DOCSLIB.ORG

Skin Lesions Due to Drugs 28

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Skin Lesions Due to Drugs 28 Chapter 28 28 Skin Lesions Due to Drugs Due to a constantly increasing number and use of • Hypercoagulability (Sect. 8.4) drugs, reactions provoked by drugs or their metabo- • Warfarin skin necrosis (Sect. 8.5) lites are very common and may affect internal organs • Contact dermatitis (Sect. 4.5) as well as the skin. However, it is important to realize • Erythroderma (Sect. 22.5) that food additives, such as preservatives, colorings • Lichenoid lesions (Sect. 24.1.4) and quinine (used in tonic water), and chemicals, in- • Erythema multiforme (Sect. 26.1.3) haled or absorbed through the skin, may also cause • Eosinophilic cellulitis (Sect. 26.2.3) adverse skin reactions. • Lymphomatoid drug reactions (Sect. 26.3.5) Adverse reactions to drugs are usually not serious if Skin eruptions caused by drugs can be divided roughly they are recognized and the drug withdrawn, but oc- into two groups: those due to an immunologic (aller- casionally become critical, and even fatal. Skin erup- gic) reaction and those that are nonallergic. Allergic tions are probably the most prevalent and include skin reactions may be categorized as belonging to one a wide spectrum of clinical and histopathologic pat- of the hypersensitivity reactions types I–IV. Best elu- terns. A particular drug, or a metabolite of it, may give cidated are the mechanisms of those related to type I rise to several kinds of eruptions, but usually one kind (urticaria, angioedema), type II (such as drug-induced prevails. Stubb et al. (1994) reported on 1997 consecu- thrombocytopenia), and type III (leukocytoclastic tive patients with drug-related eruptions seen during a vasculitis) (described in Sect. 4.3), and the mecha- period of 35 years at the Department of Dermatology nism of delayed hypersensitivity reaction type IV in of the University Central Hospital, Helsinki, Finland. contact dermatitis (described in Sect. 4.5). However, Most of the patients were hospitalized and in nearly all the pathways of drug reactions thought to belong to cases the causative drug was verified by oral provoca- delayed hypersensitivity reaction type IV are much tion. Maculopapular exanthemata, urticaria, and fixed more complicated and variable. Naisbitt et al. (2001) eruptions were the most common kinds of lesions. and Pichler et al. (2002) have summarized the possible Antibiotics, antipyretic/antiinflammatory analgesics, occurrences. and drugs acting on the central nervous system were Most drugs are proteins with a low molecular the most common causative drugs. In another large weight (haptens) and are not antigenic until they have study, Hunziker et al. (1997) analyzed the records bound covalently (strongly) to a larger protein, a car- of 1317 hospitalized patients with definite or prob- rier molecule (Sect. 4.1). To be able to bind covalently able drug-induced skin reactions, observed during to the carrier protein, the drug or metabolite must a 20-year period in the divisions of general internal become chemically reactive. It is believed that most medicine in Berne and St. Gallen in Switzerland. The adverse drug reactions that give rise to delayed-type incidence was 2.7%. The reactions comprised maculo- immune-mediated reaction are caused by chemically papular exanthema (91.2%), urticaria (5.9%), and vas- reactive metabolites, generated by the normal process culitis (1.4%). Only six cases (0.5%) of fixed eruption of drug metabolism. This is called drug bioactivation were observed and none of toxic epidermal necrolysis. and usually takes place in hepatocytes, but may also In the previous chapters a number of skin lesions take place in other kinds of