethrin. The open application test with Topiscab® was strongly positive at 20min with the appearance of an urticaria plaque in the area of application. The open test with sorbic acid was positive at 2h. Accidental exposure to permethrin spray caused dyspnoea and recurrence of urticaria. DISCUSSION: Mild and transient symptoms are regularly described after cutaneous application (burning, paraesthesia or increased itching). Delayed hypersensitivity reactions such as contact dermatitis have been reported in the literature. Exceptional cases of severe IH reactions have been described following occupational exposure to airborne pyrethroid insecticides. No cases of severe IH reaction secondary to application of topical permethrin have been reported.
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Dermatitis por Contacto/etiología , Hipersensibilidad Inmediata/inducido químicamente , Insecticidas/efectos adversos , Permetrina/efectos adversos , Urticaria/inducido químicamente , Adulto , Femenino , Humanos , Pruebas Cutáneas , Inconsciencia/inducido químicamenteRESUMEN
INTRODUCTION: Atopic keratoconjunctivitis is associated with eyelid eczema. It may require the use of local corticosteroids which if prolonged can be a source of ocular complications. Tacrolimus is an immunosuppressant used in cutaneous application in atopic dermatitis. The aim of this study was to measure the efficacy and tolerance of tacrolimus 0.1% ointment in palpebral application in atopic keratoconjunctivitis. PATIENTS AND METHODS: This retrospective, single-center study was conducted between June 2014 and February 2017. Patients with atopic keratoconjunctivitis not controlled by first-line medical treatments were included. The primary endpoint was the evolution of functional signs as assessed by the NEI-VFQ25 and OSDI quality of life scores. Secondary endpoints were visual acuity and local corticosteroid use. RESULTS: Among the 18 patients included, the mean age was 37.9±16.8 years. The first follow-up visit was on average 68.3±55.3 days after initiation of treatment. The NEI-VFQ25 score was significantly improved for seven of its sub-scores (P<0.05) and the mean OSDI decreased significantly from 52.3±26.2 to 22.0±27.0 (P<0.001) showing a decrease in eye discomfort. A significant reduction was observed in the number of patients using local corticosteroids. There was no significant change in visual acuity. CONCLUSION: Tacrolimus ointment 0.1% in palpebral application appears to be an effective treatment for the management of atopic keratoconjunctivitis.
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Dermatitis Atópica/tratamiento farmacológico , Inmunosupresores/administración & dosificación , Queratoconjuntivitis/tratamiento farmacológico , Tacrolimus/administración & dosificación , Administración Tópica , Adulto , Conjuntivitis Alérgica/tratamiento farmacológico , Conjuntivitis Alérgica/epidemiología , Dermatitis Atópica/epidemiología , Femenino , Humanos , Queratoconjuntivitis/epidemiología , Masculino , Persona de Mediana Edad , Pomadas , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Atopic keratoconjunctivitis is frequently associated with atopic eyelid dermatitis. It may require topical steroids, the prolonged use of which may cause ocular complications. Tacrolimus is an immunosuppressant used topically on the skin in atopic dermatitis. The purpose of this study is to evaluate the efficacy and tolerability of tacrolimus 0.1% ointment applied to the eyelids in atopic keratoconjunctivitis. PATIENTS AND METHODS: This is a single center, retrospective study carried out between June 2014 and February 2017. Patients presenting with atopic keratoconjunctivitis uncontrolled by first-line medical treatment were included. The main outcome was change in functional symptoms as evaluated by the NEI-VFQ25 and OSDI quality of life scores. Secondary criteria were visual acuity and topical steroids use. RESULTS: Among the 18 patients included, the mean age was 37.9±16.8years. The first follow-up visit occurred on average 68.3±55.3 days after initiation of treatment. The NEI-VFQ25 score improved significantly for seven of the sub-scores (P<0.05), and the mean OSDI decreased significantly from 52.3±26.2 to 22.0±27.0 (P<0.001), demonstrating a decrease in ocular symptoms. A significant reduction in the number of patients requiring topical steroid treatment was observed. There was no significant change in visual acuity. CONCLUSION: Tacrolimus 0.1% ointment applied to the eyelids appears to be an effective treatment in the management of atopic keratoconjunctivitis.
