Dermatitis-eczema disorders.
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Adrenal Cortex Hormones↗
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Results for “Dermatitis, Exfoliative”
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Complications mimicking lupus flare-up in a uremic patient undergoing pegylated liposomal doxorubicin therapy for cervical cancer.
Patients with systemic lupus erythematosus (SLE) have an increased risk for malignancy and end-stage renal disease itself might further augment the risk. Treating uremic patients with cervical cancer by cisplatin-based chemotherapy combined with radiation is hampered by the reduced renal excretion of cisplatin. Doxorubicin, a potential radiosensitizer with an established effect on carcinomas that arise in the ovary, uterine cervix and endometrium, might be applied in these cases. We describe a 36-year-old woman, who had a 9-year history of SLE and was maintained on dialysis, and who developed severe drug reaction manifesting as fever, skin rash and exfoliative dermatitis with positive lupus band test after infusion of pegylated liposomal doxorubicin therapy for advanced cervical cancer. These skin manifestations improved after i.v. methylprednisolone pulse therapy.
Adult↗
Skin rash secondary to bevacizumab in a patient with advanced colorectal cancer and relation to response.
Bevacizumab (Avastin) in combination with intravenous 5-fluorouracil-based chemotherapy as first-line as well as second-line treatment of metastatic colorectal cancer improves survival. Although skin rash (type unspecified) has been described in some patients following infusion of bevacizumab, it is not a common toxicity of bevacizumab, while acneiform rash occurs in more than 90% of patients who receive cetuximab (Erbitux), the severity of which appears to be predictive of response. We report a patient with colorectal cancer who developed a rash secondary to bevacizumab that correlated with response. A 40-year-old patient with stage IV colorectal cancer received FOLFOX-4 and bevacizumab, which he tolerated very well except for a skin rash related to bevacizumab. The rash cleared every time bevacizumab was eliminated from the chemotherapy regimen. When use of bevacizumab was resumed, similar rash reappeared. Therefore, we believe that this observation of the rash emergence was linked to bevacizumab administration. The most common toxicities associated with bevacizumab include hypertension, hemorrhage, gastrointestinal perforation, arterial thromboembolism, wound healing and proteinuria. Exfoliative dermatitis and a nonspecific rash have been reported with bevacizumab. This case report, we believe, is the first report of a possible correlation between a rash and a positive drug response associated with bevacizumab, and may initiate further investigation of similar observation.
Adenocarcinoma↗
Erythrodermic phytophotodermatitis after application of aqueous fig-leaf extract as an artificial suntan promoter and sunbathing.
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Adult↗
Severe adverse cutaneous reaction to insulin due to cresol sensitivity.
We present the case of an 80-year-old lady known to be sensitive to chlorocresol (4-chloro-3-methyl phenol) who developed severe erythrodermic exfoliative dermatitis with atypical features 2 weeks after commencing subcutaneous insulin. All medications except insulin were stopped, without major improvement. It was noted that the insulin contained m-cresol (m-methyl phenol) so a parabens-based insulin was substituted. There was a significant improvement in her clinical condition within 72 hr. Further patch and intradermal testing to the insulin and m-cresol was planned, but she developed a nosocomial infection and died. We hypothesize that the adverse cutaneous reaction was a systemic manifestation of cresol sensitivity, given the rapid clinical resolution on changing insulins and the previously demonstrated sensitivity to chlorocresol, particularly as cross-reactivity between different low molecular weight methyl phenols is documented. Local injection site reactions and systemic side-effects including nausea, diarrhoea and vomiting have previously been reported with cresol-containing insulins, although to our knowledge, this is the first reported case of a severe cutaneous reaction. It is important to be aware of m-cresol as a potential allergen, as it is contained in most commercially available insulins.
Aged, 80 and over↗
Keratin: a journey of three decades.