cells such as professional that may be provoked by drugs are exemplified and/or antigen presenting cells (i.e., macrophages, dendritic discussed: cells, B cells), and even in epidermal keratinocytes. • Neutrophilic venular vasculitis (Sect. 7.1) T cells recognize small peptide fragments of the • Lymphocytic venular vasculitis (Sect. 7.2) original antigen, presented on a MHC molecule by • Livedo reticularis (Sect. 7.5.4) antigen-presenting cells. The process of presenting • Thrombocytopenia (Sect. 8.3) antigen peptides can take place inside or outside the • Thrombotic-thrombocytopenic purpura (Sect. 8.3) antigen-presenting cell. Endogenous antigens are 28.1 Acute Allergic Urticaria/Angioedema 215 presented on MHC class I molecules to CD8+ cells, responsible for the conspicuous eosinophilia often whereas exogenous antigens are presented on MHC seen in vesicular and bullous lesions (Pichler 2002). class II molecules to CD4+ cells. It has also been proved that some types of T cells The following are examples of these processes: may attract a large number of neutrophils and even • Reactive drug metabolites generated in the liver that drugs may give rise to drug-specific T cell lines and bound to some intracellular protein are pro- and clones (Britschgi and Pichler 2002). cessed to peptides inside the liver cells. The pro- The final activation of the cellular immune response cess is endogenic and the antigen is consequently is thought to occur via two signals between the anti- presented to cytotoxic CD8+ T cells by MHC class I gen-presenting cell and the lymphocyte. The binding molecules. (receptor–ligand interaction) between the MHC-re- • A drug protein bound to a carrier molecule may es- stricted antigen and the TCR is the first signal. The cape endogenous processing to antigenic peptides second signal occurs through further receptor–ligand in the liver and enter the peripheral circulation. interactions, called costimulatory interactions. How- This exogenous antigen may instead be processed ever, there is probably a third signal, the danger signal, in professional antigen-presenting cells and pre- represented by the cytokine IL-1 in the case of CD4+ sented to CD4+ T cells on MHC class II molecules. cells and of IL-12 in the case of CD8+ cells. Cells that However, it is not known whether drug metabolites are under oxidative stress (see Glossary), cells infected formed in the liver are stable enough to circulate in with virus, necrotic cells, and cells undergoing apop- the periphery. tosis release the third signal. • A circulating drug (stable or reactive hepatic me- From the above and previous discussion it is evi- tabolite) may accumulate inside a specific type of dent that the scenarios of drug eruptions are legion. A cell, e.g. macrophages. Processing may occur in the few are discussed in detail here. cell giving rise to endogenous antigen presented on MHC class I molecules to CD8+ T cells or outside the cell as a cell-surface reaction with antigen pre- 28.1 sentation on MHC class II molecules to CD4+ cells. Acute Allergic Urticaria/Angioedema • Some chemically nonreactive drugs (metabolites) Acute allergic urticaria with or without angioedema may also bind directly and noncovalently to MHC is the second most common skin reaction caused by molecules and may be able to provoke adverse im- drugs. The condition appears at any age, but is most munologic reactions without going through bioac- common in young adults. tivation. The binding is MHC-restricted, but less stable. The diversity of the pathways of T-cell recognition of 28.1.1 drug antigens explains why drugs may activate both Clinical Appearance CD8+ and CD4+ T cells. Also the kind of stimulated T Acute allergic urticaria is characterized by a sudden