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PubMed1975

Sjogren's syndrome and drug reaction to practalol.

A case is reported of a patient who developed exfoliative dermatitis while being treated with practalol for angina pectoris. The patient also had trigeminal neuropathy, renal impairment and keratoconjunctivitis sicca. The antinuclear factor was diffusely positive but other antibodies were negative. At post mortem the patient was found to have acute pancreatitis, and peritonitis. It is postulated that the patient has antecedent Sjogren's syndrome and on introduction of practalol therapy developed a drug reaction with a generalised exfoliative dermatitis and exacerbation of keratoconjunctivitis sicca leading to bilateral corneal ulceration. The association of similar conditions in patients receiving practalol therapy is reviewed.

Aged↗

PubMed2006

The sulfone syndrome secondary to dapsone prophylaxis in a patient undergoing unrelated hematopoietic stem cell transplantation.

Dapsone is commonly used for pneumocystis carinii pneumonia (PCP) prophylaxis in immunocompromised patients. It has been used as an alternative therapy in the hematopoietic stem cell transplant (HSCT) setting in patients who can't tolerate trimethoprim-sulfamethoxazole. The Sulfone syndrome is not a well-known sequela of dapsone therapy and occurs at various doses, ranging from 50-300 mg/d. In all cases the syndrome occurs within 2 months of initiating therapy. Its clinical manifestations include: fever, methemoglobinemia, hemolytic anemia, exfoliative dermatitis and transaminits. A 51-year old female underwent a matched unrelated hematopoiectic stem cell transplant for acute mylogenous leukemia. Dapsone therapy was initiated on day +28 at a dose of 100 mg/day for PCP prophylaxis secondary to the patient's history of a sulfonamide allergy. On day +59, one month after initiation of therapy she developed hepatitis, hemolytic anemia, fever and methemoglobinemia of 8%. She was transferred to the intensive care unit and subsequently developed an exfoliative dermatitis. We conclude that the clinical presentation of this patient after HSCT on dapsone therapy coincide with the sulfone syndrome not previously described in a patients after HSCT.

Anemia, Hemolytic↗

PubMed1996

Staphylococcal scalded skin syndrome in an immunocompromised adult.

Staphylococcal scalded skin syndrome, a generalized exfoliative dermatitis complicating infections by exfoliative toxin-producing strains of Staphylococcus aureus, is rarely observed in adults. In contrast to mortality in infants, mortality in adults is usually high. A case of generalized staphylococcal scalded skin syndrome in an immunocompromised woman is reported. Culture of skin biopsy and pleural fluid yielded identical strains of staphylococcus aureus belonging to phage group II. Exfoliative toxins A and B were detected in both isolates. As far as can be determined, this is the first reported case of generalized staphylococcal scalded skin syndrome in an adult with detection of exfoliate toxins A and B in which the patient was treated successfully.

Adult↗

PubMed2002

Staphylococcal scalded skin syndrome.

Staphylococcal Scalded Skin Syndrome (SSSS) is a disease primarily of young children, characterized by exfoliative dermatitis caused by exfoliative toxin producing Staphylococcus aureus. We had three cases of SSSS with varied dermatological manifestations-diffuse/scarlitiniform erythema, generalized exfoliation, sand paper skin texture, flaccid bullae, erosions, seborrheic dermatitis like scaling and cracking in skin creases which can be confused with other skin conditions. Hence, a high index of suspicion, early diagnosis and prompt treatment is imperative.

Female↗

PubMed1978

Atopic dermatitis and Ritter's disease: differential diagnosis by means of total and specific serum IgE.

Atopic dermatitis and Ritter's disease in infants and children frequently present diagnostic as well as therapeutic problems. Both conditions are characterized by generalized exfoliative dermatitis, and are prone to recurrent infections with Staphylococcus. However, in Ritter's disease, it has been shown that these are specifically coagulase-positive Staphylococcus phage Group 2 organisms. This combination of exfoliative dermatitis, with lysis and separation of the skin, associated with infection has been aptly named the staphylococcal scalded skin syndrome. An unusual case is reported herein of a nine year old boy who had a condition clinically resembling Ritter's disease since birth, but with enormously elevated total and specific serum IgE levels characteristic of atopic dermatitis and not seen in Ritter's disease.

Antibody Specificity↗

PubMed1997

Drug eruption induced by cyanamide (carbimide): a clinical and histopathologic study of 7 patients.

