Dermatological complications of therapy with biologics in inflammatory autoimmune diseases.

BACKGROUND AND OBJECTIVE: Cutaneous adverse events (CAEs) occur in up to 10 % of patients with immune-mediated inflammatory disease (IMID) treated with antitumor necrosis factor (TNF)α agents. The aim of this clinical study was to track and observe the course of CAEs in all biologic therapies. PATIENTS AND METHODS: The population for this study consisted of patients with CAEs under biologic therapy who were examined by experienced board-certified dermatologists in the outpatient department of the University Hospital Essen, Department of Dermatology. RESULTS: Altogether 39 patients with a total of 45 CAEs were included in this study. In 60 % of the cases a form of paradoxical psoriasis was diagnosed. Two thirds (66.6 %) of the patients with CAEs were diagnosed with an underlying inflammatory bowel disease (IBD). TNFα antagonists were the triggering agents in about 95 % of the cases. Changes in biological therapy were required in nearly half of the cases (46.2 %). Almost 90 % of the patients had either a complete (42.1 %) or a partial response (47 %). CONCLUSIONS: Management of CEAs under biological therapy can be challenging in clinical practice. Case discussions between gastroenterologists, rheumatologists and dermatologists should be undertaken to best manage patients with CAEs and avoid unnecessary changes of therapy.

Reacciones cutáneas debido al uso de icodextrina en pacientes en diálisis peritoneal / Skin reactions with the use of icodextrin in peritoneal dialysis patients

No disponible

Treatment of human scabies with oral ivermectin. Eczematous eruptions as a new non-reported adverse event / Tratamiento de la sarna en humanos con ivermectina oral. Erupciones eccematosas como nuevos efectos adversos no reportados

Background: Oral ivermectin is an alternative therapy for human scabies infection due to its ease of administration and good safety profile. However, there is no definitive consensus on the optimal dosing regimen. Objective: To describe the treatment of human scabies with different dosages of oral ivermectin and the possible adverse events. Methods: 23 patients with human scabies were treated with oral ivermectin: 10 patients received a single oral dose of 200μg/kg and 13 a dose of 400μg/kg. A second, or even a third dose, was administered in cases of treatment failure. Results: A complete clinical response was achieved by all of the patients. The first ten patients required at least two (80%) or three (20%) doses of ivermectin for complete resolution of the infection. The remaining cases resolved with a single 400μg/kg oral dose. Within the first 72h after the administration of oral ivermectin, new cutaneous lesions were observed in eleven patients (47.8%). Cutaneous biopsies showed signs of subacute eczema. The eruption was treated with topical corticosteroids and emollient therapy. There was no other new drug administration or a history of irritants. There was no history of atopic diathesis except for one patient. Conclusions: Oral ivermectin is an effective therapy for the treatment of human scabies. A single 400μg/kg oral dose demonstrated high efficacy and good tolerance. However, the appearance of eczematous cutaneous lesions induced by oral ivermectin has not previously been reported in the literature. Dermatologists should be aware of this possible adverse event (AU)

Introducción: La ivermectina oral es una alternativa terapéutica en el tratamiento de la escabiosis humana debido a su fácil administración y buen perfil de seguridad. Sin embargo, no existe un consenso definido sobre un esquema adecuado de dosificación. Objetivo: Describir el tratamiento de escabiosis en humanos con diferentes dosis de ivermectina oral y sus posibles efectos adversos. Métodos: 23 pacientes con escabiosis fueron tratados con ivermectina oral; 10 pacientes recibieron una única dosis de 200 μg/kg y 13 pacientes, una dosis de 400 μg/kg. Una segunda, e incluso, una tercera dosis fueron administradas en casos de fallo terapeútico. Resultados: Todos los pacientes tuvieron respuesta clínica al tratamiento. Los primeros 10 pacientes necesitaron, al menos, 2 dosis (80%) o 3 dosis (20%) para conseguir una remisión completa de la infección. En el resto de pacientes se resolvió con una única dosis oral de 400 μg/kg. En las primeras 72 horas tras la administración de ivermectina oral se observaron nuevas lesiones cutáneas en 11 pacientes (47,8%). Las biopsias cutáneas mostraron signos de eccema subagudo. Se realizó tratamiento con corticoterapia tópica y emolientes. No había antecedentes de toma de otros fármacos, contacto con agentes irritantes ni historia de dermatitis atópica salvo en 1 paciente. Conclusiones: Ivermectina oral es una terapia eficaz en el tratamiento de escabiosis humana. Una dosis única de 400 μg/kg demostró una alta eficacia y buena tolerancia. Sin embargo, la aparición de lesiones cutaneas eccematosas inducidas por ivermectina oral no había sido descrito previamente en la literatura y por tanto, consideramos que los dermatólogos deberían conocer este posible efecto adverso (AU)

