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3.
Pharmacogenomics ; 20(7): 503-516, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31124417

RESUMEN

Aim: To evaluate the effects of gene polymorphisms in the treatment of erythema nodosum leprosum with prednisone/thalidomide. Patients & methods: A total of 152 patients from different regions of Brazil were included. Generalized estimating equation was used to evaluate the influence of polymorphisms and haplotypes on the drug dose variation throughout the treatment. Results: An association between the genotype tuberculoid of polymorphism ABCB1 3435C>T (rs1045642; p = 0.02) and prednisone dose was found in the recessive model. An association between the haplotypes 1031T/-863C/-857C/-308A/-238G (p = 0.006) and 1031T/-863C/-857T/-308A/-238G (p = 0.040) of the TNF gene and the CYP2C19*2 polymorphism were also identified, in relation to thalidomide dosage variation over the course of treatment. Conclusion: This work presents the first pharmacogenetic report of association between gene polymorphisms and erythema nodosum leprosum treatment with prednisone/thalidomide.


Asunto(s)
Citocromo P-450 CYP2C19/genética , Eritema Nudoso/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/genética , Subfamilia B de Transportador de Casetes de Unión a ATP/genética , Adulto , Brasil/epidemiología , Relación Dosis-Respuesta a Droga , Eritema Nudoso/genética , Eritema Nudoso/patología , Femenino , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Genotipo , Haplotipos/genética , Humanos , Masculino , Polimorfismo Genético , Prednisona/administración & dosificación , Prednisona/efectos adversos , Receptores de Glucocorticoides/genética , Talidomida/administración & dosificación , Talidomida/efectos adversos
5.
Indian J Pharmacol ; 51(1): 72-74, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31031470

RESUMEN

The distressing consequences of immunology in leprosy is the lepra reaction. Erythema nodosum leprosum(ENL) in special cases need to be managed with capsule thalidomide in varying doses. We report such a case of bradycardia in thalidomide dose dependent manner in a young ENL male.


Asunto(s)
Bradicardia/inducido químicamente , Eritema Nudoso/tratamiento farmacológico , Leprostáticos/efectos adversos , Lepra Lepromatosa/tratamiento farmacológico , Talidomida/efectos adversos , Adulto , Relación Dosis-Respuesta a Droga , Humanos , Leprostáticos/administración & dosificación , Masculino , Talidomida/administración & dosificación , Adulto Joven
8.
PLoS One ; 14(1): e0210436, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30682031

RESUMEN

BACKGROUND/AIMS: Extraintestinal cutaneous manifestations of IBD represent a severe disease complication and an early and accurate treatment might positively influence the disease course. Using the patient collective of the Swiss IBD Cohort Study (SIBDCS), we analysed epidemiological as well as clinical factors being associated with the onset of pyoderma gangrenosum, erythema nodosum and aphthous ulcers in IBD patients. METHODS: We included 3266 SIBDCs patients, 1840 with Crohn's disease (CD) and 1426 with ulcerative colitis (UC) or IBD unclassified (IBDU) and analysed the association of cutaneous manifestations with age, age at diagnosis time, type of disease, gender, family history, HLA-allotype, smoking, intestinal disease activity, therapy and other extraintestinal manifestations (EIM). RESULTS: 354 CD patients and 136 UC/IBDU patients presented with skin manifestations at any time during their disease course. In both, CD and UC, female gender and younger age at IBD diagnosis were significantly associated with extraintestinal skin manifestations. For CD, we also detected a positive family history as associated factor. As an indicator of more intensive intestinal disease activity, patients with cutaneous manifestations of IBD needed more frequently therapy with antibiotics, steroids, immunomodulators and anti-TNF. Multivariate analysis revealed female gender, younger age at diagnosis and presence of other extraintestinal manifestations as factors being associated with skin EIM in IBD patients and anti-TNF as well as immunomodulatory treatment in CD patients. CONCLUSION: Our results suggest that young females with a positive family history of IBD might be at increased risk for the onset of skin manifestations and require a careful screening for such complications.