BACKGROUND: In some countries, cyanamide is used as an alcohol intake inhibitor with few harmful side effects. So far 3 cases of allergic contact dermatitis and only 1 of lichenoid drug eruption due to cyanamide have been reported. OBJECTIVES AND METHODS: We describe the clinical manifestations, course, histopathologic and immunohistochemical findings of 7 cases of cyanamide-induced drug eruption. RESULTS: Of the 7 patients, 6 developed exfoliative dermatitis and 1 a lichen-planus-like eruption. Three patients with exfoliative dermatitis showed high fever, severe itching, anorexia, insomnia and general malaise, suggesting the diagnosis of hypersensitivity reaction. In all cases, mononuclear cell infiltration in the upper dermis with epidermotropism and dyskeratosis of the epidermal cells were observed histopathologically. The infiltrating cells consisted mainly of T4-positive lymphocytes. CONCLUSION: The cyanamide-induced skin reaction may be included in the spectrum of lichenoid drug eruptions, and its incidence may be much higher than previously reported.

Alcohol Deterrents↗

PubMed1990

A suspected case of trimethoprim/sulfonamide-induced localized exfoliation.

A variety of skin reactions have been associated with the use of sulfonamides. Most of the reactions are uneventful and abate with drug discontinuation. Rare but severe skin reactions can occur and include the Stevens-Johnson syndrome and exfoliative dermatitis. Dermal reactions appear to be the most commonly reported adverse effect in children. Drug continuance following the development of a mild skin rash may be associated with the development of a more severe dermal reaction. This report summarizes a case involving a six-year-old white girl who developed exfoliative dermatitis confined to the feet following a course of oral trimethoprim/sulfamethoxazole (TMP/SMX) for otitis media. Exfoliation is an uncommon cutaneous manifestation following sulfonamide use. Although usually a generalized process, it is unusual to find it confined to the feet. Unfortunately there is no useful diagnostic method that could specifically elucidate the cause of a dermatologic eruption. Available evidence suggest that TMP/SMX was the probable cause of our patient's rash. Adjunctive antihistamines and corticosteroids are often useful when pruritus is present. Severe reactions require vigorous supportive treatment.

Child↗

PubMed1977

"Witch doctor?" A hexing case of dermatitis.

A Mexican-American woman presented with exfoliative dermatitis complicated by a "curse". She was cured by a combination of bland topical therapy and casting off of the spell by a curandero.

Adult↗

PubMed2003

Dapsone induced cholangitis as a part of dapsone syndrome: a case report.

BACKGROUND: Dapsone can rarely cause a hypersensitivity reaction called dapsone syndrome, consisting of fever, hepatitis, exfoliative dermatitis, lymphadenopathy and hemolytic anemia. Dapsone syndrome is a manifestation of the DRESS (drug rash with eosinophilia and systemic symptoms) syndrome which is a serious condition that has been reported in association with various drugs. Cholangitis in dapsone syndrome has not been reported so far in the world literature. CASE PRESENTATION: We report a patient who presented with fever, exfoliative dermatitis, jaundice and anemia within three weeks of starting of dapsone therapy. These features are typical of dapsone syndrome, which is due to dapsone hypersensitivity and is potentially fatal. Unlike previous reports of hepatitic or cholestatic injury in dapsone syndrome we report here a case that had cholangitic liver injury. It responded to corticosteroids. CONCLUSION: We conclude that cholangitis, though unusual, can also form a part of dapsone syndrome. Physicians should be aware of this unusual picture of potentially fatal dapsone syndrome.

Adult↗

PubMed2003

Adult staphylococcus scalded skin syndrome in a peritoneal dialysis patient.

