Bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT): A case series from a center in Brazil.

Bilateral acute depigmentation of the iris and bilateral acute iris transillumination (BAIT) are similar clinical entities. The former causes acute-onset depigmentation of the iris stroma without transillumination, whereas the latter causes depigmentation of the iris pigment epithelium with transillumination. The etiopathogenesis of these conditions is not yet fully understood, but the proposed causes include the use of systemic antibiotics (especially moxifloxacin) and viral triggers. We present a case series of five female patients with a mean age of 41 (32-45) years, all of whom suffered acute onset of bilateral pain and redness of the eyes after moxifloxacin use (oral or topical). It is important for ophthalmologists to be aware of the two forms of iris depigmentation since this case series suggests that SARS-CoV-2 or its empirical treatment with moxifloxacin may trigger iris depigmentation. If this is the case, clinicians will likely see increased incidences of bilateral acute depigmentation of the iris and bilateral acute iris transillumination during and after the COVID-19 pandemic.

Bilateral ocular deposit of chlorpromazine / Depósito ocular bilateral de clorpromazina

ABSTRACT Chlorpromazine is a medication widely used in psychiatry for the treatment of psychoses, especially schizophrenia. Since 1964, published articles have been correlating this medication with the appearance of ocular alterations. In this paper, we report the case of a 65-year-old patient with ocular effects due to long-term therapy with chlorpromazine. Biomicroscopy of both eyes presented diffuse granular brown deposits, most prominent at the deep stroma and corneal endothelium level. Also showed anterior subcapsular brown deposits with a stellate pattern in the lens. The total amount exceeds 2.000g (significant for the ocular alterations described) considering the patient's daily dosage of chlorpromazine of 300mg for ten years. After performing complete ophthalmic evaluation and discarding other causes for the ocular deposits, we diagnosed a secondary corneal deposit and cataract due to the use of chlorpromazine. This case reinforces the importance of periodic follow-up with an ophthalmologist for chlorpromazine users to trace ocular changes, heeding the exposure time and its dosage.

RESUMO A clorpromazina é uma medicação muito empregada na psiquiatria para tratamento de psicoses, especialmente em casos de esquizofrenia. Desde 1964 existem artigos publicados que correlacionam o uso dessa medicação com o aparecimento de alterações oculares. Neste trabalho, relatamos o caso de um paciente de 65 anos com efeitos oculares devido à terapia de longo prazo com clorpromazina. A biomicroscopia de ambos os olhos apresentou depósitos granulares difusos e de cor marrom, mais proeminente ao nível do estroma profundo e do endotélio da córnea, além de depósitos castanhos subcapsulares anteriores centrais em um padrão estrelado no cristalino. Considerando a dose diária de clorpromazina de 300mg por 10 anos usada pelo paciente, a quantidade total ultrapassa 2.000g (dose considerada significativa para as alterações oculares descritas). Após avaliação oftalmológica completa e descartado outras causas desses depósitos oculares, foram diagnosticados depósito corneano e catarata secundários ao uso de clorpromazina. O caso apresentado reforça a importância do acompanhamento oftalmolÓgico periÓdico de usuários de clorpromazina para o rastreio de alteraçÕes oculares, atentando-se ao tempo de exposição à droga e à posologia da mesma.

Facial pigmentation associated with amiodarone.

Amiodarone is one of the most commonly used drugs for treatment of cardiac arrhythmia. Several undesirable effects are associated with its long-term use. This report describes the case of a 71-year-old female patient, with a diagnosis of cardiac arrhythmia, who presented with a stigmatizing blue-gray facial pigmentation and altered serum values of thyroid hormones associated with the intake of amiodarone. The patient was referred to her cardiologist. The aim of this report is to increase clinicians' awareness about the potential adverse effects of this drug.

Melanonychia induced by topical treatment of periungual warts with 5-fluorouracil.

Periungal and subungual warts are benign epidermal neoplasms caused by human papillomaviruses. They represent a challenge for management because of resistance to treatment. 5-flourouracil is an antimetabolite that interferes with DNA synthesis and inhibits RNA formation. We present a 32-year-old female with subungual and periungual warts of the fingers of both hands and first right toe. She was treated with 5-fluorouracil twice daily under occlusion plus 20 percent urea. After a month she presented with grayish transverse melanonychia along and parallel to the lunula with some maceration of the periungal folds. Nail pigmentation may be a consequence of dermal deposition by systemic drugs and less frequently by topical drugs. In this case melanonychia was induced by the topical application of 5-fluorouracil. The brown-grayish pigmentation, with parallel involvement of the lunula of all the nails treated, presented like that induced by systemically administered cytotoxic drugs.

