- A pediatric case of anaphylactic shock induced by tipepidine hibenzate (Asverin). [Journal Article]
- APAsia Pac Allergy 2018; 8(4):e37
- Tipepidine hibenzate (Asverin) is commonly used as an antitussive drug for acute and chronic cough in various age groups and is generally safe and well-tolerated. However, we experienced a case of ti...
Tipepidine hibenzate (Asverin) is commonly used as an antitussive drug for acute and chronic cough in various age groups and is generally safe and well-tolerated. However, we experienced a case of tipepidine hibenzate-induced anaphylactic shock in a 1-year-old boy. After ingesting cold medication including tipepidine hibenzate, the patient presented with generalized erythema and urticaria, swollen face, coughing, wheezing and vomiting, together with hypotension and a decreased level of consciousness. To identify the culprit drug, we performed skin prick tests (SPTs) and oral drug provocation tests (DPTs). SPTs revealed a negative reaction for all drugs, but DPTs caused a positive reaction only for a full therapeutic dose of tipepidine hibenzate. Physicians need to consider tipepidine hibezate as a culprit drug when anaphylaxis occurs after taking anticough or common cold medication.
- Autoimmune Progesterone Dermatitis Diagnosed by Lymphocyte Transformation Test and Progesterone Provocation Test. [Journal Article]
- ADActa Dermatovenerol Croat 2018; 26(3):276-277
- Autoimmune progesterone dermatitis (APD) is rare autoimmune response to endogenous progesterone or to earlier exposure to exogenous progesterone (1). Skin lesions typically occur due to increases in ...
Autoimmune progesterone dermatitis (APD) is rare autoimmune response to endogenous progesterone or to earlier exposure to exogenous progesterone (1). Skin lesions typically occur due to increases in progesterone during the luteal phase of the menstrual cycle (2). A-31-year-old mother of two children presented to our Department with a 5-year history of pruritic and painful erythematosus macules, papules, and patches on her neck, pectoral region, and face, which appeared 2-3 days before the onset of menses and gradually resolved 7-10 days later (Figure 1). The lesions first appeared 10 months after her second pregnancy and a few months after she had started using oral contraceptive pills (OCP) containing gestodene combined with ethinyloestradiol. A few months before presenting to us, the lesions had started spreading on her forearms, elbows, and pretibial areas. Since one year prior to our visit she had complained of occasional urticaria with angioedema one week prior to menses, which resolved after menses. The lesions were accompanied by malaise, headache, and fatigue. The patient was asymptomatic between the outbreaks. She reported that she had been using various local corticosteroids, peroral antihistamines, and prednisone for the treatment of her skin lesions, but this treatment had not improved her symptoms. She suffered from mild seasonal rhinoconjunctivitis. We performed multiple laboratory tests that were unremarkable. Histopathological examination of a biopsy taken from a lesion on the neck showed epidermal hyperplasia and nonspecific mild dermal inflammation. Since progesterone was not available in aqueous solution in our country, we did not perform an intradermal test, but we performed a lymphocyte transformation test (LTT) to medroxyprogesterone and estradiol. The patient's lymphocytes showed markedly enhanced proliferation to medroxyprogesterone in vitro, while being negative to estradiol. We had performed control LTT in 10 healthy controls and 10 patients with atopy, and such hyperactivity was not observed in any of them. We performed an oral provocation test with OCP containing gestodene combined with ethinyloestradiol. Two days after commencing treatment, the patient developed widespread dermatitis (Figure 2) with nausea, malaise, and angioedema. The patient was informed about treatment options and possible side-effects. She started with OCP with the lowest amount of progesterone, containing ethinyloestradiol and dropirenone for treatment of APD, but terminated treatment after the second cycle due to a worsening of the skin lesions and urticaria accompanied with angioedema. At the time of writing, our patient continues to have premenstrual flares. The typical symptoms of APD are skin lesions such as eczema, erythema multiforme, prurigo, stomatitis, papulopustular lesions, folliculitis, urticaria, angioedema, and rarely anaphylaxis (2) that develop 3-10 days before and subside 1-2 days after menses, with recurrent cyclic aggravation (1,3,4). Frequently, patients have a history of exogenous progesterone intake (1,5,6), as in our patient, which could have resulted in antibody formation. The diagnosis of APD is established by an appropriate clinical history (premenstrual flare of skin lesions), a progesterone intradermal test, an intramuscular (7), oral (8), or intravaginal (1, 6) progesterone challenge test, and circulating antibodies to progesterone. Progesterone testing has not been standardized. Most of the sex hormones are not suitable for testing since they contain an oily component that can produce an irritant test reaction. Gestodene, which was used for the oral provocation test in our patient, is a potent progesterone (9). The LTT shows reactions to circulating lymphocytes and reflects immune reactions within the body. The goal of treatment is suppression of ovulation. Currently, the first-line choice of therapy is a combination oral contraceptive (3). We believe that OCP have a limited effect because all of them contain a progesterone component. If this treatment is ineffective, patients have been treated with danazol, gonadotropin releasing hormone analogs (3,4,6), conjugated estrogens (7), tamoxifen, oophorectomy (8), and progestogen desensitization (10) with varying success.
