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Causative Drug (causative + drug)
Selected AbstractsCross-reactivity among p -amino group compounds in sulfonamide fixed drug eruption: diagnostic value of patch testingCONTACT DERMATITIS, Issue 2 2004P. Tornero We studied 28 patients with fixed drug eruption (FDE) caused by sulfonamide antibiotics to investigate cross-reactivity between sulfonamide derivatives and p -amino compounds and to explore the usefulness of patch testing, as an alternative to controlled oral challenge testing (COCT), in diagnosis within this clinical area. COCT with sulfamethoxazole (SMX), sulfadiazine (SDZ), sulfamethizole (SMZ), furosemide (FU), procaine (PRO) and glipizide (GPZ) was performed. Patch testing (PT) with SMX and SDZ was carried out. In all patients, the diagnosis of FDE was confirmed by positive COCT and allergy to trimethoprim ruled out by COCT. 42.8 and 31.8% of the SMX-induced FDE patients reacted to SMZ and SDZ, respectively. All patients (n = 28) tolerated FU, PRO and GPZ. COCT performed with the 3 sulfonamide antibiotics in 12 patients was positive in 2 subjects with the 3 drugs, in 2 patients only with SMX and SMZ and in the remaining 8, SMX was the only causative drug. PT was positive in 5 of 25 patients positive on COCT. The probability of obtaining a positive PT was higher among patients who had a residual lesion than that among those who lacked this. Cross-reactivity between different sulfonamide antibiotics is thus variable, being most likely between SMX and SMZ. We have found no cross-reactivity between sulfonamide antibiotics and other sulfonamide derivatives or p -amino drugs in FDE. PT is a useful tool in the diagnosis of FDE, especially if there are residual lesions, because it avoided the need for COCT in 20% of patients. [source] Acute generalized exanthematous pustulosis (AGEP) , A clinical reaction patternJOURNAL OF CUTANEOUS PATHOLOGY, Issue 3 2001Alexis Sidoroff Background: A wide range of diseases or reactions can cause pustular eruptions of the skin. In this spectrum there seems to be a subgroup with characteristic clinical features and a typical course which is mostly caused by drugs for which the term acute generalized exanthematous pustulosis (AGEP) has been established. Objective: To describe the clinical features of AGEP. Methods: The authors' experience from a multinational epidemiological study on severe cutaneous adverse reactions and a comprehensive review of the literature were used to provide an overview of the disease and it's possible causes. An algorithm for validating cases which was established for this study is also presented. Results: AGEP typically presents with at least dozens of non follicular sterile pustules occurring on a diffuse, edematous erythema predominalty in the folds and/or on the face. Fever and elevated blood neutrophils are common. Histopathology typically shows spongiform subcorneal and/or intraepidermal pustules, a marked edema of the papillary dermis, and eventually vasculitis, eosinophils and/or focal necrosis of keratinocytes. Onset is acute, most often following drug intake, but viral infections can also trigger the disease. Pustules resolve spontaneously in less than 15 days. Conclusion: The diagnosis AGEP should be considered in cases of acute pustular rashes and detection of the causative drug should be strived for. Knowledge of the clinical features and usual course of this disease can often prevent unnecessary therapeutical measures. [source] Rapid clearing of acute generalized exanthematous pustulosis after administration of ciclosporinCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 8 2009V. Di Lernia Summary Acute generalized exanthematous pustulosis (AGEP) is a rare disorder, usually drug-induced, and is clinically characterized by widespread, non-follicular aseptic pustules. Although spontaneous resolution usually occurs once the causative drug has been withdrawn, more severe cases often require treatment with systemic corticosteroids. We report a 63-year-old woman who developed AGEP after a 30-day course of hydroxychloroquine. Extensive re-exacerbation of AGEP after an 18-day course of methylprednisolone led us to switch the treatment to oral ciclosporin with a prompt and satisfactory improvement. Ciclosporin has many inhibitory effects on the main cell population (T cells) involved in AGEP. In particular, a significant reduction in producton of interleukin-8 by T cells is a possible explanation of the rapid remission observed in this case. To our knowledge, this is the