Intravenous Iron Therapy: Re-administration after Prior Adverse Reaction.

BACKGROUND: Intravenous (IV) iron therapy is performed in community practices and hospitals with modern formulations when oral administration becomes impractical. Effective replacement of iron is important for the treatment of iron deficiency and anemia. Can IV iron be rechallenged in individuals with a history of adverse reactions? This review is to explore the challenge of this, when clinically indicated. METHODS: After performing a literature search, five studies (combined total sample number=1,006) for re-exposure of IV iron to individuals with a history of past reactions were identified, observed, and analyzed. Re-exposure included reactions ranging from mild to moderate and few cases of severe type. RESULTS: The majority (>80%) of IV iron rechallenges were tolerable, safe, and successful without major serious incidents. There were no reports of major reactions (severe hypersensitivity reactions or anaphylaxis) in these re-exposures. CONCLUSION: Re-administration of IV iron therapy in patients with a previous adverse reaction is plausible, with benefit and risk stratification. A rechallenge would depend on the nature and degree of the adverse reaction and use of alternative formulations. Rechallenge to a previous severe hypersensitivity reaction or anaphylaxis with the same product has not been reported in these studies. Evidence on the benefit of premedication use is conflicting and requires further studies.

Scaly erythematous eruptions of intertriginous locations.

Intertriginous or flexural eruptions are common presenting problems in clinical practice, raising several differential diagnoses. A clinico-histopathological correlation is important to establish a correct diagnosis when a clinical diagnosis cannot be ascertained. We here present a case of flaky erythematous eruptions in a female adult, with a final diagnosis of granular parakeratosis, involving nonflexural area mid-back (under bra cover) in addition to flexural zones of the groin, gluteal fold, inframammary fold and axilla. It seems that mechanism of pressure and friction as well as occlusion all play a part. Management with potent topical steroid and avoidance of inciting triggers offered resolution in 4 weeks in this case.

A red scaly patch diagnosed as hypomelanotic melanoma.

Early detection of melanoma is important and the diagnosis of amelanotic/hypomelanotic melanoma (AHM) is challenging. Nevertheless, dermatoscopy has been shown to improve diagnostic accuracy for non-pigmented skin lesions as well as pigmented lesions, and several algorithms for cutaneous neoplasms evaluation are available. We present a hypomelanotic melanoma detected on an asymptomatic patient at routine skin examination utilising a dermatoscopic decision algorithm. General practitioners, also known as primary care practitioners, are likely to be the first practitioners to encounter a skin cancer on a patient with further necessary actions.

Selection of an effective topical corticosteroid.

BACKGROUND: There are different topical corticosteroid (TCS) agents and potencies available to treat various dermatological disorders. There have been a number of publications on steroid phobia among general practitioners and patients, resulting in non-adherence and unresolved skin conditions, affecting patients' quality of life and healthcare costs. OBJECTIVE: The aim of this article is to discuss the process of selection of TCS for the treatment of a particular condition. DISCUSSION: It is crucial to choose the correct potency of TCS for treatment to avoid steroid phobia and undertreated conditions. TCS agents have different formulations, percentages and molecular structures, which affect potency, efficacy and effect. The adverse effects from TCS treatment are rare if the agent is correctly selected and applied. Patients can generally be treated effectively - without undesirable effects, steroid phobia and undertreated conditions - by factoring in patient and lesion characteristics, topical medication potency and method of application.

Intravenous iron infusion and newer non-dextran formulations.

There are several newer intravenous iron formulations to treat iron deficiency and its anaemia. Its use in the primary care setting has been infrequent compared to tertiary centres, due to historical concerns such as anaphylaxis. There is a lack of overall comparison among the intravenous formulations of iron. Compared to oral iron therapy, the newer intravenous formulations, which allow a complete or near-complete replacement in a single sitting of 15-30 minutes, have an improved safety profile with better tolerability, efficacy and effectiveness. They are suited for administration in the primary care setting. The four non-dextran formulations (ferric carboxymaltose, iron sucrose, iron isomaltoside and ferumoxytol) share an equal or near equal efficacy and safety profile. This article also outlines how to provide iron infusion safely and effectively in the community.