During the past three decades, major progress has been made in our understanding of the processes which lead to the formation of a keratinized epidermis in normal and pathologic situations. Stimulated by clinical studies of exfoliative dermatitis and related diseases, a series of investigations have been performed which proved initially that the pathways and controls of epidermal protein synthesis were equivalent to protein synthetic pathways in all other tissues of the body. Keratin was identified as not only an insoluble protein which makes up the vast majority of the intracellular protein in the stratum corneum, but as a member of the intermediate filament family of cytoskeletal proteins. Of all such proteins, the keratins are most complex, occurring in two families separable on the basis of size, structure and isoelectric point. The keratin intermediate filaments are heteropolymers of two paired components, one from each family. The pairs of keratins which form the intermediate filaments in basal and differentiated layers of epidermis and other epithelia have been defined and antibodies to specific keratins are now being used for diagnostic purposes. Sophisticated biochemical, physicochemical, and molecular biologic studies have led to complete definitions of almost all the epithelial keratin molecules and to cloning of their genes. These genes are currently being used in analyses of control of keratin expression and definition of the specific abnormalities associated with "keratinopathies" including epidermolysis bullosa simplex and epidermolytic hyperkeratosis.
Animals↗
Treatment of severe drug eruptions.
Severe drug eruptions are rare, life-threatening events. The management begins with the withdrawal of the suspect drug(s). We recently confirmed that an earlier withdrawal of drugs with short elimination half-life was associated with a better survival of patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). In cases of "acute skin failure" (exfoliative dermatitis, extensive SJS or TEN), management of patients must be undertaken in specialized intensive care units or in burn units. The main principles of symptomatic therapy are the same as for major burns: warming of the environment, correction of electrolyte disturbances, high caloric intake, and prevention of sepsis. The suspected immunologic orgin of drug eruptions prompted the use of corticosteroids, immunosuppressive drugs, and anti-cytokines. Systemic corticosteroids are useful in "hypersensitivity syndrome" when visceral lesions depend on infiltration by activated cosinophils. Systemic corticosteroids were shown to be deleterious in cases of advanced TEN. Their potential usefulness at earlier stages of SJS or TEN remains controversial. High intravenous doses of cyclophosphamide or oral cyclosporin have been administered to a few patients with TEN, most often following ineffective treatment with corticosteroids for 1 to 5 days. It remains doubtful that the progression of the lesions was shortened. A few patients appeared to benefit from treatment with pentoxifyllin, a drug suppressing the production of TNF. Thalidomide, another suppressor of TNF production, significantly increased the death rate when tested in a double-blind placebo controlled trial in patients with early TEN. High dose intravenous immunoglobulins were used in 10 patients with TEN on the basis of their ability to inhibit fas-fas ligand mediated apoptosis. The potential benefit of this treatment needs confirmation by further studies. Patients and their first degree relatives should be advised to avoid the responsible drug and chemically related compounds. Regulatory agencies should be notified of such cases.
Adrenal Cortex Hormones↗
Dapsone hypersensitivity syndrome: a clinico-epidemiological review.
Diaminodiphenyl sulphone (dapsone) is a drug of choice in the treatment of leprosy. It is also useful for the treatment of many neutrophilic and other dermatoses. Dapsone hypersensitivity syndrome is a rare but well recognized serious adverse effect characterized by fever, skin rashes, generalized lymphadenopathy, hepatitis, and hepato-splenomegaly. Twenty-six patients with dapsone hypersensitivity syndrome were studied for clinical profile, outcome, and prognosis. The male:female ratio was 2.2:1, and the mean age was 33.19 years (range 13 to 64 years). The interval between start of dapsone therapy and appearance of symptoms varied from 2-7 weeks (mean 29.82 days). Twenty-four patients received dapsone as a part of multi-drug therapy for leprosy; the other two patients received dapsone for lichen planus and acne vulgaris. Exfoliative dermatitis was the most common cutaneous manifestation followed by erythematous maculo-papular eruption and Stevens-Johnson syndrome-like lesion. The other common systemic manifestations were: fever (26 cases), itching (22 cases), lymphadenopathy (21 cases), jaundice (21 cases), pallor (20 cases), hepatomegaly (19 cases), and pedal edema (14 cases). Investigation profile revealed elevated levels of serum liver enzymes in 100% of patients, elevated erythrocyte sedimentation rate in 92.3%, raised bilirubin in 84.6%, leucocytosis in 69.23%, low hemoglobin (<9 gm/dl) in 46.15% and hypoproteinemia in 42.3%. Eosinophilia, hemolytic anemia, and reticulocytosis count were found in 4 patients each. All the patients had favorable outcomes except three who died due to hepatic failure. Medical personnel must be aware of this potentially fatal syndrome, because it can cause considerable morbidity and mortality.