first reported case of AGEP successfully treated with ciclosporin. [source] Treatment of erythema multiforme, Stevens,Johnson Syndrome, and toxic epidermal necrolysisDERMATOLOGIC THERAPY, Issue 4 2002Klemens Rappersberger The "erythema multiforme disease spectrum" comprises four distinct, severe, clinical subvariants: (1) bullous erythema multiforme (bullous-EM), (2) Stevens,Johnson syndrome (SJS), (3) SJS,toxic epidermal necrolysis (TEN)-overlap syndrome, and (4) TEN. These diseases are closely related to severe mucocutaneous intolerance reactions that are mostly elicited by drugs/drug metabolites and associated with a high mortality rate. Old age and area of detached skin negatively influence the course of disease, and early withdrawal of causative drugs with short half-life is a positive prognostic factor. Therapeutic management represents a multidisciplinary challenge for colleagues from various specialities including specialized nurses and usually can be performed at a dermatologic ward unless technical equipment of an intensive care unit is needed. Topical therapy with biologic and (semi-)synthetic dressings is aimed at early re-epithelialization and the prevention of scarring, synechia formation, and infection. Systemic treatment includes antibiotics, fluid and electrolyte replacement, protein preparations and blood products, etc. Various anti-inflammatory and immunosuppressive treatment regimens with corticosteroids, cyclosporine A, cyclophosphamide, plasmapheresis have been considered to halt ongoing immunologic pathomechanisms, and some of these have shown significant efficacy. However, because we lack formal clinical trials, none of these regimens can be definitively proposed as a therapy of choice in any of the severe clinical variants of the EM spectrum. [source] Toxic epidermal necrolysis and hemolytic uremic syndrome after allogeneic stem-cell transplantationPEDIATRIC TRANSPLANTATION, Issue 6 2007Johan Arvidson Abstract:, TEN and HUS are challenging complications with excessive mortality after HSCT. We report the development of these two conditions in combination in a nine-yr-old boy after HSCT from an unrelated donor. TEN with skin detachment of more than 90% of body surface area developed after initial treatment for GvHD. Within a few days of admission to the burns unit, the patient developed severe hemolysis, hypertension, thrombocytopenia, and acute renal failure consistent with HUS, apparently caused by CSA. The management included intensive care in a burns unit, accelerated drug removal using plasmapheresis, and a dedicated multi-disciplinary team approach to balance immunosuppression and infections management in a situation with extensive skin detachment. The patient survived and recovered renal function but requires continued treatment for severe GvHD. Suspecting and identifying causative drugs together with meticulous supportive care in the burns unit is essential in the management of these patients and long-term survival is possible. [source] Topical provocation in fixed drug eruption due to metamizol and naproxenCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 4 2004E. Özkaya-Bayazit Summary The aim of this study was to investigate the usefulness of topical provocation in the diagnosis of metamizol- and naproxen-induced fixed drug eruption (FDE). Five patients with metamizol- and four patients with naproxen-induced FDE established by oral provocation were tested with the causative drugs at concentrations of 10%, 20%, and 50% in white petrolatum both on previously involved and uninvolved skin using the occlusive patch test technique. Additionally, four patients with metamizol- and five patients with naproxen-induced FDE, and 20 healthy controls were tested openly with drug preparations in dimethyl sulfoxide (DMSO). Tape-stripping occlusive patch testing in petrolatum remained negative in all. Open testing with drug preparations in DMSO revealed positive results in all four patients tested with metamizol mainly at concentrations of 20%, and in three of five patients tested with naproxen exclusively at concentrations of 50%. No positive reaction was seen on previously uninvolved skin and in healthy controls with any drug concentration and pure DMSO. In conclusion, repeated open testing with concentrations of the drugs up to 50% in DMSO seems to be a reliable test method in metamizol-induced FDE whereas oral provocation is still the most reliable method for naproxen-induced FDE as false negative results were common when testing topically with naproxen. [source] | ||||||||||