Staphylococcal scalded skin syndrome (SSSS), a generalized exfoliative dermatitis complicating infections by exfoliative toxin-producing strains of Staphylococcus aureus, is rarely observed in adults, especially in those with chronic renal failure. In contrast to the mortality in infants, the mortality in adults is usually high. A case of generalized SSSS in a peritoneal dialysis patient is reported. A-62-year old Japanese man in whom peritoneal dialysis had been carried out was admitted to our hospital with acute peritonitis. It was intractable peritonitis in terms of resistance to various antibiotics; however, improvement of the peritonitis was shown after the injection of vancomycin. Nine days after the completion of this medication, erythema appeared in the eyes and mouth, and around the nostrils, with an exothermic reaction at 39.0 degrees C. Radial cracks formed in the face within a few days, and the erythema rapidly expanded to the neck, axilla, the whole body. The blood pressure was also lowered, and this led to a state of shock. Culture of skin biopsy specimens yielded identical strains of S. aureus. A presumptive diagnosis of SSSS was made. The patient was treated with antibiotics that were effective against the organisms and with both fluid supplementation and dopamine, resulting in subsidence of the signs and symptoms. The exothermic reaction and skin symptoms were improved promptly, with improvement in the general condition, including the state of shock. This appears to be the first reported case of SSSS caused by S. aureusin an adult patient with peritoneal dialysis who was treated successfully. It is very important that SSSS be differentiated from toxic epidermal necrosis, as the treatment is different.

Anti-Bacterial Agents↗

PubMed1985

Chronic eosinophilic dermatitis: a manifestation of a multisystemic, eosinophilic, epitheliotropic disease in five horses.

A generalized, chronic, progressive, exfoliative dermatitis in five horses is described. Histologically, the lesion is characterized by a superficial and deep perivascular dermatitis which is eosinophil-rich with a marked lymphocytic and plasmacytic component, accompanied by marked acanthosis and hyperkeratosis. More severe cases progress to a lichenoid pattern with the same cellular composition with focal eosinophilic spongiosis and eosinophilic subcorneal pustules. Clinically, the disease is associated with chronic, severe weight loss and is fulminating. The skin lesions are accompanied by lymphoplasmacytic and eosinophilic infiltrates and formation of eosinophilic granulomas in other epithelial organs, most noticeably the pancreas, in which a chronic, fibrosing pancreatitis develops. Other epithelial organs involved to various degrees are salivary glands, the gastrointestinal system, including the oral cavity and esophagus, biliary epithelium and bronchial epithelium. The etiology of this disease is unknown.

Animals↗

PubMed1985

Clinical syndromes caused by staphylococcal epidermolytic toxin.

Coagulase-positive staphylococci of phage group II produce an epidermolytic toxin that results in a spectrum of diseases that include localized bullous impetigo, generalized scarlatiniform syndrome without exfoliation, and staphylococcal scalded-skin syndrome (SSSS). The mechanism of action of the toxin occurs at the level of the lower stratum granulosum, resulting in intraepidermal cleavage. Generalized exfoliative dermatitis, or SSSS, is one of the most severe infections characterized by generalized epidermolysis with desquamation. Generalized scarlatiniform syndrome is an erythematous rash without exfoliation. A localized infection that results in a bulla larger than 5 mm in diameter is bullous impetigo.

Bacterial Toxins↗

PubMed2001

Toxin levels in serum correlate with the development of staphylococcal scalded skin syndrome in a murine model.

Staphylococcal scalded skin syndrome (SSSS) is an exfoliative dermatitis that results from infection with exfoliative toxin-producing Staphylococcus aureus. SSSS is seen primarily in infants and children. Here we ask if there is a specific maturation process that protects healthy adults from this syndrome. For these studies, an active recombinant exfoliative toxin A (rETA) was used in a neonatal mouse model. A time course generated on the susceptibility to the toxin as a function of mouse age indicated that BALB/c mice developed the characteristic symptoms of SSSS until day 7 of life. Between day 7 and day 8 of life there was a dramatic decrease in susceptibility, such that mice at day 9 of life were resistant to the effects of the toxin. This time course corresponds approximately to the time needed for maturation of the adaptive immune response, and SSSS in adults is often identified with immunocompromised states. Therefore, mice deficient in this response were examined. Adult mice thymectomized at birth and adult SCID mice did not develop the symptoms of SSSS after injection with the toxin, indicating that the adaptive immune response is not responsible for the lack of susceptibility observed in the older mice. SSSS in adults is also associated with renal disorders, suggesting that levels of toxin in serum are important in the development of the disease. rETA was not cleared as efficiently from the serum of 1-day-old mice compared to clearance from 10-day-old mice. Ten-day-old mice were given repeated injections of toxin so that the maximal level of toxin was maintained for a sustained period of time, and exfoliation occurred in these mice. Thus, whereas the adaptive immune response is not needed for protection of adult mice from SSSS, efficient clearance of the toxin from the bloodstream is a critical factor.

Aging↗

PubMed1987

[Allopurinol-induced kidney failure with hepatitis and squamous dermatitis in pre-existing kidney insufficiency].