Tatuajes de henna negra, ¿temporales? / Black henna tattoos, are they temporary?

Los tatuajes de henna natural (marrón/roja) se llevan realizando desde antaño con escasos efectos secundarios. En la actualidad está aumentando la práctica de tatuajes temporales de henna negra (que está adulterada principalmente con parafenilendiamina [PPD]) gracias a su aparente inocuidad y a su desaparición en pocas semanas. La PPD es un colorante sintético de uso frecuente en tintes capilares, que permite mejorar sus propiedades cosméticas, pero, secundariamente, presenta un gran poder sensibilizante, lo que ha propiciado la aparición de múltiples casos de eccemas de contacto, muchos de ellos en niños y adolescentes, debido a la cada vez más amplia oferta de tatuadores y al desconocimiento de los padres acerca de los riesgos de esta práctica. Nuestra labor como pediatras es informar adecuadamente a los padres acerca de estos riesgos, con el fin de evitar los efectos dañinos derivados de ella. Presentamos un caso de dermatitis de contacto tras la realización de un tatuaje y revisamos de forma breve la bibliografía publicada al respecto (AU)

Tattoos of natural red/brown henna have been traditionally performed with a few side effects. Black henna temporary tattoos, which contain paraphenylenediamine (PPD), have become increasingly popular because of their apparent harmlessness and disappearance in few weeks. PPD is a synthetic colorant used in hair dyes which improves its cosmetic properties; but, secondly, it has a great sensitization power. Due to that sensitization many cases of allergic contact dermatitis occurring after tattooing have been reported, especially in children and teenagers, since there are many tattoo-painters and the parents are unaware of the risks of these tattoos. Our labor as pediatricians should be to report parents on the risks of this practice properly for avoiding harmful effects. We present one case of allergic contact dermatitis after tattooing and briefly review the literature on the risks of this practice (AU)

Lesiones eccematosas de distribución generalizada / Widespread eczematous lesions

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Placas eritematoedematosas y dolorosas: un inusual efecto secundario por pemetrexed / Painful generalized erythematous patches: A very rare cutaneous adverse effect of pemetrexed

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Efectos adversos cutáneos del imatinib (inhibidor de la tirosín cinasa) / Adverse Skin Effects of Imatinib, a Tyrosine Kinase Inhibitor

El imatinib mesilato es un inhibidor de la tirosín cinasa de administración oral que inhibe la BCR-abl, c-KIT y el platelet-derived growth factor receptor (PDGFR). Sus indicaciones fundamentales son la leucemia mieloide crónica y los tumores del estroma gastrointestinal. En Dermatología se emplea en enfermedades como el dermatofibrosarcoma protuberans, esclerosis sistémica y mastocitosis sistémica, entre otras. Es un fármaco en general bien tolerado, con la mayoría de efectos adversos leves o moderados. Los efectos secundarios dermatológicos son muy frecuentes e incluyen erupciones cutáneas inespecíficas como edema o erupciones maculopapulosas o con características clínicas distintivas (liquenoides, psoriasiformes, pustulosis exantemática aguda generalizada, síndrome de Stevens- Johnson…). Identificar y tratar correctamente estas reacciones puede ayudar a optimizar la adherencia del paciente al tratamiento y mejorar el pronóstico de su enfermedad de base