- Actinic Lichen Planus Triggered by Drug Photosensitivity. [Letter]
- PPPhotodermatol Photoimmunol Photomed 2018 Oct 29
- A 73-year-old Spanish woman with skin phototype II and a history of hypertension and plaque psoriasis attended our clinic in April 2016 for a mild, pruritic and erythematous dermatosis affecting her ...
A 73-year-old Spanish woman with skin phototype II and a history of hypertension and plaque psoriasis attended our clinic in April 2016 for a mild, pruritic and erythematous dermatosis affecting her face and the dorsal aspect of her forearms. The lesions had developed following exposure to sunlight while the patient was being treated with acitretin for plaque psoriasis. Physical examination showed facial erythema and small erythematous papules on the dorsa of the forearms. No abnormalities were observed in the hair, nails or mucosa. The results of routine blood tests and antinuclear antibody testing were negative or within normal limits. This article is protected by copyright. All rights reserved.
- Anatomic Site-Specific Treatment Response With 40% Hydrogen Peroxide (w/w) Topical Formulation for Raised Seborrheic Keratoses: Pooled Analysis of Data from Two Phase 3 Studies. [Journal Article]
- JDJ Drugs Dermatol 2018 Oct 01; 17(10):1092-1098
- CONCLUSIONS: SK clearance with HP40 was highest among SKs on the face and lowest among SKs on the extremities. Dyspigmentation rates were lowest among SKs treated on the face. Anatomic location of SK was a predictor of both treatment response and risk of dyspigmentation with HP40 application. ClinicalTrials.gov listings: NCT02667236 and NCT02667275 J Drugs Dermatol. 2018;17(10):1092-1098.
- Pediatric Bilateral Facial Paralysis: An Unusual Presentation of Lyme Disease. [Journal Article]
- PEPediatr Emerg Care 2018 Oct 25
- Pediatric bilateral facial nerve paralysis (FNP) is a rare condition, representing less than 2% of all cases of FNP. The differential diagnosis of FNP is extensive (ranging from infectious, traumatic...
Pediatric bilateral facial nerve paralysis (FNP) is a rare condition, representing less than 2% of all cases of FNP. The differential diagnosis of FNP is extensive (ranging from infectious, traumatic, neurologic, to idiopathic) and often can present as a diagnostic challenge. In contrast to unilateral presentation, bilateral FNP presents as a manifestation of serious systemic conditions, including meningitis (infectious and neoplastic), brain stem encephalitis, Guillain-Barre syndrome, sarcoidosis, Lyme disease, human immunodeficiency virus infection, leukemia, and vasculitis. In the evaluation of a child who presents with bilateral FNP, history plays the utmost role in the diagnosis. A history of rash consistent with erythema chronicum migrans, recent tick exposure, or travel to a Lyme disease-endemic area is highly suggestive that the facial paralysis is a result of Lyme disease. It is also important to recognize that Lyme disease is emerging as the most common infectious etiology of bilateral FNP in the pediatric population. In this case report, we describe a 16-year-old boy who presented to the emergency department with complaints of headache and bilateral FNP, an unusual presentation of Lyme disease.
- [Allopurinol-induced DRESS syndrome: Drug Reaction with Eosynophilia and Systemic Symptoms (DRESS)]. [Journal Article]
- PAPan Afr Med J 2018; 30:120
- We report the case of a 60-year old patient with a 1-month history of hyperuricemia treated with allopurinol. The patient presented to the Department of Dermatology with acute rash on the face and th...
We report the case of a 60-year old patient with a 1-month history of hyperuricemia treated with allopurinol. The patient presented to the Department of Dermatology with acute rash on the face and the lower limbs associated with fever, arthralgias and myalgias. Clinical examination showed symmetric macular erythema on the face at the level of the cheeks with discreet edema (A), erythematous plaques at the level of both legs with healthy skin areas extending progressively from the bottom-up. Lesions were very itchy with burning sensation (B). The examination of the oral cavity showed very painful erosive lesions at the level of the internal face of the cheeks. Lymph nodes were free. Paraclinical tests showed leukocyte counts at 20000, elevated transaminases > 100 IU, eosinophil counts at 1500, HHV6 serology was negative. The diagnosis of DRESS syndrome was retained. The patient underwent corticosteroid therapy at a dose of 1 mg/kg/day associated with symptomatic treatment. Treatment evolution was marked by spectacular improvement after 06 days (C and D) with regression of skin lesions and gradual normalization of laboratory results.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Erysipelas is a skin infection involving the dermis layer of the skin, but it may also extend to the superficial cutaneous lymphatics. It is characterized by an area of erythema that is well demarcat...