cell is of importance: and more or less widespread eruption of swellings • CD4+-1 cells secrete IFN-γ, which gives rise to the (wheals) with a white center surrounded by an ery- CD8+ response, and IL-2 secrefion. thematous area and usually associated with severe itch. • CD4+-2 cells secrete IL-4 and IL-5. These attract eo- The size and form vary from small papules to large sinophils. lesions, which may be rounded, irregular, annular, or • CD4+-3 cells secrete transforming growth factor β serpiginous. The rash is transient and individual ef- (TGF-β) and IL-10. florescences usually disappear within 24 hours. When TGF-β and IL-10 counteract cytokines secreted by angioedema occurs, the face is the most common lo- CD4+-1 and CD4+-2 cells and the cellular immune re- cation. sponse does not appear. This is referred to as the silent immune response and may explain why most individu- als do not develop adverse reactions. 28.1.2 Furthermore, investigations have revealed that, as Histopathologic Appearance compared to maculopapular lesions, vesicular and A typical urticaria wheal below an essentially normal bullous lesions contain a higher number of infiltrating epidermis shows subepidermal edema and small cell CD8+ cells and a higher level of IL-5 secretion. The lat- infiltrates consisting mainly of lymphocytes with an ter, together with the chemokine eotaxin (present in T admixture of both neutrophils and eosinophils. Thin- cells, endothelial cells, and keratinocytes), is probably walled vessels (lymphatics and venules) are dilated 216 28 Skin Lesions Due to Drugs and some venules are filled with erythrocytes. There Histologic investigation showed marked subepi- is no vasculitis. In angioedema the edema includes the dermal edema and in the upper half of the dermis deep dermis and subcutaneous tissue. sparse to moderate dense perivascular and interstitial cell infiltrates composed of lymphocytes, neutrophils, nuclear fragment, and eosinophils. Vasculitis was not 28.1.3 observed (Fig. 28.1a). Pathogenesis Allergic urticaria is due to a hypersensitivity type I re- Case 2. Urticaria Caused by Methimazole action, in which CD4+-2 T cells are activated. These A 40-year-old woman was given methimazole for cells secrete IL-4 and IL-5, which is followed by pro- hyperthyroidism. Three days later severe itching oc- duction of IgE antibodies, release of histamine from curred all over the body and she presented with ery- mast cells, and activation of eosinophils. The reaction thematous papules in the axilla. A biopsy specimen may be provoked by, for example, drugs, food and was taken from a papule.
Load more

Recommended publications
  • Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs
    Specific Drugs Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs Chief Editors: Ana Dioun Broyles, MD, Aleena Banerji, MD, and Mariana Castells, MD, PhD Ana Dioun Broyles, MDa, Aleena Banerji, MDb, Sara Barmettler, MDc, Catherine M. Biggs, MDd, Kimberly Blumenthal, MDe, Patrick J. Brennan, MD, PhDf, Rebecca G. Breslow, MDg, Knut Brockow, MDh, Kathleen M. Buchheit, MDi, Katherine N. Cahill, MDj, Josefina Cernadas, MD, iPhDk, Anca Mirela Chiriac, MDl, Elena Crestani, MD, MSm, Pascal Demoly, MD, PhDn, Pascale Dewachter, MD, PhDo, Meredith Dilley, MDp, Jocelyn R. Farmer, MD, PhDq, Dinah Foer, MDr, Ari J. Fried, MDs, Sarah L. Garon, MDt, Matthew P. Giannetti, MDu, David L. Hepner, MD, MPHv, David I. Hong, MDw, Joyce T. Hsu, MDx, Parul H. Kothari, MDy, Timothy Kyin, MDz, Timothy Lax, MDaa, Min Jung Lee, MDbb, Kathleen Lee-Sarwar, MD, MScc, Anne Liu, MDdd, Stephanie Logsdon, MDee, Margee Louisias, MD, MPHff, Andrew MacGinnitie, MD, PhDgg, Michelle Maciag, MDhh, Samantha Minnicozzi, MDii, Allison E. Norton, MDjj, Iris M. Otani, MDkk, Miguel Park, MDll, Sarita Patil, MDmm, Elizabeth J. Phillips, MDnn, Matthieu Picard, MDoo, Craig D. Platt, MD, PhDpp, Rima Rachid, MDqq, Tito Rodriguez, MDrr, Antonino Romano, MDss, Cosby A. Stone, Jr., MD, MPHtt, Maria Jose Torres, MD, PhDuu, Miriam Verdú,MDvv, Alberta L. Wang, MDww, Paige Wickner, MDxx, Anna R. Wolfson, MDyy, Johnson T. Wong, MDzz, Christina Yee, MD, PhDaaa, Joseph Zhou, MD, PhDbbb, and Mariana Castells, MD, PhDccc Boston, Mass; Vancouver and Montreal,