Asunto(s)
Colitis Ulcerosa/complicaciones , Enfermedad de Crohn/complicaciones , Eritema Nudoso/diagnóstico , Piodermia Gangrenosa/diagnóstico , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Piodermia Gangrenosa/tratamiento farmacológico , Piodermia Gangrenosa/etiología , Factores de Riesgo , Factores Sexuales , Suiza , Adulto Joven
10.
Dermatology ; 235(2): 137-143, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30463069

RESUMEN

OBJECTIVES: Potassium iodide (KI) is a medication that has been used for decades in dermatology and it is mentioned as a treatment option in all major dermatology textbooks. Yet, there is little recent information on its efficacy. In our study, we wanted to retrospectively evaluate the therapy response to KI in our patients. METHODS: The hospital information system was searched for patients treated with KI at the Department of Dermatology (University Hospital Zurich) in the last 20 years (January 1, 1998 to December 31, 2017). A total of 52 patients were found and, subsequently, 35 patients were included in our study. RESULTS: KI was prescribed for the following skin conditions: erythema nodosum, disseminated granuloma anulare, necrobiosis lipoidica, nodular vasculitis, cutaneous sarcoidosis, and granulomatous perioral dermatitis/ rosacea. The median duration of KI intake was 5 ± 7.7 weeks (range 1-26). The global assessment of efficacy by the treating physician showed an improvement of disease in about a third of all patients. No response was seen in 14 patients and 9 even had a progression of disease. An adverse event was documented in 16 cases. CONCLUSIONS: Our findings show that an improvement was reached in only about a third of all cases. High response rates with only mild side effects (in 16 out of 35 patients) were observed.


Asunto(s)
Fármacos Dermatológicos/uso terapéutico , Yoduro de Potasio/uso terapéutico , Sarcoidosis/tratamiento farmacológico , Enfermedades de la Piel/tratamiento farmacológico , Adolescente , Adulto , Anciano , Dermatitis Perioral/tratamiento farmacológico , Eritema Nudoso/tratamiento farmacológico , Femenino , Granuloma Anular/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Necrobiosis Lipoidea/tratamiento farmacológico , Estudios Retrospectivos , Rosácea/tratamiento farmacológico , Enfermedades Cutáneas Vasculares/tratamiento farmacológico , Vasculitis/tratamiento farmacológico , Adulto Joven
11.
PLoS Negl Trop Dis ; 12(12): e0007035, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30592714

RESUMEN

BACKGROUND: Erythema nodosum leprosum (ENL) is a systemic inflammatory complication occurring mainly in patients with lepromatous leprosy (LL) and borderline lepromatous leprosy (BL). Prednisolone is widely used for treatment of ENL reactions. However, it has been reported that prolonged treatment with prednisolone increases the risk for prednisolone-induced complications such as osteoporosis, diabetes, cataract and arteriosclerosis. It has been speculated that perhaps these complications result from lipid profile alterations by prednisolone. The effects of extended prednisolone treatment on lipid profiles in ENL patients have not been studied in leprosy patients with ENL reactions. Therefore, in this study we conducted a case-control study to investigate the changes in lipid profiles and serological responses in Ethiopian patients with ENL reaction after prednisolone treatment. METHODS: A prospective matched case-control study was employed to recruit 30 patients with ENL and 30 non-reactional LL patient controls at ALERT Hospital, Ethiopia. Blood samples were obtained from each patient with ENL reaction before and after prednisolone treatment as well as from LL controls. The serological host responses to PGL-1, LAM and Ag85 M. leprae antigens were measured by ELISA. Total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were measured by spectrophotometric method. RESULTS: The host antibody response to M. leprae PGL-1, LAM and Ag85 antigens were significantly reduced in patients with ENL reactions compared to LL controls after treatment. Comparison between patients with acute and chronic ENL showed that host-response to PGL-1 was significantly reduced in chronic ENL after prednisolone treatment. Untreated patients with ENL reactions had low lipid concentration compared to LL controls. However, after treatment, both groups had comparable lipid profiles except for LDL, which was significantly higher in patients with ENL reaction. Comparison within the ENL group before and after treatment showed that prednisolone significantly increased LDL and HDL levels in ENL patients and this was more prominent in chronic ENL than in acute patients with ENL. CONCLUSION: The significantly increased prednisolone-induced LDL and TG levels, particularly in patients with chronic ENL reactions, is a concern in the use of prednisolone for extended periods in ENL patients. The findings highlight the importance of monitoring lipid profiles during treatment of patients to minimize the long-term risk of prednisolone-induced complications.