Adolescent↗
Leukotactic properties of soluble substances in psoriasis scale.
In an attempt to elucidate the mechanisms underlying the production of transepidermal migration of leukocytes toward the stratum corneum in psoriatic lesions, the chemotactic properties of soluble substances in psoriasis scales were examined by a modified Boyden's chamber. All crude extracts of horny tissues studied, i.e. callus, scales of exfoliative dermatitis and of psoriasis vulgaris, showed chemotactic activity for human peripheral blood leukocytes. But only the chemotactic activity of the psoriasis scale extract was highly potent. This was greatly reduced after dialysis. Fresh serum was not required to manifest the chemotactic activity. By Sephadex G-200 chromatography, the scale extracts from psoriasis vulgaris and pustular psoriasis had potent activity eluted near the cytochrome C marker. The same fractions of other horny tissue extracts, bacterial filtrate prepared from cultured psoriasis scale fragments, and serum did not show such potent activity. On the basis of analysis by gel filtration and recent findings of immunopathological studies, a postulate was made that a complement derived chemotactic factor, possibly a C5 cleavage product, developed as a result of antigen-antibody reaction in the stratum corneum of psoriatic lesions.
Aged↗
Leiner's disease associated with metabolic acidosis.
A female infant with failure to thrive, erythroderma and recurrent diarrhoea died at 10 months of age from a Haemophilus influenzae respiratory tract infection. Her clinical course was complicated by a persistent metabolic acidosis. Investigations revealed a low level of the fourth component of complement and reduced neutrophil mobility.
Acidosis↗
Follicular toxic pustuloderma associated with allopurinol.
Allopurinol is widely prescribed for primary and secondary hyperuricaemia, and cutaneous adverse reactions are seen in 0.8-2.1% of recipients. The majority of these are mild and include pruritus, diffuse or maculo-papular erythema, urticaria and ichthyosis. More severe reactions are well recognized and include exfoliative dermatitis, toxic epidermal necrolysis and a generalized hypersensitivity syndrome. The latter typically comprises fever, rash, hepatic and renal dysfunction and eosinophil leucocytosis. The occurrence of toxic pustuloderma due to allopurinol, confirmed by re-challenge, is reported.
Allopurinol↗
ADULT ectodermal dysplasia syndrome resulting from the missense mutation R298Q in the p63 gene.
Several ectodermal dysplasia syndromes have been shown to result from mutations in the gene that encodes the transcription factor p63. We describe an 11-year-old boy, with clinically normal parents, who had a developmental disorder that resembled EEC (ectrodactyly ectodermal dysplasia-clefting) syndrome (OMIM 604292). He had ectrodactyly and missing middle fingers bilaterally, onychodysplasia, hypodontia with missing teeth, hypohidrosis and lacrimal duct obstruction. DNA sequencing disclosed a heterozygous G-->A substitution at nucleotide 893, that converts an arginine residue (CGA) to glutamine (CAA), the mutation being designated R298Q. This mutation occurs within the DNA-binding domain of p63, and is close to many of the published EEC syndrome mutations. However, R298Q has been described once previously in a large German pedigree, not with EEC syndrome, but another ectodermal dysplasia disorder, ADULT (acro-dermato-ungual-lacrimal-tooth) syndrome (OMIM 103285). Further clinical assessment in our patient revealed that, apart from not having cleft lip and/or palate, he had an exfoliative dermatitis of his hands and feet, and some freckling on his face and shoulders. Collectively, these features support a diagnosis of ADULT syndrome. This study has identified a specific genotype-phenotype correlation in a rare ectodermal dysplasia syndrome and the findings are useful in improving genetic counselling in this family.