    [Show full text]
  • The Prevalence of Paediatric Skin Conditions at a Dermatology Clinic
    RESEARCH The prevalence of paediatric skin conditions at a dermatology clinic in KwaZulu-Natal Province over a 3-month period O S Katibi,1,2 MBBS, FMCPaed, MMedSci; N C Dlova,2 MB ChB, FCDerm, PhD; A V Chateau,2 BSc, MB ChB, DCH, FCDerm, MMedSci; A Mosam,2 MB ChB, FCDerm, MMed, PhD 1 Dermatology Unit, Department of Paediatrics and Child Health, University of Ilorin, Kwara State, Nigeria 2 Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa Corresponding author: O S Katibi ([email protected]) Background. Skin conditions are common in children, and studying their spectrum in a tertiary dermatology clinic will assist in quantifying skin diseases associated with greatest burden. Objective. To investigate the spectrum and characteristics of paediatric skin disorders referred to a tertiary dermatology clinic in Durban, KwaZulu-Natal (KZN) Province, South Africa. Methods. A cross-sectional study of children attending the dermatology clinic at King Edward VIII Hospital, KZN, was carried out over 3 months. Relevant demographic information and clinical history pertaining to the skin conditions were recorded and diagnoses were made by specialist dermatologists. Data were analysed with EPI Info 2007 (USA). Results. There were 419 children included in the study; 222 (53%) were males and 197 (47%) were females. A total of 64 diagnosed skin conditions were classified into 16 categories. The most prevalent conditions by category were dermatitis (67.8%), infections (16.7%) and pigmentary disorders (5.5%). For the specific skin diseases, 60.1% were atopic dermatitis (AD), 7.2% were viral warts, 6% seborrhoeic dermatitis and 4.1% vitiligo.
    [Show full text]
  • 86A1bedb377096cf412d7e5f593
    Contents Gray..................................................................................... Section: Introduction and Diagnosis 1 Introduction to Skin Biology ̈ 1 2 Dermatologic Diagnosis ̈ 16 3 Other Diagnostic Methods ̈ 39 .....................................................................................Blue Section: Dermatologic Diseases 4 Viral Diseases ̈ 53 5 Bacterial Diseases ̈ 73 6 Fungal Diseases ̈ 106 7 Other Infectious Diseases ̈ 122 8 Sexually Transmitted Diseases ̈ 134 9 HIV Infection and AIDS ̈ 155 10 Allergic Diseases ̈ 166 11 Drug Reactions ̈ 179 12 Dermatitis ̈ 190 13 Collagen–Vascular Disorders ̈ 203 14 Autoimmune Bullous Diseases ̈ 229 15 Purpura and Vasculitis ̈ 245 16 Papulosquamous Disorders ̈ 262 17 Granulomatous and Necrobiotic Disorders ̈ 290 18 Dermatoses Caused by Physical and Chemical Agents ̈ 295 19 Metabolic Diseases ̈ 310 20 Pruritus and Prurigo ̈ 328 21 Genodermatoses ̈ 332 22 Disorders of Pigmentation ̈ 371 23 Melanocytic Tumors ̈ 384 24 Cysts and Epidermal Tumors ̈ 407 25 Adnexal Tumors ̈ 424 26 Soft Tissue Tumors ̈ 438 27 Other Cutaneous Tumors ̈ 465 28 Cutaneous Lymphomas and Leukemia ̈ 471 29 Paraneoplastic Disorders ̈ 485 30 Diseases of the Lips and Oral Mucosa ̈ 489 31 Diseases of the Hairs and Scalp ̈ 495 32 Diseases of the Nails ̈ 518 33 Disorders of Sweat Glands ̈ 528 34 Diseases of Sebaceous Glands ̈ 530 35 Diseases of Subcutaneous Fat ̈ 538 36 Anogenital Diseases ̈ 543 37 Phlebology ̈ 552 38 Occupational Dermatoses ̈ 565 39 Skin Diseases in Different Age Groups ̈ 569 40 Psychodermatology
