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1.
Medicine (Baltimore) ; 99(21): e20389, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481338

RESUMO

RATIONALE: Acute generalized exanthematous pustulosis (AGEP) is a severe pustular cutaneous adverse drug reaction. Sterile, non-follicular pustules overlying the erythematous skin characterize this reaction. PATIENT CONCERNS: A 30-year-old Asian women presented with sterile, non-follicular lesions with pus-fluid levels on her back 2 days after taking clindamycin. Skin biopsy revealed a spongiotic change in the epidermis with a focal subcorneal pustule and perivascular eosinophil and lymphocyte infiltration. DIAGNOSIS: Clindamycin-induced AGEP. INTERVENTIONS: We discontinued clindamycin treatment and prescribed systemic corticosteroids. OUTCOMES: The pustule stopped spreading within 1 day and the rash improved within 2 days. LESSONS: AGEP is a pustular cutaneous adverse drug reaction that can appear with pus-fluid levels, clinically mimicking Sneddon-Wilkinson disease. The differentiation between both conditions is a history of drug use, characteristic skin lesions and histopathology.


Assuntos
Pustulose Exantematosa Aguda Generalizada/etiologia , Clindamicina/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Clindamicina/uso terapêutico , Exantema/tratamento farmacológico , Exantema/etiologia , Exantema/fisiopatologia , Feminino , Humanos , Faringite/tratamento farmacológico
7.
Complement Ther Med ; 47: 102167, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31780021

RESUMO

OBJECTIVE: To systematically review and evaluate the effectiveness of Chinese herbal medicine (CHM) therapy for epidermal growth factor receptor inhibitor (EGFRI)-induced skin rash in patients with malignancy. METHODS: The electronic databases of Medline, PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, VIP Chinese Sci-tech Journal, Wan Fang, and Chinese Biomedicine were searched from their inception to 31 st September 2018. Randomized controlled trials (RCTs) investigating the effectiveness of CHM in improving EGFRI-induced skin rash were analyzed by Review Manager 5.3. RESULTS: Twenty-three eligible RCTs with 1392 participants were identified and divided into four subgroups according to different treatment rules of Traditional Chinese Medicine (TCM) and different controls. CHM (dispel wind, clear heat, and eliminate dampness), the representative formula Xiao Feng San, is more effective than western medicine in improving and curing skin rash(RR,95%CI: 1.46,1.26-1.70 and 1.65,1.24-2.20); CHM (nourish yin, clear heat, and remove toxin for eliminating blood stasis), the representative formula Yang Fei Xiao Zhen Tang, is more effective than western medicine in improving skin rash(RR,95%CI: 1.45,1.10-1.92). CHM (clear lung and purge heat, cool blood, and remove toxic substance) is more effective in improving and curing skin rash, compared with the western medicine group (RR,95%CI: 1.42,1.21-1.67 and 2.43,1.23-4.81) or the blank control group(RR,95%CI:2.37,1.21-4.63 and 2.98,1.20-7.41). The side effects of CHM are all mild and tolerable. Sensitivity analysis indicates that the results of the study are stable. The asymmetry funnel plots described that publication bias of this research may exist. CONCLUSION: The limited evidence suggests that CHM exhibits clinical effectiveness and good safety on the treatment of EGFRI-induced skin rash. Large-sample RCTs are required to further determine the effectiveness of CHM.


Assuntos
Antineoplásicos/efeitos adversos , Medicamentos de Ervas Chinesas/uso terapêutico , Receptores ErbB/antagonistas & inibidores , Exantema/induzido quimicamente , Exantema/tratamento farmacológico , Neoplasias/tratamento farmacológico , Humanos , Medicina Tradicional Chinesa , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
Gastroenterology ; 157(4): e8-e9, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476298
13.
BMJ Case Rep ; 12(8)2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31377719

RESUMO

Systemic drug exposure can produce a skin reaction consisting of symmetrical erythema involving the gluteal and intertriginous areas in the absence of systemic involvement. Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) occurs after systemic exposure to a drug in which the patient was not previously sensitised, either in the first dose or after several doses. The mechanism of SDRIFE is unknown but is hypothesised to be the result of a delayed hypersensitivity response resulting in a cutaneous eruption some days after the exposure to the drug. The diagnosis should be clinical, based on the history and examination, but skin tests can also be performed to confirm sensitisation. But, as always, the gold-standard test is oral provocation. It is important to know this clinical entity to prevent re-exposure to the responsible allergen in the future.