Erysipelas is a skin infection involving the dermis layer of the skin, but it may also extend to the superficial cutaneous lymphatics. It is characterized by an area of erythema that is well demarcated, raised, and often affects the lower extremities, with the face being the second most commonly affected site. Erysipelas is also referred to “St. Anthony’s Fire” due to its intense fiery rash. Its diagnosis can overlap with cellulitis, and often a definite diagnosis cannot be made. Cellulitis has ill-defined borders and is slower to develop, while erysipelas has better-defined borders and faster development. Erysipelas can be serious but rarely fatal. It has a rapid and favorable response to antibiotics. Local complications are more common than systemic complication.
- Adverse Cutaneous Effects of Neratinib. [Journal Article]
- JDJ Dermatolog Treat 2018 Oct 15; :1-8
- Neratinib is a tyrosine kinase inhibitor that was FDA-approved for extended adjuvant treatment in adults with HER-2 positive breast cancer in 2017. Due to the novelty of the drug, there are no curren...
Neratinib is a tyrosine kinase inhibitor that was FDA-approved for extended adjuvant treatment in adults with HER-2 positive breast cancer in 2017. Due to the novelty of the drug, there are no current reports in the literature of adverse cutaneous effects associated with neratinib therapy. We present a case of a woman on neratinib for HER-2 positive infiltrating ductal carcinoma of the right breast who presented to the dermatology clinic with changes to the fingernails, acne, and a rash on the face. Physical examination revealed erythema, induration, and some serum crust along the lateral nail folds of the right 4th and left 3rd digits as well as monomorphic acneiform papules and pustules on the face. The timeline of the patient's paronychia and acneiform rash were consistent with a diagnosis of neratinib-associated skin changes. The patient was prescribed doxycycline to control the acneiform eruption. For the nails, she used mupirocin ointment as well as Listerine soaks. She experienced great improvement on this regimen at her 3-month follow-up visit. This case highlights similar cutaneous side effects to EGFR inhibitors with a newer agent, neratinib, that have not been documented in the literature.
- Toxic epidermal necrolysis: the red eye and red herrings in casualty. [Journal Article]
- BCBMJ Case Rep 2018 Oct 12; 2018
- A 38-year-old woman presented to casualty with bilateral red eyes associated with a recent upper respiratory tract infection. This was initially diagnosed as conjunctivitis, however systemic review r...
A 38-year-old woman presented to casualty with bilateral red eyes associated with a recent upper respiratory tract infection. This was initially diagnosed as conjunctivitis, however systemic review revealed an erythematous facial and skin rash, mildly swollen lips and mild swallowing difficulties. The patient was referred for an urgent medical assessment, by which time she was found to have erythema affecting 54% of her body surface area and diagnosed with suspected toxic epidermal necrolysis (TEN). She rapidly deteriorated over 24 hours with a spreading blistering skin rash and airway compromise requiring urgent intubation and admission to the intensive treatment unit (ITU). Subsequent skin biopsies confirmed the diagnosis of TEN, attributed to recent use of ibuprofen. Treatment included broad-spectrum antibiotics and high-dose corticosteroids. The patient had a prolonged hospital stay and developed severe scarring of the ocular surface. She was discharged home and remains under continuing outpatient follow-up with ophthalmology and dermatology teams.
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- Variable expressivity and novel PTEN mutations in Cowden syndrome. [Journal Article]
- OSOral Surg Oral Med Oral Pathol Oral Radiol 2018 Sep 07
- Cowden syndrome (CS) is a phosphatase and tensin homolog gene (PTEN)-associated condition characterized by multiple mucocutaneous hamartomas and an increased risk of malignancies. We reported an isol...
Cowden syndrome (CS) is a phosphatase and tensin homolog gene (PTEN)-associated condition characterized by multiple mucocutaneous hamartomas and an increased risk of malignancies. We reported an isolated case and another of several individuals in one family affected by CS. The isolated case showed typical features, including fibrocystic breast disease, benign thyroid nodules, and multiple papillomatous lesions in the face and oral cavity, and the cause was a novel nonsense mutation-guanine (G) to thymine (T) transition at position 940 (c.940 G>T)-in PTEN. In the family, the proband showed erythema nodosum, duodenal ulcer, intestinal polyps, cervical lipoma, renal cysts, and glaucoma, whereas multiple members of her family were found to have intestinal polyps, and a sister had been diagnosed with breast cancer at early age. An intronic mutation-T>G transition at the +32 position of intron 8 (c.1026+32 T>G)-was found in this family, with in silico analysis revealing the creation of a new donor splice site. This study confirmed the involvement of PTEN in CS and the variable clinical expressivity of disease.