Asunto(s)
Eritema Nudoso/sangre , Eritema Nudoso/tratamiento farmacológico , Lepra Lepromatosa/complicaciones , Prednisolona/administración & dosificación , Adolescente , Adulto , Estudios de Casos y Controles , Colesterol/sangre , Eritema Nudoso/etiología , Eritema Nudoso/inmunología , Femenino , Humanos , Lepra Lepromatosa/microbiología , Lipoproteínas HDL/sangre , Lipoproteínas LDL/sangre , Masculino , Persona de Mediana Edad , Mycobacterium leprae/fisiología , Prednisolona/efectos adversos , Estudios Prospectivos , Triglicéridos/sangre , Adulto Joven
12.
Medicine (Baltimore) ; 97(49): e13211, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30544379

RESUMEN

RATIONALE: Primary cutaneous anaplastic large cell lymphoma (pcALCL) is a rare subtype of non-Hodgkin lymphoma, which is rarely associated with erythema nodosum (EN). PATIENT CONCERNS: A 57-year-old woman complained of recurrent rashes involving her abdomen, back, upper and lower limbs for over 20 years, with severity in symptoms for 2 weeks. DIAGNOSES: The first skin biopsy was performed in 2011 in another hospital and she was diagnosed idiopathic EN. The second skin biopsy was performed in 2014 and she was diagnosed as pcALCL with stage IA. INTERVENTIONS: She was treated with oral prednisone, cyclosporine, and thalidomide. OUTCOMES: One month later, the ulcerative lesion was decreased in size and became smooth and the patient achieved partial remission. She is still under treatment and has been monitored closely for 4 years. LESSONS: The case suggested that stimulation of inflammation in the skin lesions for a long period might be related to clonal transformation into pcALCL and hence should be closely monitored. Immunosuppressive treatment may be effective and safe for patients with pcALCL at early stages.


Asunto(s)
Eritema Nudoso/complicaciones , Linfoma Anaplásico Cutáneo Primario de Células Grandes/etiología , Neoplasias Cutáneas/etiología , Diagnóstico Diferencial , Eritema Nudoso/diagnóstico , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/patología , Femenino , Humanos , Linfoma Anaplásico Cutáneo Primario de Células Grandes/diagnóstico , Linfoma Anaplásico Cutáneo Primario de Células Grandes/tratamiento farmacológico , Linfoma Anaplásico Cutáneo Primario de Células Grandes/patología , Persona de Mediana Edad , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patología
13.
Int J Mycobacteriol ; 7(4): 390-393, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30531041

RESUMEN

Leprosy or Hansen's disease is a chronic infectious granulomatous disease with varied presentation, especially in the setting of lepra reactions. We report two such atypical presentations each of Type I and Type II Lepra reactions; the first being an elderly male presenting with fever, while the second case being of a young boy being evaluated for cervical lymphadenitis.