Assuntos
Clindamicina/efeitos adversos , Erupção por Droga/diagnóstico , Exantema/induzido quimicamente , Intertrigo/induzido quimicamente , Administração Oral , Biópsia , Erupção por Droga/tratamento farmacológico , Erupção por Droga/patologia , Exantema/tratamento farmacológico , Exantema/patologia , Feminino , Humanos , Intertrigo/tratamento farmacológico , Intertrigo/patologia , Pessoa de Meia-Idade , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento
16.
BMJ Case Rep ; 12(6)2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167767

RESUMO

Immune checkpoint inhibitors, such as pembrolizumab, have significantly improved cancer patient outcome. Toxicities are usually moderate and manageable. However, some adverse events, if not early recognised, could be life-threatening. We report a patient with non-small cell lung cancer who received treatment with pembrolizumab and developed multiple immune-related adverse events both during and after completing treatment, including rash, pericarditis, colitis and myasthenia gravis.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/uso terapêutico , Colite/induzido quimicamente , Colite/tratamento farmacológico , Exantema/induzido quimicamente , Exantema/tratamento farmacológico , Feminino , Humanos , Neoplasias Pulmonares/patologia , Miastenia Gravis/induzido quimicamente , Miastenia Gravis/tratamento farmacológico , Pericardite/induzido quimicamente , Pericardite/tratamento farmacológico , Plasmaferese/métodos , Resultado do Tratamento
17.
Dtsch Med Wochenschr ; 144(11): 759-763, 2019 06.
Artigo em Alemão | MEDLINE | ID: mdl-31163477

RESUMO

HISTORY AND ADMISSION FINDINGS: In this case series, we describe 4 patients who presented to a rheumatologic clinic with very different complains however were ultimately diagnosed with the same underlying disease. The wide spectrum of symptoms included generalized maculopapular exanthema, arthralgia, myalgia and vision problems. One patient received anti-TNF therapy for ankylosing spondylitis and recurrent uveitis. On exam, joint swelling and skin changes were found. INVESTIGATION: All patients were found to have an elevated Treponema pallidum antibody titer and a positive of the rapid plasma reagin test. DIAGNOSIS: Patients were diagnosed with syphilis. TREATMENT AND COURSE: The first three patients received an intramuscular injection of 2.4 million benzabine penicillin G. The fourth patient was treated with penicillin 6 million IV 4 times a day for more than 14 days, due to immunosuppression CONCLUSION: In the presence of non-specific and often rather diffuse symptoms, with which patients in rheumatology often present, a non-primary rheumatological, e. g. infectious genesis, also needs to be considered. Due to the increasing incidence of syphilis in Germany in recent years special attention needs to be paid to this disease in rheumatological care.


Assuntos
Artralgia/microbiologia , Exantema , Infecções Oculares Bacterianas , Sífilis , Treponema pallidum , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Exantema/complicações , Exantema/diagnóstico , Exantema/tratamento farmacológico , Exantema/microbiologia , Infecções Oculares Bacterianas/complicações , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Penicilina G/administração & dosagem , Penicilina G/uso terapêutico , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sífilis/microbiologia , Sorodiagnóstico da Sífilis , Adulto Jovem
18.
J Cardiovasc Pharmacol ; 73(6): 394-396, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31162248

RESUMO

We report the case of an elderly woman who developed exanthematic drug eruption after administration of efonidipine. An 84-year-old woman presented to emergency department with complaints of generalized itching and erythema since 4 days. She was on human-soluble insulin since 11 years. In view of her hypertension and left anterior descending artery stenosis, she was initiated on aspirin, clopidogrel, atorvastatin, pantoprazole, nebivolol, aldactone, and efonidipine a week ago. Her presenting complaints were initially managed with parenteral pheniramine maleate and hydrocortisone. She was admitted, and all her medications except antiplatelets and insulin were discontinued. She was prescribed topical beclomethasone and oral antihistamines for better control of her symptoms. To confirm the drug precipitating the reaction, she was rechallenged with efonidipine, 20 mg once daily on the third day of admission. She developed itching 8 hours after administering the medication, and efonidipine was stopped and nebivolol 5 mg once daily was restarted for hypertension. She did not develop any adverse event when the remaining medications were reinitiated. World Health Organization-Uppsala Monitoring Centre causality assessment criteria indicated a "certain" association. To the best of the knowledge of the authors, this is one among the first reported cases of efonidipine-induced exanthematic drug eruption.