Extensive amalgam tattoo on the alveolar-gingival mucosa.

Amalgam tattoos are common exogenous pigmented lesions of the oral mucosa occurring mainly by inadvertent placement of amalgam particles into soft tissues. The diagnosis of amalgam tattoo is simple, usually based on clinical findings associated with presence or history of amalgam fillings removal. Intraoral X-rays may be helpful in detecting amalgam-related radiopacity. In cases where amalgam tattoo cannot be differentiated from other causes of oral pigmentation, a biopsy should be performed. This article deals with an extensive amalgam tattoo lesion which required a biopsy for a definitive diagnosis.

Tatuagem extensa por amálgama em mucosa gêngivo-alveolar / Extensive amalgam tattoo on the alveolar-gingival mucosa

Tatuagens por amálgama são lesões pigmentadas, exógenas, de frequente ocorrência na mucosa bucal, que resultam da introdução acidental de partículas de amálgama nos tecidos moles. O diagnóstico da tatuagem por amálgama é simples, geralmente, baseado em achados clínicos, complementado pela história recente ou pregressa de remoção de restauração por amálgama. Radiografias intraorais podem ser úteis na detecção de radiopacidade, associadas à partícula de amálgama. Nos casos em que as tatuagens por amálgama não permitem diferenciação de outras lesões melanocíticas, o exame histopatológico deve ser realizado. Os autores relatam à ocorrência de lesão extensa por tatuagem de amálgama com confirmação histopatológica.

Amalgam tattoos are common exogenous pigmented lesions of the oral mucosa occurring mainly by inadvertent placement of amalgam particles into soft tissues. The diagnosis of amalgam tattoo is simple, usually based on clinical findings associated with presence or history of amalgam fillings removal. Intraoral X-rays may be helpful in detecting amalgam-related radiopacity. In cases where amalgam tattoo cannot be differentiated from other causes of oral pigmentation, a biopsy should be performed. This article deals with an extensive amalgam tattoo lesion which required a biopsy for a definitive diagnosis.

Marginal gingiva discoloration by gray MTA: a case report.

Perforation of the root canal during insertion of an intracanal post is a complication of endodontic therapy. Mineral trioxide aggregate (MTA) has been successfully used a sealer in these situations. This material has recently been formulated in white color, allowing its application in areas of esthetic concern. This is a clinical case report of a root perforation sealed with gray MTA that resulted in discoloration of the marginal gingiva. Treatment consisted of replacing gray MTA with white MTA with the aid of a dental operating microscope, producing satisfactory esthetic results.

[Fixed pigmented erythema related to the oral administration of carbamazepine: report of one case]. / Eritema fijo pigmentario medicamentoso relacionado con el uso de carbamazepina: presentación de un caso.

Carbamazepine (CBZ) is an oral anticonvulsant drug, structurally similar to tricyclic antidepressants. It is preferred over other drugs because it has fewer adverse effects on behavior and alertness. However, hematologic toxicity is possible during therapy with CBZ. Patients should undergo routine monitoring of hematologic function. CBZ can make the skin more sensitive to the sun or ultraviolet light, therefore, dermatological effects of this drug also can happen such as, skin rash, urticaria, and erythema multiforme. The present study reports the case of a female patient that presented hyperchromic-concentric-pruriginous- spots on the skin of her hands after six months of treatment with CBZ. She came to the physicians of the Clinical Pharmacokinetic Service (Laboratory of Toxicology of IAHULA, Mérida-Venezuela) requesting a drug monitoring. The results showed a level of 8.51 microg x. mL(-1), which was found within the therapeutic range (4-12 microg x mL(-1)). Subsequently, the dermatologist diagnosed fixed pigmented erythema related to the ingestion of a specific medication which began disappearing after 15 days of CBZ free-treatment and with the aid of a dermatologic formulation.

Immunolocalization of HLA-DR and metallothionein on amalgam tattoos.

