RESUMO
Psoriasis is a chronic immune-mediated inflammatory disease. Up to 40% of patients with psoriasis may develop psoriatic arthritis. Currently, interleukin (IL)-17/IL-23 pathways are identified as key factors in the immunopathogenesis of both conditions. Here we describe the case of a patient who developed psoriasiform skin lesions 10 months after the initiation of anti-IL17 therapy for psoriatic arthritis. The underlying disease had responded well to the therapy, but the patient developed a striking pustular eruption at the fingers with nail involvement, onycholysis, yellow discoloration, and subungual keratosis. Clinical and histological findings were consistent with an acrodermatitis continua of Hallopeau-like eruption. Skin lesions subsided after discontinuation of the responsible anti-IL17 agent. The interpretation of this paradoxical side effect of biological therapies remains unclear but may relate to an unbalanced inflammatory cytokine response induced by the inhibition of TNF activity. It is likely that patients, who are genetically prone, may respond exaggeratedly to a cytokine imbalance. The identification of this kind of patient, in the future, could be useful in order to choose the correct therapy.
Assuntos
Acrodermatite , Artrite Psoriásica , Interleucina-17/antagonistas & inibidores , Psoríase , Acrodermatite/induzido quimicamente , Feminino , Humanos , Pessoa de Meia-Idade , PeleRESUMO
BACKGROUND: Since 1995, the Indian government has been launching two National Immunization Days (NIDs) annually to administer oral polio vaccines (OPVs) to children under the age of 5. Our aim was to investigate the association between OPVs and Gianotti-Crosti syndrome (GCS). METHODS: A board-certified dermatologist in solo practice conducted the examinations. The patients consulted without the need of a referral. We retrieved files of all children under the age of 5 who were diagnosed with GCS in 18 months. There were three NIDs during these months. We charted the number of children 1 month before, 1 week before, 1 week after, and 1 month after the three NIDs. RESULTS: A total of 116 children (49 boys and 67 girls) under the age of 5 with GCS were found (average age: 2.9 years) within these 18 months of three NIDs. Eleven (9.5%) and 105 (90.5%) children developed GCS 1 month before and 1 month following OPV administration, respectively (RR: 1.81; 95% CI: 1.40-2.35; P < 0.0001). Three (2.6%) and 58 (50.0%) children developed GCS 1 week before and 1 week after OPV administration, respectively (RR: 1.90; 95% CI: 1.12-3.22; P < 0.0001). CONCLUSIONS: The administration of OPV is significantly associated with the occurrence of GCS in the part of the world that we investigated. As we demonstrated a temporal relationship, this association is likely to be causal.
Assuntos
Acrodermatite/epidemiologia , Vacina Antipólio Oral , Vacinação , Acrodermatite/induzido quimicamente , Estudos de Casos e Controles , Pré-Escolar , Feminino , Humanos , Incidência , Índia/epidemiologia , Análise de Séries Temporais Interrompida , Masculino , Vacina Antipólio Oral/efeitos adversos , Vacinação/efeitos adversosRESUMO
BACKGROUND: Skin toxicity is frequent and debilitating in oncologic patients treated with epidermal growth factor receptor inhibitors (EGFRIs). Grading and management of skin adverse events (AEs) are poorly standardized. MATERIALS AND METHODS: We developed a new score (EGFRISTI: Epidermal Growth Factor Receptor Inhibitor-Related Skin Toxicity Index) which is able to quantify and monitor all EGFRI-related dermatologic AEs over time. The utility of this tool was validated in 130 patients treated with 5 different EGFRIs including both monoclonal antibodies and tyrosine kinase inhibitors. RESULTS: The mean baseline EGFRISTI score was 26.9 (range: 6.0-64.5). Mild toxicity was found in 55 patients (42.3%), moderate toxicity in 43 (33.1%), and severe toxicity in 32 patients (24.6%). After the first-line toxicity treatment, an EGFRISTI score reduction of >75% was obtained in 31 patients (34.1%) and one of 50% in 40 patients (43.9%), while an improvement of <50% was observed in the remaining 20 subjects (22.0%). CONCLUSIONS: The EGFRISTI is a simple and reliable tool to quantify and express the severity of all clinical signs and symptoms of EGFRI skin toxicity with a single numerical value, to choose the most suitable therapy, and to measure its efficacy.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antineoplásicos/efeitos adversos , Receptores ErbB/antagonistas & inibidores , Inibidores de Proteínas Quinases/efeitos adversos , Dermatopatias/induzido quimicamente , Acrodermatite/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias/terapiaAssuntos