Imatinib mesylate is a tyrosine kinase inhibitor that targets the BCR-ABL, c-kit, and PDGF (platelet-derived growth factor) receptors. Imatinib is mainly indicated for chronic myeloid leukemia and gastrointestinal stromal tumors but is also prescribed by dermatologists for dermatofibrosarcoma protuberans, systemic sclerosis, and systemic mastocytosis, among other conditions. Most adverse effects are mild or moderate and therapy is generally well tolerated. Adverse skin effects are very common and include nonspecific manifestations such as edema and maculopapular rashes or eruptions of diverse types (lichenoid or psoriasiform lesions, acute generalized exanthematic pustulosis, Stevens-Johnson syndrome, and more). Identifying and properly treating these reactions can help optimize adherence to treatment and improve the prognosis of the underlying disease

Accumulation of invariant NKT cells into inflamed skin in a novel murine model of nickel allergy.

Nickel (Ni) can cause delayed-type hypersensitivity reactions, which are thought to be mediated by the accumulation of T cells into inflamed skin. Accumulated T cells at the developmental stages in metal allergy are poorly characterized because a suitable animal model has not been established. To investigate the accumulated T cells in allergic inflamed skin, we generated a novel murine model of Ni-induced allergy. The murine model of Ni allergy was induced by two sensitizations of Ni plus lipopolysaccharide solution into the groin followed by three challenges with Ni solution into the footpad. Here we show that a specific TCR repertoire bearing Vα14Jα18, called natural killer (NK) T cells, was expanded monoclonally in BALB/c or C57BL/6 mice. Accumulation of NKT cells was characterized as CD4(+) or CD4(-)CD8(-) T cells. These results suggested that NKT cells are major pathogenic T cells at the elicitation phase of Ni allergy.

Eritema fijo medicamentoso: claves diagnósticas / Fixed drug eruption: diagnostic clues

El eritema fijo medicamentoso (EFM) es una variante especial de toxicodermia caracterizada por la aparición de lesiones cutáneas y/o mucosas que presentan recurrencias siempre en la misma localización tras la administración oral del agente causal, normalmente un fármaco. El diagnóstico es fundamentalmente clínico, basado en una anamnesis farmacológica exhaustiva y en el reconocimiento de las manifestaciones clínicas características de esta entidad. Existen algunas pruebas diagnósticas que contribuyen a confirmar el diagnóstico, como la prueba del parche aplicando sobre la piel el fármaco sospechoso, la prueba de provocación oral con la toma del fármaco por vía oral y la biopsia cutánea. Presentamos 3 casos de EFM y describimos sus características clínicas y el procedimiento diagnóstico seguido en estos casos (AU)

Fixed drug eruption (FDE) is a special variant of toxicoderma characterised by skin lesions and / or mucous which always occurs in the same location after oral administration of the causal agent, usually a drug. The diagnosis is mainly clinical, based on a thorough drug history and recognition of clinical features of this condition. There are several diagnostic tests that help confirm the diagnosis, such as applying a patch test on skin suspected drugs, the oral provocation test with oral drug intake and skin biopsy. We present three cases of fixed drug eruption and describe its clinical features and the diagnostic procedure followed in these cases (AU)

Severe skin lesions cause patients with inflammatory bowel disease to discontinue anti-tumor necrosis factor therapy.

