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Shah A, El-Feghaly J, Bender AM. Prostaglandin E-induced polycyclic cutaneous eruption with geometric features. Pediatr Dermatol 2024. [PMID: 38632884 DOI: 10.1111/pde.15617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
Prostaglandin E1 (PGE1) is a substance produced by the patent ductus arteriosus that keeps it open. PGE1 can be a lifesaving drug for infants born with ductus-dependent congenital heart disease (CHD) where there is a block of blood flow to the lungs or transposition of great arteries. We present a case of a 36-week, 2-day gestation neonate with CHD who developed bright erythematous annular and polycyclic patches on day 2 of PGE1 administration. When PGE1 dosing was decreased, the rash resolved on its own. Our case demonstrates that PGE1 treatment may not need to be interrupted.
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Affiliation(s)
- Ananya Shah
- Department of Dermatology, University of Rochester, Rochester, New York, USA
| | - Jinia El-Feghaly
- Department of Dermatology, University of Rochester, Rochester, New York, USA
| | - Alexandra M Bender
- Department of Dermatology, University of Rochester, Rochester, New York, USA
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Han J, Owji S, Agarwal A, Kamat S, Luu Y, Mubasher A, Niedt G, Ray C, Cho HJ, Gulati N, Lamb A. Bortezomib-Induced Reticular Eruption in Patient with Multiple Myeloma. Dermatopathology (Basel) 2023; 10:226-230. [PMID: 37489455 PMCID: PMC10366922 DOI: 10.3390/dermatopathology10030031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
Bortezomib is the first proteasome inhibitor to treat a variety of malignancies and is currently part of the standard of care regimen for the initial treatment of patients with newly diagnosed multiple myeloma. While bortezomib is generally well tolerated, it has been associated with various side effects, which have limited its use in some patients. Here, we describe a unique case with histological confirmation of a reticular eruption that appeared at the site of a subcutaneous administration of bortezomib in a 62-year-old male who was newly diagnosed with IgG kappa multiple myeloma. A skin biopsy was performed, which revealed superficial perivascular dermatitis predominantly composed of lymphocytes with rare eosinophils. The patient was successfully treated with betamethasone dipropionate 0.05% cream. When consulted, dermatologists should advise the oncology team of multiple myeloma patients treated with bortezomib to maintain a high threshold before discontinuing the drug when a patient experiences an atypical, reticular rash following subcutaneous administration. Additionally, potent topical corticosteroids, such as betamethasone dipropionate 0.05% cream, should be considered in managing the cutaneous reticular eruptions related to bortezomib administration, in order to maintain an optimal treatment regimen for patients with multiple myeloma.
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Affiliation(s)
- Joseph Han
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Shayan Owji
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Aneesh Agarwal
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Samir Kamat
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yen Luu
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Adnan Mubasher
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - George Niedt
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Chloe Ray
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Hearn Jay Cho
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nicholas Gulati
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Angela Lamb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Magone MT, Maiberger M, Clayton J, Pasieka H. Vulvovaginal and ocular involvement and treatment in female patients with Stevens-Johnson syndrome and toxic epidermal necrolysis: A review. Int J Womens Dermatol 2022; 7:520-528. [PMID: 35024409 PMCID: PMC8721055 DOI: 10.1016/j.ijwd.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 10/31/2022] Open
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious adverse cutaneous drug reactions, characterized by epidermal detachment and mucous membrane involvement. SJS/TEN is more common in female patients, with unique findings in the ocular and vulvar regions. Early recognition and intervention, as well as long-term follow-up, are crucial to prevent devastating scarring and sequelae. This review examines the vulvar and ocular manifestations of SJS/TEN and describes the current treatment recommendations for female patients, requiring close consultation and collaboration among dermatology, ophthalmology, and gynecology.
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Affiliation(s)
- M Teresa Magone
- Ophthalmology Consult Services Section, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary Maiberger
- Department of Dermatology, Veterans Affairs Medical Center, Washington, DC
| | - Janine Clayton
- Ophthalmology Consult Services Section, National Eye Institute, National Institutes of Health, Bethesda, Maryland.,Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland
| | - Helena Pasieka
- Uniformed Services University of Health Sciences, Bethesda, Maryland
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Almukhadeb E. A Case of Recurrent Fixed Drug Eruption Secondary to Desloratadine. Cureus 2021; 13:e16762. [PMID: 34476136 PMCID: PMC8403490 DOI: 10.7759/cureus.16762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/26/2022] Open
Abstract
Desloratadine is a second-generation H1-type antihistamine that is widely prescribed for multiple indications including allergic rhinitis and urticaria. It is well-tolerated and is not known to cause cutaneous side effects including fixed drug eruption (FDE). In this report, a case of recurrent fixed drug eruption induced by desloratadine is reported.