Asunto(s)
Eritema Nudoso/diagnóstico , Lepra Lepromatosa/diagnóstico , Piel/patología , Adolescente , Artritis Reumatoide/diagnóstico , Biopsia , Diagnóstico Diferencial , Eritema Nudoso/tratamiento farmacológico , Fiebre/etiología , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Piel/microbiología , Tuberculosis Ganglionar/diagnóstico
15.
J Assoc Physicians India ; 66(4): 63-6, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-30347957

RESUMEN

A 30-year old male presented with fever for last 1 year. There were associated multiple painful skin eruptions with hyperpigmentation and scaling over whole body which had been progressively increasing. He also had anasarca along with generalized weakness. He presented to us in shock after an acute episode of gastroenteritis. After stabilization, he was evaluated for cause of fever. Routine fever workup (for typhoid, syphilis, malaria, filariasis, HIV, scrub typhus, leishmaniasis) was negative. CECT chest and abdomen revealed hepatosplenomegaly. There was no response to intravenous (IV) antibiotics and anti-fungal medications. Slit skin smears revealed 3+ acid fast bacilli (AFB). Skin biopsy revealed fragmented acid-fast bacilli with dense collection of neutrophils and foamy histiocytes in upper and middle dermis suggestive of Erythema Nodosum Leprosum (ENL). A diagnosis of ENL with lepromatous leprosy was made and patient started on steroids and thalidomide and subsequently on multidrug therapy (MDT). On therapy, patient's symptoms improved, and skin lesions resolved. Though Leprosy itself is a well-known common cause of PUO in India, its first presentation as ENL is rare and needs good index of suspicion and timely management.


Asunto(s)
Eritema Nudoso/diagnóstico , Lepra Lepromatosa/diagnóstico , Adulto , Quimioterapia Combinada , Eritema Nudoso/complicaciones , Eritema Nudoso/tratamiento farmacológico , Fiebre/diagnóstico , Humanos , India , Leprostáticos/uso terapéutico , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/tratamiento farmacológico , Masculino
16.
Cytokine ; 112: 87-94, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30017389

RESUMEN

The disease leprosy is caused by Mycobacterium leprae. The disease displays a spectrum of clinical manifestations relating to the stage of the infection and the pathogen-specific immune response. The most frequent M. leprae-specific hypersensitivity reactions are erythema nodosum leprosum (ENL) and type-1 (reversal) reaction (T1R). Omega-3 and omega-6 fatty acid-derived lipid mediators are involved in the regulation of these M. leprae-specific inflammatory and immune responses. Studies on lipid mediators showed their presence during different manifestations of leprosy-before and after multidrug therapy (MDT) and during T1R. This review aims to compare the lipid mediators at different stages of the disease. This review also presents new data on the significance of lipid mediators (cysteinyl leukotrienes and leukotriene B4, prostaglandin E2 and D2, lipoxin A4 and resolvin D1) on ENL.


Asunto(s)
Ácidos Grasos Omega-3/sangre , Ácidos Grasos Omega-6/sangre , Lepra/sangre , Animales , Quimioterapia Combinada , Eritema Nudoso/sangre , Eritema Nudoso/tratamiento farmacológico , Humanos , Leprostáticos/farmacología , Lepra/tratamiento farmacológico , Mycobacterium leprae/efectos de los fármacos
17.
An Bras Dermatol ; 93(2): 181-184, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29723371

RESUMEN

BACKGROUND: Erythema nodosum leprosum may appear before, during or after treatment of leprosy and is one of the main factors for nerve damage in patients. When it occurs or continues to occur after treatment, it may indicate disease recurrence and a new treatment may be instituted again. OBJECTIVE: To evaluate the retreatment of patients with multibacillary leprosy who underwent standard treatment with multidrug therapy, but developed or continued to present reactions of erythema nodosum leprosum and/or neuritis 3-5 years after its end. METHOD: For this objective, a new treatment was performed in 29 patients with multibacillary leprosy who maintained episodes of erythema nodosum and/or neuritis 3-5 years after conventional treatment. RESULTS: In general, we observed that 27 (93.10%) had no more new episodes after a follow up period of eight months to five years. In five of these patients the reason for the retreatment was the occurrence of difficult-to-control neuritis, and that has ceased to occur in all of them. STUDY LIMITATIONS: Small number of patients.. CONCLUSION: In the cases observed, retreatment was an effective measure to prevent the occurrence of erythema nodosum leprosum and/or persistent neuritis.