Despite studies concerning toxic reactions related to amalgam components in the literature, few studies have been devoted to evaluate local noxious effects of amalgam tattoos (AT) on biological tissues. In addition, little is known about activation of inflammatory cells by mucosa-implanted amalgam debris. Tissue reaction to AT depends on the particle size. Human leukocyte antigen DR (HLA-DR) is an activation marker of inflammatory cells associated with antigen presentation. Metallothioneins (MT) are proteins involved with metal detoxication, including mercury and silver. The purpose of the present study was to investigate the immunolocalization of HLA-DR and MT in AT with large or powdered particles. Paraffin-embedded AT tissue blocks were sectioned and subjected to immunohistochemistry for HLA-DR and MT localization. The results demonstrated a dense mononuclear inflammatory infiltrate associated with large and powdered debris and positivity for HLA-DR and MT in inflammatory cells. While blood vessel walls and connective fibers impregnated with powdered particles were negative for HLA-DR, they were positive for MT. In addition, wherever epithelial basement membrane impregnation by powdered amalgam particles was observed, a strong positivity for MT was detected. These findings demonstrate that residual elements of AT still have noxious local effects over tissues.

Dermatitis in Ecuadorean farm workers.

Using a cross-sectional survey of potato farm workers in northern Ecuador, we examined the relationship between pesticide exposure and skin disorders. From a farm population census, all pesticide applicators and 1/2 of exposed field workers were selected. Controls were age-matched from urban occupations. Individual exposure measures included overall years and current hours working with pesticides. Farm-level measures included numbers of applications over the last 6 months and an application practices score (range 0-4). Each participant underwent a clinical skin examination, with patch tests to maneb on a sample of dermatitis cases. Exposure-related increases in conjunctivitis (7% of applicators, 0% in other groups), dermatitis (68% of exposed and 55% of applicators versus 31% of controls, p < 0.001) and pigmentation disorders (25% of exposed and applicators vs 10% controls, p = 0.06) were found. Among dermatitis cases (n = 117), 5% were positive to maneb on patch testing. In logistic regression analysis, significant predictors (p < 0.1) of dermatitis included years using fungicides (OR = 1.12 per year) and poor application practices (OR = 1.42 per score unit). Agricultural fungicide application in high-exposure situations can contribute to dermatitis prevalence among farm populations.

Amiodarona y efectos secundarios cutáneos / Amiodarone and secondary cutaneous effects

El clorhidrato de amiodarona es un agente antiarrítmico con efectos secundarios cutáneos conocidos. Un grupo multidisciplinario de especialistas estudió durante 2 años a 148 pacientes en tratamiento crónico con amiodarona, con el propósito de evaluar los efectos secundarios del fármaco. Todos los pacientes fueron examinados por el mismo dermatólogo, buscando la presencia de alteraciones cutáneas y su correlación con la dosis y duración del tratamiento; 79 eran mujeres, con un promedio de edad de 65 años. Las dosis de amiodarona comprendían un rango de 100 a 400 mg/día. Los pacientes fueron controlados durante 2 años, pero el período de terapia con amiodarona fue de 1 a 9 años. Se encontró fotosensibilidad en 39,3 por ciento de los pacientes, hiperpigmentación azul-grisácea en 10 por ciento , ambos sin relación con la dosis. La presencia de eritema facial se constató en el 24 por ciento de los casos y se estableció que existía relación con la dosis. Un paciente debió suspender la terapia debido a una erupción pruriginosa de placas infiltrativas, las que regresaron completamente al suspender fármacos. 76 por ciento de los pacientes presentaban uno o más trastornos cutáneos diferentes de los relacionados con la miodarona. Estos incluyen micosis de pies y uñas, queratosis actínicas y seborreicas, xerosis y distrofias ungueales. Los efectos secundarios cutáneos son muy comunes y bien tolerados en los pacientes en terapia con amiodarona. La suspensión del tratamiento debido a los efectos secundarios cutáneos fue poco frecuente

Duty to warn about likely adverse effects - news

A 48-year-old West Indian woman with hypertension sued the district health authority and doctors at the district hospital for negligence in not warning her about adverse effects of minoxidil. The drug had led to excessive hair growth and darkening of the face, causing great distress and limiting her social life.(AU)