    [Show full text]
  • Dermatologic Practice Review of Common Skin Diseases in Nigeria
    International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Review Article Dermatologic Practice Review of Common Skin Diseases in Nigeria Eshan Henshaw1, Perpetua Ibekwe2, Adedayo Adeyemi3, Soter Ameh4, Evelyn Ogedegbe5, Joseph Archibong1, Olayinka Olasode6 1Department of Internal Medicine, 4Department of Community Medicine, University of Calabar, Calabar, Nigeria 2University of Abuja Teaching Hospital, Gwagwalada, 3Center for Infectious Diseases Research and Evaluation, 5Cedarcrest Hospitals Abuja, Abuja Nigeria 6Department of Dermatology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria Corresponding Author: Eshan Henshaw ABSTRACT Objective: Dermatology is a relatively novel medical specialty in Nigeria, requiring a needs assessment to ensure optimal provision of dermatologic care to the general public. While several authors have catalogued the pattern of skin diseases in their respective regions of practice, none can be said to provide a panoramic representation of the general pattern in Nigeria. This article reviews and synthesizes findings from existing studies on the pattern of skin diseases in Nigeria published from January 2000 to December 2016, with the aim of presenting a unified data on the common dermatoses in Nigeria. Methods: Electronic and hand searches of articles reporting on the general pattern of skin diseases in Nigeria, published between the years 2000 and 2016 was performed. Eleven articles met the criteria for inclusion, two of which were merged into one, as they were products of a single survey. Thus ten studies were systematically reviewed and analysed. Results: A cumulative total of 16,151 patients were seen, among which one hundred and twenty two (122) specific diagnoses were assessed. The ten leading dermatoses in descending order of relative frequencies were: atopic dermatitis, tinea, acne, contact dermatitis, urticaria, seborrheic dermatitis, pityriasis versicolor, vitiligo, human papilloma virus infections, and adverse cutaneous drug reactions.
    [Show full text]
  • Adalimumab Injection
    PRODUCT MONOGRAPH INCLUDING PATIENT MEDICATION INFORMATION PrHUMIRA® adalimumab injection 40 mg in 0.8 mL sterile solution (50 mg/mL) subcutaneous injection 10 mg in 0.1 mL sterile solution (100 mg/mL) subcutaneous injection 20 mg in 0.2 mL sterile solution (100 mg/mL) subcutaneous injection 40 mg in 0.4 mL sterile solution (100 mg/mL) subcutaneous injection 80 mg in 0.8 mL sterile solution (100 mg/mL) subcutaneous injection Biological Response Modifier Humira (adalimumab injection) treatment should be initiated and supervised by specialist physicians experienced in the diagnosis and treatment of rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, adult and pediatric (13 to 17 years of age weighing ≥ 40 kg) Crohn’s disease, adult and pediatric (5 to 17 years of age) ulcerative colitis, adult and adolescent (12 to 17 years of age weighing ≥ 30 kg) hidradenitis suppurativa, psoriasis or adult and pediatric uveitis, and familiar with the Humira efficacy and safety profile. Date of Initial Approval: September 24, 2004 Date of Previous Revision: March 19, 2021 AbbVie Corporation Date of Revision: 8401 Trans-Canada Highway April 21, 2021 St-Laurent, QC H4S 1Z1 Submission Control No: 239280 HUMIRA Product Monograph Page 1 of 192 Date of Revision: April 21, 2021 and Control No. 239280 RECENT MAJOR LABEL CHANGES Dosage and Administration, Recommended Dose and Dosage Adjustment (4.2) 06/2019 TABLE OF CONTENTS PART I: HEALTH PROFESSIONAL INFORMATION ..................................................................