BACKGROUND & AIMS: Psoriasiform and eczematiform lesions are associated with anti-tumor necrosis factor (TNF)-α therapies. We assessed clinical characteristics, risk factors, and outcomes of skin disease in patients with inflammatory bowel diseases that presented with psoriasiform and eczematiform lesions induced by anti-TNF-α agents. METHODS: We studied 85 patients (69 with Crohn's disease, 15 with ulcerative colitis, and 1 with indeterminate colitis; 62 women) with inflammatory skin lesions (62 psoriasiform and 23 eczematiform lesions). RESULTS: Twenty-four patients had a history of inflammatory skin lesions and 15 had a familial history of inflammatory skin disease. Locations of eczematiform lesions varied whereas scalp and flexural varieties were mostly psoriasiform. Skin lesions emerged but inflammatory bowel disease was quiescent in 69 patients following treatment with any type of anti-TNF-α agent (60 with infliximab, 20 with adalimumab, and 5 with certolizumab). Topical therapy resulted in partial or total remission in 41 patients. Patients with psoriasiform lesions that were resistant to topical therapy and that changed anti-TNF-α therapies once or twice developed recurring lesions. Overall, uncontrolled skin lesions caused 29 patients to stop taking TNF-α inhibitors. CONCLUSIONS: Inflammatory skin lesions following therapy with TNF-α inhibitors occurred most frequently among women and patients with a personal or familial history of inflammatory skin disease; lesions did not correlate with intestinal disease activity. Recurring and intense skin lesions caused 34% of patients in this study to discontinue use of anti-TNF-α agents.

[Skin diseases among workers engaged into copper-nickel and aluminium production in Far North]. / Zabolevaniia kozhi sredi rabotnikov medno-nikelevogo i aliuminievogo proizvodstva na Krainem Severe.

The article covers materials obtained in study of skin diseases in workers engaged into non-ferrous metals production. The authors specified suggestions on prevention of metal allergies among major professions of metallurgy complex in Far North.

Ricina: una fitotoxina de uso potencial como arma / Ricin: a phytotoxin with potential use as a weapon

La ricina es una fitotoxina con actividad citotóxica que está presente en las semillas de ricino ( Ricinus communis L.). Su estructura consta de dos cadenas polipeptídicas: una con propiedades de lectina, que le permite fijarse a glicolípidos y glicoproteínas presentes en la superficie de la membrana celular, y otra capaz de inhibir la síntesis de proteínas a nivel de los ribosomas. El acceso desde la superficie de la célula hasta los ribosomas supone un complejo proceso que incluye un transporte retrógrado desde el aparato de Golgi hasta el retículo endoplasmático, donde se produce la translocación al citosol. Hoy se sabe que algunas publicaciones paramilitares y manuales relacionados con la red terrorista Al Qaeda explican procedimientos para la extracción de ricina a partir de las semillas de ricino. Esto ha llevado a la actual preocupación por que la ricina pueda ser empleada con fines terroristas. La ricina fue incluida en los programas de armamento químico y biológico de distintos países, en los que se comprobó la dificultad que presenta para ser diseminada de forma eficaz con el fin de causar un elevado número de afectados. Las ventajas que presentaría la intoxicación por ricina, utilizada como arma, incluyen: un período de latencia de varias horas; la poca especificidad de los síntomas y signos por cualquier vía de exposición; y la inexistencia de un tratamiento antidótico (AU)

Ricin is a phytotoxin with cytotoxic activity present in castor plant ( Ricinus communis L.) seeds. Its structure consists of two polypeptide chains: one with lectin properties that allows it to bind to glycoproteins and glycolipids on the cell surface and the other one which inhibits protein synthesis at the ribosomes level. Access of the toxin from the cell surface to the ribosomes is a complex process with retrograde transport from the Golgi complex to the endoplasmic reticulum, followed by translocation to the cytosol. It is now known that some paramilitary publications and manuals related to the Al Qaeda terrorist network detail procedures regarding the method for extracting ricin from the castor plant seeds. This has increased the fear that ricin may be used for terrorist purposes. Ricin has been part of the chemical and biological weapons programs in different countries and it was found that this toxin is not easy to disseminate for the purpose of causing a large number of casualties. Advantages of ricin intoxication, if used as a weapon, include a latency period of several hours; nonspecific symptoms and signs regardless of the exposure route; and the lack of an antidotal treatment (AU)

Pattern of use of skin care products in children with and without eczematous skin lesions.