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Queratoconjuntivitis/tratamiento farmacológico , Tacrolimus/administración & dosificación , Administración Tópica , Adulto , Conjuntivitis Alérgica/complicaciones , Conjuntivitis Alérgica/tratamiento farmacológico , Dermatitis Atópica/complicaciones , Dermatitis Atópica/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pomadas , Estudios Retrospectivos , Tacrolimus/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Food urticaria is common and generally benign, and it may be of viral or idiopathic aetiology. A food origin of the allergy is frequently sought but rarely found. Mammalian meat anaphylaxis, or alpha-galactose (α-gal) anaphylaxis, is a rare and recently discovered entity. PATIENTS AND METHODS: Herein, we report a case of alpha-galactose (α-gal) anaphylaxis in a 60-year-old woman presenting four episodes of acute urticaria with signs of anaphylaxis occurring a few hours after meals containing mammalian meat (beef meat, pork meat and offal). The diagnosis was confirmed by a positive gelatine prick-test and the presence of α-gal IgE. DISCUSSION: In the event of acute urticaria associated with systemic symptoms, in particular gastrointestinal signs, allergy to α-galactose should be considered.
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Dolor Abdominal/etiología , Hipersensibilidad a los Alimentos/diagnóstico , Galactosa/efectos adversos , Urticaria/etiología , Animales , Femenino , Hipersensibilidad a los Alimentos/etiología , Humanos , Carne/efectos adversos , Persona de Mediana Edad , RecurrenciaRESUMEN
Acrodermatitis chronica atrophicans (ACA) is the late cutaneous form of Lyme borreliosis. The early inflammatory phase manifests with a bluish-red discoloration and doughy swelling of the skin. The atrophic phase represents a late-phase process with red discoloration, and a thin and wrinkled appearance of the skin. We present a patient who exhibited a previously undescribed form of late cutaneous Lyme borreliosis (LCLB) with a foot tumour. A 64-year-old woman had a large tumorous lesion on the right sole. The tumour size and deformation of the feet made wearing shoes difficult. On skin histology, a granulomatous lymphohistiocytic infiltrate with plasma cells was noticed. In fact, the patient recalled tick bites 2 or 3 years before. Borrelia burgdorferi (Bb) serology was highly positive and a polymerase chain reaction analysis on the skin biopsy detected Bb sensu lato, genospecies B. afzelii. We diagnosed LCLB and antibiotics were prescribed. On the more recent examination, the tumour had totally disappeared; the skin was atrophic and dry with only few scales. We report an atypical case of European LCLB, suggesting that ACA is not the only possible presentation of LCLB. The diagnosis of ACA is often clinically missed for months or years, and may be mistaken at the inflammation phase for vascular disorders, erysipelas or bursitis/arthritis, and at the atrophic phase for lichen sclerosus atrophicus, morphoea or anetoderma. To our knowledge, no such tumorous LCLB has previously been described.
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Enfermedades del Pie/diagnóstico , Enfermedad de Lyme/diagnóstico , Enfermedades Cutáneas Bacterianas/diagnóstico , Acrodermatitis/diagnóstico , Acrodermatitis/tratamiento farmacológico , Antibacterianos/uso terapéutico , Grupo Borrelia Burgdorferi , Diagnóstico Diferencial , Femenino , Enfermedades del Pie/tratamiento farmacológico , Humanos , Enfermedad de Lyme/tratamiento farmacológico , Persona de Mediana Edad , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Mordeduras de GarrapatasRESUMEN
BACKGROUND: Leprosy continues to be present in certain regions throughout the world, and the dermatologist plays a central role in its diagnosis. Herein we report a case of tuberculoid leprosy that is atypical in terms of its linear presentation which appears to follow the lines of Blaschko. PATIENTS AND METHODS: A patient from Mayotte was referred to the neurological department for suspected tuberculoid leprosy. He was presenting a deficiency of the ulnar nerve together with neuronal hypertrophy and cutaneous involvement. Dermatological examination revealed linear hypo-aesthetic hypopigmented lesions on the arm and forearm. The atypical clinical presentation also suggested to us pigmented mosaicism or post-inflammatory pigmentation. The biopsy showed granulomatous epithelial dermatitis with perinervous involvement. Imaging examinations confirmed the presence of neuronal hypertrophy. A diagnosis of linear tuberculoid leprosy was made. DISCUSSION: This case illustrates the need to bear in mind a diagnosis of leprosy in the event of hypopigmented lesions, even where they are linear and of Blaschkoid appearance. Several potential hypotheses may account for this particular topographical pattern.