    [Show full text]
  • Lichen Sclerosus, Lichen Planus, and Lichen Simplex Chronicus Are Dermatologic Conditions That Can Affect the Vulva
    Journal of Midwifery & Women’s Health www.jmwh.org Original Review Recognition and Management of Vulvar Dermatologic Conditions: Lichen Sclerosus, Lichen Planus, CEU and Lichen Simplex Chronicus Katrina Alef Thorstensen, CNM, MSN, Debra L. Birenbaum, MD Lichen sclerosus, lichen planus, and lichen simplex chronicus are dermatologic conditions that can affect the vulva. Symptoms include vulvar itching, irritation, burning, and pain, which may be chronic or recurrent and can lead to significant physical discomfort and emotional distress that can affect mood and sexual relationships. With symptoms similar to common vaginal infections, women often seek care from gynecological providers and may be treated for vaginal infections without relief. Recognition and treatment of these vulvar conditions is important for symptom relief, sexual function, prevention of progressive vulvar scarring, and to provide surveillance for associated vulvar cancer. This article reviews these conditions including signs and symptoms, the process of evaluation, treatment, and follow-up, with attention to education and guidelines for vulvar care and hygiene. J Midwifery Womens Health 2012;57:260–275 c 2012 by the American College of Nurse-Midwives. Keywords: dyspareunia, erosive, lichen planus, lichen sclerosus, lichen simplex chronicus, vulvar dermatitis, vulvar dermatosis, vulvar itching, vulvitis A related patient education handout Certified-nurse midwives (CNMs), certified midwives can be found at the end of this issue (CMs), and other clinicians who provide primary gynecologic and at www.sharewithwomen.org care are likely to see women with lichen sclerosus and lichen simplex chronicus, and, while lichen planus is less common, INTRODUCTION early recognition is important. This article presents informa- tion so that midwives and other clinicians can provide or help A woman presents with vulvar itching she has had on and off these women find effective care.
    [Show full text]
  • A Refractory Fixed Drug Reaction to a Dye Used in an Oral Contraceptive
    A Refractory Fixed Drug Reaction to a Dye Used in an Oral Contraceptive Lt Col Steven E. Ritter, USAF, MC, FS; Col Jeffrey Meffert, USAF, MC, FS A young woman presented with a classic fixed infiltrate consistent with a fixed drug eruption drug eruption (FDE) after taking the inactive (FDE). The inactive green pills were thought to be green pills of her oral contraceptives (OCs). The responsible for this classic FDE. The patient was patient’s history was unique in that the FDE did instructed to continue taking her active pills but to not occur every time she took the inactive pills discontinue the inactive green pills. She has but was refractory, occurring every third month remained free of recurrence for more than 2 years within hours after she took the green pills. After and continues to take OCs. Rechallenge was con- discontinuing the green pills but continuing the sidered but not attempted. active oral contraceptive pills, the patient has not experienced a recurrence of the rash in more Comment than 2 years. This case report reviews the FDEs account for approximately 16% of cutaneous unusual phenomenon of refractory periods in drug reactions, usually presenting as dusky brown FDEs and highlights the importance of under- oval patches that recur in the same location. An standing this phenomenon in the diagnosis of acute inflammatory phase develops within hours of drug eruptions. drug exposure; in its extreme form, the inflamma- Cutis. 2004;74:243-244. tion can result in blistering. The inflammatory phase is followed by postinflammatory hyperpigmen- tation resulting in the classic brown discoloration.1 This case highlights the occurrence of an Case Report unusual refractory period that can be associated A 23-year-old white woman presented with a with FDEs.
    [Show full text]
  • New Advances in Drug Hypersensitivity Research and Treatment
    Journal of Immunology Research New Advances in Drug Hypersensitivity Research and Treatment Lead Guest Editor: Yi-Giien Tsai Guest Editors: Wen-Hung Chung, Riichiro Abe, and Wichittra Tassaneeyakul New Advances in Drug Hypersensitivity Research and Treatment Journal of Immunology Research New Advances in Drug Hypersensitivity Research and Treatment Lead Guest Editor: Yi-Giien Tsai Guest Editors: Wen-Hung Chung, Riichiro Abe, and Wichittra Tassaneeyakul Copyright © 2018 Hindawi. All rights reserved. This is a special issue published in “Journal of Immunology Research.” All articles are open access articles distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial Board B. D. Akanmori, Congo Eung-Jun Im, USA Ilaria Roato, Italy Jagadeesh Bayry, France Hidetoshi Inoko, Japan Luigina Romani, Italy Kurt Blaser, Switzerland Juraj Ivanyi, UK Aurelia Rughetti, Italy Eduardo F. Borba, Brazil Ravirajsinh N. Jadeja, USA Francesca Santilli, Italy Federico Bussolino, Italy Peirong Jiao, China Takami Sato, USA Nitya G. Chakraborty, USA Taro Kawai, Japan Senthamil R. Selvan, USA Cinzia Ciccacci, Italy Alexandre Keller, Brazil Naohiro Seo, Japan Robert B. Clark, USA Hiroshi Kiyono, Japan TrinaJ.Stewart,Australia Mario Clerici, Italy Bogdan Kolarz, Poland Benoit Stijlemans, Belgium Nathalie Cools, Belgium Herbert K. Lyerly, USA Jacek Tabarkiewicz, Poland M. Victoria Delpino, Argentina Mahboobeh Mahdavinia, USA Mizue Terai, USA Nejat K. Egilmez, USA Giulia Marchetti, Italy Ban-Hock Toh, Australia Eyad Elkord, UK Eiji Matsuura, Japan Joseph F. Urban, USA Steven E. Finkelstein, USA Chikao Morimoto, Japan Paulina Wlasiuk, Poland Maria Cristina Gagliardi, Italy Hiroshi Nakajima, Japan Baohui Xu, USA Luca Gattinoni, USA Paola Nistico, Italy Xiao-Feng Yang, USA Alvaro González, Spain Enrique Ortega, Mexico Maria Zervou, Greece Theresa Hautz, Austria Patrice Petit, France Qiang Zhang, USA Martin Holland, UK Isabella Quinti, Italy Douglas C.