Asunto(s)
Eritema Nudoso/tratamiento farmacológico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Multibacilar/tratamiento farmacológico , Neuritis/tratamiento farmacológico , Eritema Nudoso/microbiología , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/microbiología , Lepra Multibacilar/microbiología , Masculino , Neuritis/microbiología , Recurrencia , Retratamiento , Factores de Tiempo , Resultado del Tratamiento
18.
Dermatol Ther ; 31(4): e12610, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29644775

RESUMEN

Erythema nodosum migrans (subacute nodular migratory panniculitis) is an uncommon type of panniculitis characterized by migrating subcutaneous nodules or plaque on the lower extremity. There are a very few cases of Erythema nodosum migrans reported and thus its appropriate treatment modality is not defined. We describe a case of a 30-year-old male with idiopathic erythema nodosum migrans which was manifest centrifugally spreading, slightly morpheaform erythematous plaque on the lower left leg. The patient was diagnosed initially and treated as a case of furunculosis with poor clinical response. The skin biopsy showed features consistent with subacute nodular panniculitis. Saturated Solution of Potassium Iodide along with topical Heparin successfully treated the patient, when the conventional treatment modalities failed. In a morpheaform centrifugally expanded plaque, erythema nodosum migrans should be kept in mind in the differential diagnosis, especially in the lower extremities in cases of unknown etiology.


Asunto(s)
Eritema Nudoso/tratamiento farmacológico , Heparina/administración & dosificación , Paniculitis/tratamiento farmacológico , Yoduro de Potasio/administración & dosificación , Administración Cutánea , Administración Oral , Adulto , Biopsia , Quimioterapia Combinada , Eritema Nudoso/diagnóstico , Humanos , Masculino , Paniculitis/diagnóstico , Inducción de Remisión , Resultado del Tratamiento
20.
An. bras. dermatol ; 93(2): 181-184, Mar.-Apr. 2018. graf
Artículo en Inglés | LILACS | ID: biblio-887190

RESUMEN

Abstract: Background: Erythema nodosum leprosum may appear before, during or after treatment of leprosy and is one of the main factors for nerve damage in patients. When it occurs or continues to occur after treatment, it may indicate disease recurrence and a new treatment may be instituted again. Objective: To evaluate the retreatment of patients with multibacillary leprosy who underwent standard treatment with multidrug therapy, but developed or continued to present reactions of erythema nodosum leprosum and/or neuritis 3-5 years after its end. Method: For this objective, a new treatment was performed in 29 patients with multibacillary leprosy who maintained episodes of erythema nodosum and/or neuritis 3-5 years after conventional treatment. Results: In general, we observed that 27 (93.10%) had no more new episodes after a follow up period of eight months to five years. In five of these patients the reason for the retreatment was the occurrence of difficult-to-control neuritis, and that has ceased to occur in all of them. Study limitations: Small number of patients.. Conclusion: In the cases observed, retreatment was an effective measure to prevent the occurrence of erythema nodosum leprosum and/or persistent neuritis.


Asunto(s)
Humanos , Masculino , Femenino , Lepra Lepromatosa/tratamiento farmacológico , Eritema Nudoso/tratamiento farmacológico , Lepra Multibacilar/tratamiento farmacológico , Neuritis/tratamiento farmacológico , Recurrencia , Factores de Tiempo , Lepra Lepromatosa/microbiología , Resultado del Tratamiento , Retratamiento , Eritema Nudoso/microbiología , Lepra Multibacilar/microbiología , Leprostáticos/uso terapéutico , Neuritis/microbiología
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