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Affiliation(s)
- Eman Almukhadeb
- Dermatology, College of Medicine, King Saud University, Riyadh, SAU
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Moya-Martínez C, Torre-Castro J, Fariña-Sabarís MC, Santiago Sánchez-Mateos D, Eraña-Tomás I, Jo-Velasco M, Requena L. Cutaneous eruption with reactive endothelial atypia due to emerging targeted cancer therapies: Report of two cases with clinico-pathologic correlation. J Cutan Pathol 2021; 48:789-794. [PMID: 33576042 DOI: 10.1111/cup.13981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
Targeted anticancer therapy is being used with greater frequency and dermatologic toxicities are among the most frequent adverse events of these drugs. However, histopathological features of these adverse events are not yet well characterized. We present two cases of clinically different cutaneous toxicities on two patients with hematologic neoplasia. They were treated with different drugs and in both cases medications shared inhibition of PI3K as mechanism of action. The skin biopsy specimen showed endothelial cell atypia with large nuclei and mitotic figures. To the best of our knowledge, no other cases with these striking histopathologic findings have been reported with PI3K inhibitors or other anticancer targeted therapy.
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Affiliation(s)
| | - Juan Torre-Castro
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Itziar Eraña-Tomás
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Margarita Jo-Velasco
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Mokhtari F, Nikyar Z, Naeini BA, Esfahani AA, Rahmani S. Adverse cutaneous drug reactions: Eight year assessment in hospitalized patients. J Res Med Sci 2014; 19:720-5. [PMID: 25422656 PMCID: PMC4235091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/05/2014] [Accepted: 08/20/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adverse cutaneous drug reactions (ACDRs) are the most commonly reported adverse drug events. The causative drugs and clinical patterns of ACDRs are different in various populations. This study was conducted to identify the clinical patterns, causative drugs and reasons for drug administration in patients hospitalized due to ACDR. MATERIALS AND METHODS This retrospective study was carried out in a referral university hospital, Isfahan, Iran. The medical records of all patients who were hospitalized in the Dermatology Department due to ACDRs were reviewed covering an 8-year period between December 2006 and August 2013. RESULTS A total number of 282 patients with the mean age of 29.48 ± 21.18 years were hospitalized in this time period, of which 61% were females. The most common clinical patterns regarding the final diagnosis were Stevens-Johnson syndrome (SJS) (32%), exanthematous drug eruptions (24.5%) and toxic epidermal necrolysis (TEN) (11%). Anticonvulsants were the most frequently implicated drug group (51.8%) followed by antibiotics (33.7%) and analgesics and non-steroidal anti-inflammatory drugs (5.7%). The most common cause of drug administration was seizure (30%) and then upper respiratory tract infections (12%). The frequency distribution of clinical types of reactions was different between age groups (P < 0.001). The severe types (SJS, TEN, drug rash with eosinophilia and systemic symptoms and overlap syndrome) were more frequent in the patients aged ≤50 years old (55.2%) compare to those aged ≤50 years (28%) (P = 0.001). CONCLUSION The main causative drugs of ACDRs were anticonvulsants and antibiotics. However, the sever types of reactions were more prevalent.
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Affiliation(s)
- Fatemeh Mokhtari
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Nikyar
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Zahra Nikyar, Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Bahareh Abtahi Naeini
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Asemi Esfahani
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Siamak Rahmani
- Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Pai VV, Bhandari P, Kikkeri NN, Athanikar SB, Sori T. Fixed drug eruption to fluconazole: a case report and review of literature. Indian J Pharmacol 2013; 44:643-5. [PMID: 23112430 PMCID: PMC3480801 DOI: 10.4103/0253-7613.100403] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/14/2012] [Accepted: 07/01/2012] [Indexed: 11/04/2022] Open
Abstract
Fixed drug eruption (FDE) is mainly characterized by skin lesions that recur at the same anatomic sites upon repeated exposures to an offending agent. It represents the most common cutaneous adverse drug reaction pattern in Indian patients. Here, we report an FDE to fluconazole.
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Affiliation(s)
- Varadraj V Pai
- Department of Dermatology, Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
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Abstract
Background: Few clinical studies are found in the literature about patients hospitalized with a diagnosis of cutaneous drug eruption. Aims: To determine the clinical types of drug eruptions and their causative agents in a hospital-based population. Materials and Methods: This retrospective study was performed in the Dermatology Department of Haseki General Hospital. Through 1751 patients hospitalized in this department between 2002 and 2009, inpatients diagnosed as drug eruption were evaluated according to WHO causality definitions. 106 patients composed of probable and possible cases of cutaneous drug eruptions were included in this study. Results: Seventy one females and 35 males were evolved. Mean age was 44.03±15.14. Duration between drug intake and onset of reaction varied from 5 minutes to 3 months. The most common clinical type was urticaria and/or angioedema in 48.1% of the patients, followed by maculopapular rash in 13.2%, and drug rash with eosinophilia and systemic symptoms in 8.5%. Drugs most frequently associated with cutaneous drug eruptions were antimicrobial agents in 40.5% of the patients, followed by antipyretic/anti-inflammatory analgesics in 31.1%, and antiepileptics in 11.3%. Conclusion: Urticaria and/or angioedema and maculopapular rash comprised majority of the drug eruptions. Rare reactions such as acute generalized exanthematous pustulosis, sweet syndrome, oral ulceration were also found. Antimicrobial agents and antipyretic/anti-inflammatory analgesics were the most commonly implicated drugs. Infrequently reported adverse reactions to myorelaxant agents, newer cephalosporins and fluoroquinolones were also detected. We suppose that studies on drug eruptions should continue, because the pattern of consumption of drugs is changing in every country at different periods and many new drugs are introduced on the market continuously.
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Affiliation(s)
- Fatma Akpinar
- Department of Dermatology, Haseki General Hospital, Istanbul, Turkey
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