    [Show full text]
  • “Only Skin Deep?” Guided Tour of Skin & Soft Tissue Infections
    C. Lynn Besch, MD Ass Prof Clinical Medicine, ID August 8, 2014 I, C. Lynn Besch, M.D., do not have any relationship(s) with commercial interests. A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Understand differential diagnosis of SSTI’s and use this to optimize diagnosis and management Learn the latest guideline recommendations for SSTI treatment Will understand the approach and management of the most serious SSTI’s 58 y/o WF with DM & CHF on insulin in clinic complains of redness & pain of the right leg. Exam – she is afebrile, has uniform redness and warmth over anterior thigh. The appropriate treatment is: A. Oral cephalexin for 5 days B. Admit for 7-14 days of IV vancomycin C. admit to the ICU for pip-tazo + vancomycin D. send emergently to surgery for debridement What is needed for a tour? Map Know the language Know the rules Identify danger Know the terrain Know the Language Know Identify danger: customs Ireland not part of and laws Britain; don’t wear Union Jack clothes The Skin/Soft Tissue Map Primary infections – ▪ Impetigo necrotizing fasciitis Secondary infections complicating pre- existing skin lesions . Post-surgical infections . Traumatic SSTI . Bite infections . Diabetic foot / vascular insufficiency infections Impetigo Ecthyma Furuncle, carbuncle Cellulitis – erysipelas, necrotizing, synergistic, gangrenous Abscess – primary vs post-operative infections Abbreviations SSTI = skin & soft tissue infections
    [Show full text]
  • Full Text Article
    BJKines -NJBAS Volume -9(1), June 201 7 201 7 A study of pattern and profile of non infectious dermatoses in paediatric age group <12 years. Dr. Jeta Buch 1* , Dr. Ranjan Raval 2 1Resident Doctor, 2Professor & Head, Department of Dermatology , Smt.NHL Municipal Medical College, Ahmedabad. Abstract: The aim of the study is to assess the incidence of non infectious dermatoses in children under 12 years of age; the incidence and prevalence of various physiological, genetic, papulosquamous, nutritional, autoimmune and drug induced disorders; the systemic association in various dermatoses and early identification of genetic disorder which will help in estimating the genetic risk and planning of future pregnancies. Present clinical study comprises of 1000 children less than 12 years of age in the department of Dermatology, V.S General Hospital, Ahmedabad. The study was conducted from Oct 2012 to Oct 2014. The time of occurrence, extent of involvement and the anatomical location was recorded. Relevant obstetrical history, history of any illness during pregnan cy, history of drug ingestion, sibling history and parental consanguinity was noted and various skin lesions recorded. Observations were tabulated and statistically analysed. Follow up was done every 15 days. The dermatoses were classified as papulosquamou s (61.0%), nevi (4.8%), genetic (4.2%), hair (9.6%) , autoimmune (5.8%) , drug reactions (3.1%), nutritional (2.8%), physiological (11.4%), and others (2.5%).The commonest skin manifestations observed were papulosquamous, genetic and autoimmune disorders. Be tter parent awareness, proper hygiene, adequate nutrition and early identification of the condition help in preventing many of these disorders.