Acrodermatite/tratamento farmacológico , Acrodermatite/etiologia , Zinco/deficiência , Acrodermatite/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Receptores de Angiotensina/efeitos adversos , Dieta , Suplementos Nutricionais , Diuréticos/efeitos adversos , Feminino , Humanos , Masculino , Zinco/sangue , Zinco/uso terapêuticoAssuntos
Acrodermatite/induzido quimicamente , Eritema/induzido quimicamente , Dermatoses Faciais/induzido quimicamente , Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza/efeitos adversos , Adjuvantes Imunológicos/efeitos adversos , Pré-Escolar , Feminino , Humanos , MasculinoAssuntos
Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Erupção por Droga/classificação , Eritema/classificação , Parestesia/induzido quimicamente , Terminologia como Assunto , Acrodermatite/induzido quimicamente , Acrodermatite/patologia , Diagnóstico Diferencial , Erupção por Droga/etiologia , Erupção por Droga/patologia , Glândulas Écrinas/patologia , Epiderme/patologia , Eritema/induzido quimicamente , Eritema/patologia , Hidradenite/induzido quimicamente , Hidradenite/patologia , Humanos , Pele/patologiaAssuntos
Antineoplásicos/efeitos adversos , Benzenossulfonatos/efeitos adversos , Erupção por Droga/etiologia , Indóis/efeitos adversos , Piridinas/efeitos adversos , Pirróis/efeitos adversos , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Quinases raf/antagonistas & inibidores , Acrodermatite/induzido quimicamente , Inibidores da Angiogênese/efeitos adversos , Doenças do Cabelo/induzido quimicamente , Humanos , Doenças da Unha/induzido quimicamente , Niacinamida/análogos & derivados , Compostos de Fenilureia , Inibidores de Proteínas Quinases/efeitos adversos , Pele/efeitos dos fármacos , Sorafenibe , SunitinibeAssuntos
Hipersensibilidade Alimentar/diagnóstico , Dermatopatias Metabólicas/diagnóstico , Zinco/deficiência , Acrodermatite/induzido quimicamente , Acrodermatite/etiologia , Diagnóstico Diferencial , Hipersensibilidade Alimentar/complicações , Humanos , Lactente , Masculino , Zinco/uso terapêuticoAssuntos
Acrodermatite/induzido quimicamente , Anti-Inflamatórios/uso terapêutico , Antineoplásicos Alquilantes/efeitos adversos , Dacarbazina/análogos & derivados , Dexametasona/uso terapêutico , Erupção por Droga/etiologia , Eritema/induzido quimicamente , Glucocorticoides/uso terapêutico , Parestesia/induzido quimicamente , Acrodermatite/tratamento farmacológico , Idoso , Dacarbazina/efeitos adversos , Erupção por Droga/tratamento farmacológico , Humanos , Masculino , TemozolomidaRESUMO
This report describes a patient with metastatic kidney cancer who developed a deep yellow skin discoloration while on therapy with the oral multitargeted tyrosine kinase inhibitor (TKI), sorafenib. A significant hand-foot syndrome, featuring acral skin desquamation and tender erythema at pressure points, was also present. A thorough clinicolaboratory investigation did not reveal any evidence of jaundice, B12 deficiency, anemia, carotenemia, hypothyroidism, or any other disorder of endocrine or metabolic etiology.
Assuntos
Antineoplásicos/efeitos adversos , Benzenossulfonatos/efeitos adversos , Carcinoma de Células Renais/secundário , Transtornos da Pigmentação/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Piridinas/efeitos adversos , Quinases raf/antagonistas & inibidores , Acrodermatite/induzido quimicamente , Carcinoma de Células Renais/tratamento farmacológico , Eritema/induzido quimicamente , Humanos , Neoplasias Renais/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Niacinamida/análogos & derivados , Compostos de Fenilureia , Sorafenibe , Neoplasias da Coluna Vertebral/secundárioRESUMO
Zinc deficiency syndrome with acrodermatitis enteropathica-like skin changes developed in a 66-year-old patient during treatment of manganese poisoning with the chelating agents CaNa2-EDTA and Ca-trisodium-pentetate, which had reduced the serum-zinc level. The skin changes cleared up after oral administration of zinc aspartate.