Base Sequence↗
Cutaneous paraneoplastic syndromes in dogs and cats: a review of the literature.
Cutaneous paraneoplastic syndromes are a group of noncancerous dermatoses associated with internal malignancy. Their recognition can facilitate detection and timely treatment of underlying cancer. More than 30 such disorders have been identified in the human scientific literature, whereas only a few are described in veterinary medicine. This may reflect a lower incidence in animals than in people or may be the result of failure to recognize an association between certain skin lesions and neoplasia. Establishing a relationship between a cutaneous disorder and neoplasia can be difficult unless the skin lesions are rare and almost always associated with a particular tumour type, as is the case for most recognized veterinary paraneoplastic dermatoses. Among these are feline paraneoplastic alopecia, feline thymoma-associated exfoliative dermatitis, nodular dermatofibrosis, feminization syndrome associated with testicular tumours, superficial necrolytic dermatitis and paraneoplastic pemphigus. The aetiology of most cutaneous paraneoplastic syndromes has remained elusive in both people and animals.
Animals↗
Trichloroethylene toxicity.
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Dermatitis, Exfoliative↗
Pattern of skin diseases at the National Skin Centre (Singapore) from 1989-1990.
At the National Skin Centre, 74,589 new attendances were seen from 1989 to 1990. The M:F ratio was 1:1. The majority of the patients belonged to the 20-39 year age groups (40%). Frequencies of psoriasis (20.4%) and alopecia (17.2%) were higher among Indians; exfoliative dermatitis was higher among Malays (19.72%); and insect bites were higher among Chinese (87%) [P less than 0.05] compared with ethnic distribution (9.9%, 7.6%, and 77.2% respectively) of NSC patient population. Dermatitis (34.2%) and acne (10.9%) were the most common skin disorders seen. The more common dermatoses seen in 1989/90 differ slightly from those reported in 1950s and 1980s; however, the frequencies of contact dermatitis, fungal infection, and insect bite reactions of 5.8%, 10.9%, and 7.6%, respectively, in 1980 have decreased to 4.7%, 5.4%, and 2.3%, respectively, in 1989/90. There was no seasonal variation in the frequency of various dermatoses except for psoriasis, which was more prevalent during the first quarters of 1989 and 1990. Our results showed that the pattern of skin diseases in Singapore is slowly approximating that of developed countries. The changes in the pattern of skin diseases are probably due to improved economic status, better education and hygiene, ready availability of dermatology services, as well as changes in occupational and environmental contactants over the last decade.
Adult↗
Antistreptolysin and antistaphylolysin titres in allergic skin conditions. Observations on 6104 patients suffering from various eczemas and urticaria.
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Adult↗
Management of drug eruptions: Part II. Diagnosis and treatment.
In this second of two articles on adverse cutaneous drug reactions, the management of drug eruptions is reviewed. This necessitates, above all, a full history and may involve observation of the effects of drug elimination. Skin testing may be helpful in some circumstances, but is hampered by false positive and negative results, and lack of knowledge of the significant antigenic determinants for most drugs. In vitro tests are for the most part unreliable and are research tools. Challenge tests are safe in fixed drug eruption, but are absolutely contraindicated in Stevens-Johnson syndrome and toxic epidermal necrolysis. The approach to the treatment of the more serious adverse cutaneous drug reactions, including angioedema/anaphylaxis, exfoliative dermatitis erythroderma and toxic epidermal necrolysis is reviewed. For those patients who develop reactions to an essential medication for which there is no alternative, desensitization is possible.
Anti-Inflammatory Agents↗