We report on a female patient with analgetic nephropathy in whom allopurinol therapy was started because of asymptomatic hyperuricemia and who 2 months later developed a syndrome characterized by icteric hepatitis, exfoliative dermatitis and progressive renal failure. After discontinuation of allopurinol and temporary peritoneal dialysis the patient recovered from the initially threatening condition. Analysis of case reports from the literature indicates that this syndrome is due to the allopurinol metabolite oxypurinol and is most frequently observed in patients with renal failure on concomitant treatment with diuretics.

Acute Kidney Injury↗

PubMed2005

Frequency of radiation recall dermatitis in adult cancer patients.

BACKGROUND: The re-occurrence of an inflammatory skin reaction which is limited to previously irradiated areas after the administration of a promoting agent is called radiation recall dermatitis. Despite a number of case reports no systematic analysis about the frequency of the phenomenon exists. Therefore we performed an observation study in order to obtain information about this phenomenon in clinical practice. PATIENTS AND METHODS: 142 patients who underwent palliative radiotherapy were included in the study. The skin reaction at the day of completion of radiotherapy was documented and the patients were followed until cytotoxic chemotherapy was administered or at least 6 months. RESULTS: 91 patients received different types of chemotherapy. In 8 patients a radiation recall dermatitis was observed, corresponding to a frequency of 8.8%. The radiation skin reactions occurred within 6 weeks after the completion of radiotherapy which corresponded to the time-period most of the chemotherapies were applied in. The grade of observed radiation recall dermatitis ranged from a mild erythema to a severe exfoliative dermatitis. CONCLUSION: The radiation recall dermatitis is a reaction of moderate frequency among adult cancer patients. Its possible severity as well as consecutive therapeutic consequences argue for its consideration in clinical settings.

Adult↗

PubMed1994

Pattern of skin diseases in the elderly seen at the National Skin Centre (Singapore) 1990.

A retrospective study was conducted at the National Skin Centre (Singapore) for the period 1st January 1990 to 31st December 1990 to determine the pattern of skin disorders in the elderly. A total of 2,571 patients aged 65 years and above were studied. This constituted 6.4% (2,571/39,941) of patients seen at the Centre for that year. 38.1% of the elderly patients were aged 75 years or older. The male to female ratio was 1.3 to 1. There were differences in the pattern of skin problems when compared with the young. Xerosis and asteatotic eczema were distinctly common in the elderly. The most common dermatosis in the elderly was eczema. Endogenous eczema (including seborrhoeic dermatitis, lichen simplex chronicus, hand/feet eczema, stasis eczema, generalised exfoliative dermatitis), exogenous eczema (ie contact dermatitis) and dermatitis (not otherwise specified) formed 35.3% (907/2,571) of the skin disorders encountered at the National Skin Centre. Eczema, fungal, viral infections and psoriasis were on the whole less common in the elderly compared with the general population. Common skin infestations and infections were scabies, viral warts, monilial and bacterial intertrigo and tinea corporis. Urticaria, alopecia, insect bite reactions and post-inflammatory pigmentation were uncommon referral problems in the elderly.

Aged↗

PubMed1988

Generalized eruption with severe liver dysfunction associated with occupational exposure to trichloroethylene.

Generalized dermatitis due to trichloroethylene is rare. A 21-year-old printer developed exfoliative dermatitis with mucous membrane involvement, fever and liver dysfunction after a 2-week occupational exposure to trichloroethylene. Positive patch-test reactions to trichloroethylene and to one of its metabolites, trichloroethanol, were observed. This dermatitis is considered to be mediated by a delayed-type hypersensitivity mechanism.

Adult↗

PubMed2000

Recombinant Staphylococcus aureus exfoliative toxins are not bacterial superantigens.

Staphylococcal scalded-skin syndrome is an exfoliative dermatitis characterized by the separation of the epidermis at the stratum granulosum. This disruption is mediated by one of two Staphylococcus aureus exotoxins, exfoliative toxins A and B (ETA and ETB). Both ETA and ETB have been reported to be bacterial superantigens. A controversy exists, however, as other data indicate that these exotoxins are not superantigens. Here we demonstrate that recombinant exfoliative toxins produced in Escherichia coli do not act as T-cell mitogens and thus are not bacterial superantigens. These data fit the clinical profile of the disease, which is not associated with the classic symptoms of a superantigen-mediated syndrome.

Animals↗