OBJECTIVE: To compare the pattern of use of skin care products between children with eczematous skin lesions and those without. DESIGN: Case control study. SETTING: Two well baby clinics at the Kenyatta National Hospital and the Mbagathi District Hospital in Nairobi. SUBJECTS: Eighty nine infants with eczematous skin lesions and 89 age and sex matched controls without skin lesions. MAIN OUTCOME MEASURES: Presence and severity of skin lesions related to the type of skin care products used by the child. RESULTS: Exposure to various products was not significantly different between infants with skin lesions and those without. However, more mothers whose children had a skin rash had made a change in the type of soap and or skin cream used for their child (p<0.0001). The principal reason for changing products was skin rash in the baby and most mothers made changes away from scented baby soap products. CONCLUSION: The study found no significant difference between the cases and controls regarding the type of skin care products used.

Clinical sequelae associated with squaric acid dibutylester topical sensitization.

BACKGROUND: Squaric acid dibutylester (SADBE) is a potent topical sensitizer used in the treatment of various cutaneous conditions. Currently, there are no standardized protocols defining safe sensitization methods or treatment regimens following sensitization. OBJECTIVE: This is a literature review of the clinical use of SADBE and a report of our experience with SADBE therapy and its potential hazards. METHODS: SADBE was applied with a cotton swab to the forearm of 14 patients to induce contact dermatitis. RESULTS: Ten of 14 patients (71%) had severe eczematous reactions at the site of sensitization, and 9 of 14 (64%) developed disseminated reactions. CONCLUSION: Standard protocols delineating safe methods of sensitization and treatment with SADBE need further development.

Exposure to selected fragrance materials. A case study of fragrance-mix-positive eczema patients.

The aim of the present study was to assess exposure to constituents of the fragrance mix from cosmetic products used by fragrance-mix-positive eczema patients. 23 products, which had either given a positive patch and/or use test in a total of 11 fragrance-mix-positive patients, were analyzed. In all cases, the use of these cosmetics completely or partly explained present or past episodes of eczema. Between 1 to 6 constituents of the fragrance mix were found in 22 out of 23 products. The cosmetics of all the patients sensitive to hydroxycitronellal, eugenol, cinnamic alcohol and alpha-amylcinnamic aldehyde were found to contain the respective substances. Exposure concentrations were seen to cover a large range. The content of hydroxycitronellal was, on average, 5 x higher in cosmetics from hydroxycitronellal-sensitive patients, compared to cosmetics from hydroxycitronellal-negative patients. It is concluded that exposure to constituents of the fragrance mix is common in fragrance-allergic patients with cosmetic eczema, and that the fragrance mix is a good reflection of actual exposure.

Eczematous-like drug eruption induced by synergistins.

The authors report 4 cases of eczematous-like drug eruption after oral ingestion of synergistins, pristinamycin (3 cases) and virginiamycin (1 case). The lesions occurred after contact sensitization with topical virginiamycin. The clinical symptoms appeared a few hours after ingestion: a generalized maculopapular eruption, sometimes with general symptoms of anaphylactic reaction. Eczema appeared again on initial areas of contact dermatitis. There is a common allergenic group between these 2 antibiotics, which is a macrocyclic lactone. Physiopathology of this drug eruption is not clear: allergic reaction of the delayed type or anaphylactic reaction. Patients allergic to virginiamycin should be strongly cautioned against oral pristinamycin.

Suspected cutaneous drug toxicity in rheumatoid arthritis--an evaluation.

Cutaneous toxicity from drugs used to treat RA is a major perceived problem. Over a 2-yr period we have prospectively reviewed 114 patients with a suspected adverse cutaneous reaction to anti-rheumatic drugs. In 71 (62%), the rash was thought to be unrelated to drug therapy. This group included 10 in whom the rash had resolved before review (usually < 1 week), 38 with a rash related to their rheumatoid disease and 23 with eruptions unrelated to either drugs or arthritis. Forty-three (38%) patients had rashes thought to be related to their drug therapy. Gold therapy (both oral and intramuscular) was implicated most frequently (31 patients). However, the majority of these (23) had a pityriasiform/discoid eczematous eruption that responded to potent topical steroids occasionally with a reduction in gold dosage. In this sample it was possible to continue drug therapy in 82% of patients with what were initially thought to be cutaneous adverse drug reactions. Careful evaluation should allow a majority of patients to continue drug therapy from which they are often gaining benefit.