Assuntos
Bloqueadores dos Canais de Cálcio/efeitos adversos , Di-Hidropiridinas/efeitos adversos , Erupção por Droga/etiologia , Exantema/induzido quimicamente , Nitrofenóis/efeitos adversos , Pele/efeitos dos fármacos , Administração Cutânea , Administração Oral , Idoso de 80 Anos ou mais , Erupção por Droga/tratamento farmacológico , Erupção por Droga/patologia , Exantema/tratamento farmacológico , Exantema/patologia , Feminino , Glucocorticoides/administração & dosagem , Antagonistas dos Receptores Histamínicos/administração & dosagem , Humanos , Compostos Organofosforados/efeitos adversos , Pele/patologia , Resultado do Tratamento
19.
J Dermatol ; 46(7): 618-621, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31144726

RESUMO

Eosinophilic dermatosis of hematological malignancy is a paraneoplastic skin eruption associated with chronic lymphocytic leukemia and other B-cell malignancies. It clinically resembles an insect bite reaction and it can precede the symptoms of the hematological malignancy or be related to a more aggressive course. Different treatments have been proposed, but partial response and recurrence are frequent. Herein, we describe a case of eosinophilic dermatosis associated with mantle cell lymphoma with remission after lenalidomide therapy.


Assuntos
Eosinofilia/tratamento farmacológico , Exantema/tratamento farmacológico , Lenalidomida/uso terapêutico , Linfoma de Célula do Manto/complicações , Síndromes Paraneoplásicas/tratamento farmacológico , Prurido/tratamento farmacológico , Eosinofilia/etiologia , Eosinofilia/patologia , Exantema/etiologia , Exantema/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/patologia , Prurido/etiologia , Prurido/patologia , Pele/patologia , Resultado do Tratamento
20.
J Am Acad Dermatol ; 81(1): 111-122, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103317

RESUMO

BACKGROUND: Eruptive squamous atypia (ESA), which is an idiopathic, sometimes koebnerizing, proliferation of atypical but well-differentiated keratinocytes (also termed eruptive keratoacanthoma), is often misdiagnosed as cancer and managed by excisional surgery, provoking further koebnerization. A clear definition of this phenomenon and treatment outcome data are lacking. OBJECTIVE: To define ESA and evaluate efficacy of intralesional (IL) 5-fluorouracil (5-FU) treatment. METHODS: A retrospective cohort study examined patients with ESA that arose spontaneously or within a recent surgical scar and was treated with IL 5-FU at a tertiary academic center between January 2008 and December 2016. Complete clearance, partial clearance, and number of surgical excisions performed were tabulated. RESULTS: Of 30 patients with 136 ESA lesions, 20 (67%) had resolution of ESA with IL 5-FU monotherapy. In all, 10 patients (33%) required additional therapy (topical 5-FU, steroids, cryotherapy, or acitretin). No IL 5-FU-treated ESA lesions required surgical excision. The number of excisional procedures decreased significantly (P = .006), with 27 patients (90%) needing fewer excisions 12 months after versus 12 months before initiation of IL 5-FU therapy. Dyspigmentation was the only adverse event. LIMITATIONS: Limitations include retrospective analysis and use of data from a single institution. CONCLUSION: With close clinical monitoring, IL 5-FU can be used to successfully treat ESA.


Assuntos
Carcinoma de Células Escamosas/patologia , Exantema/patologia , Fluoruracila/administração & dosagem , Ceratoacantoma/tratamento farmacológico , Ceratoacantoma/patologia , Neoplasias Cutâneas/patologia , Adulto , Biópsia por Agulha , Carcinoma de Células Escamosas/diagnóstico , Estudos de Coortes , Bases de Dados Factuais , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Esquema de Medicação , Exantema/tratamento farmacológico , Exantema/fisiopatologia , Feminino , Humanos , Imuno-Histoquímica , Injeções Intralesionais , Ceratoacantoma/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Neoplasias Cutâneas/diagnóstico , Estatísticas não Paramétricas , Resultado do Tratamento
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