    [Show full text]
  • Update on Cutaneous Drug Reactions
    Update on cutaneous drug reactions Jennifer Madison McNiff, M.D. Professor, Dermatology and Pathology Director, Yale Dermatopathology Update on drug reactions • New drugs, new rashes • Old drugs, new concepts MABs, NIBs, and other acronyms How are generic drugs named? • USAN (United States adopted name) • 5 members (AMA, pharma, FDA) • Name all generic drugs since 1961 • Search “stem list drug names” • Http://druginfo.nlm.nih.gov/drugportal/ Molecular targeted therapy “MABs” “NIBs” • M onoclonal antibodies • Small molecule inhibitors • Target extracellular • Target intracellular receptors signaling pathways • Prevent growth, incite • Multikinase inhibitors death Molecular targeted therapy “MABs” “NIBs” CD20: Rituximab Tyrosine kinase: Imatinib EGFR: Cetuximab EGFR: Gefitinib, Erlotinib VEGF: Bevacizumab Raf kinase: Sorafinib HER2: Trastuzumab VEGF: Cediranib Block function or signaling New drugs, new rashes… Epidermal growth factor receptor inhibitors • MABs (cetuximab, panitumumab) • NIBs (gefitinib, erlotinib) • Used for lung, colon, pancreatic, head and neck cancers • EGFR on keratinocytes, side effects in skin EGFR inhibitor Suppurative folliculitis EGFR inhibitor reaction Oct 2013 Colon cancer EGFR inhibitor Rash treated Moss and Burtness with topical NEJM 353;19:2005 acne therapy (+/- oral antibiotics) Preemptive therapy may be helpful Beware superinfection EGFR inhibitor Hair abnomalities Paronychia Br J Derm 2006;155:852 PRIDE syndrome • Papulopustules/ paronychia • Regulatory abnormalities of hair growth • Itching • Dryness •
    [Show full text]
  • M Ademecu Um
    LANDES LANDES BIOSCIENCE V a d e m e c u m BIOSCIENCE V a d e m e c u m Table of contents (excerpt) Dermatopathology 1. Hyperkeratosis 9. Infiltrates by Plasma Cells, Mast and Parakeratosis Cells and Histiocytes 2. Acanthosis 10. Granulomas 3. Papillomatosis, Atrophy 11. Dermal Necrosis and Alterations of the Granular and Transepidermal Elimination Layer 12. Purpuras, Vasculitis, Emboli 4. Spongiosis, Exocytosis and Thrombi and Acantholysis 13. Dermal Deposits, Collagen 5. Vesicles and Bullae Abnormalities and Calcifications 6. Interface, Poikilodermatous 14. Panniculitis, Inclusions, Fungi Dermatitis and Necrosis and Parasites of Keratinocytes 15. Hair Follicle Abnormalities 7. Lichenoid Dermatitis, Pigmentary Incontinence and Perivascular 16. Cysts, Polyps and Hamartomas Infiltrates 17. Tumors of the Epidermis 8. Infiltrates by Lymphocytes, and of the Hair Follicles Neutrophils and Eosiniphils This is one of a new series of medical handbooks. It includes subjects generally not covered in other handbook series, especially many technology-driven topics that reflect the increasing influence of technology in clinical medicine. The name chosen for this comprehensive medical handbook series is Vademecum, a Latin word that roughly means “to carry along”. In the Middle Ages, traveling clerics carried pocket-sized books, excerpts of the carefully transcribed canons, known as Vademecum. In the 19th century a medical publisher in Germany, Samuel Karger, called a series of portable medical books Vademecum. The Vademecum books are intended to be used both in the training of physicians and the care of patients, by medical students, medical house staff and practicing physicians. We hope you will find them a valuable resource. All titles available at ISBN 1- 57059- 496- 1 Ramón L.
    [Show full text]