Development of folliculitis in a patient with recalcitrant pustular psoriasis following acitretin treatment: A case report

2017 ◽  
Vol 2 (1) ◽  
pp. 48
Author(s):  
Nur Ashikin Ahmad ◽  
Tarita Taib ◽  
Meera Kuppusamy
Keyword(s):  
Differential Diagnosis ◽  
Side Effects ◽  
Oral Prednisolone ◽  
Skin Lesions ◽  
Pustular Psoriasis ◽  
High Dose ◽  
Topical Steroids ◽  
Dry Skin ◽  
Psoriasis Therapy ◽  
Cutaneous Side Effect

Oral retinoids are among the drugs of choice for pustular psoriasis. Therapy with retinoids, including acitretin, is potent teratogens with other common side effects such as mucocutaneous involvement. Mucocutaneous side effects including dry lips (cheilitis), skin peeling, hair loss (alopecia), dry skin, or rhinitis are dose-related, with cheilitis occurring in more than 75% of patients receiving the highest doses of acitretin (75 mg/day). We report on a 37-year-old woman who developed folliculitis with acitretin which is a rare cutaneous side effect. She presented with eruptions pruritic papules with follicular pattern on anterior thigh and forearms after almost 1 year of treatment with acitretin (50mg OD) for pustular psoriasis. The skin lesion was treated successfully with skin dressing and antibiotic treatment and skin biopsy is suggestive of folliculitis. Several treatments for pustular psoriasis including topical steroids, methotrexate and oral prednisolone were ineffective or not tolerated. Treatment with acitretin which are 50mg OD provided partial resolution of skin lesions. The case is hereby reported because of its rarity and folliculitis must be considered in the differential diagnosis of a popular eruption, especially in patients with high dose acitretin.

scholarly journals Cutaneous Side Effect of Hydroxurea in a Sickle Cell Anaemia Child-A Case Report

2019 ◽  
pp. 1-6
Author(s):  
A. O. Salako ◽  
S. O. Ogunmefun ◽  
O. W. Aworanti
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Sickle Cell ◽  
Side Effect ◽  
Low Dose ◽  
Sickle Cell Anaemia ◽  
Skin Lesions ◽  
Cutaneous Lesions ◽  
Care Givers ◽  
Cutaneous Side Effect

Background: Hydroxyurea (HU) has redefined the quality of life of children with sickle cell anaemia and their care givers. Despite the acclaimed benefits of HU, the drug could be associated with variable side effects affecting different systems in the human body, including the skin and integuments. The aim of this report is to raise the awareness about the less common side effects of HU. Case Report: A 5-year 8 months old homozygous sickle cell anaemia child presented with pruritic hyperpigmented lesions on the trunk, arms and the legs, four weeks after commencement of HU. HU was initially discontinued for two weeks and thereafter recommenced with a different brand but there was worsening skin lesions despite at a daily low dose of 10 mg/kg. The rashes eventually resolved with low dose once in 3 days HU therapy.  She had recurrent episodes of acute painful crisis; average of three [3] episodes per year warranted hospital admission prior to commencement, but with HU therapy, there has been significant improvement in the crisis. Discussion: Cutaneous lesions are uncommon side effect of hydroxyurea. This side effect is dependent on genetic predisposition and photosensitivity. However, with the established benefit of HU in the management sickle cell anaemia, it is important for the sickle cell experts to continue to monitor closely the children for both the common and rare side effects and to individualize therapy to ensure maximal benefit with minimal or no side effects.

scholarly journals Improvement of skin lesions in corticosteroid withdrawal-associated severe eczema by multicomponent traditional Chinese medicine therapy

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Serife Uzun ◽  
Zixi Wang ◽  
Tory A. McKnight ◽  
Paul Ehrlich ◽  
Erin Thanik ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Withdrawal Syndrome ◽  
Medical Condition ◽  
Skin Lesions ◽  
High Dose ◽  
Topical Steroids ◽  
Rapid Improvement ◽  
Corticosteroid Withdrawal ◽  
Severe Eczema

Abstract Rationale We recently showed that multicomponent traditional Chinese medicine (TCM) therapy had steroid-sparing effects in moderate-to-severe eczema. We sought to evaluate TCM effects in severe eczema in a 7-year-old male with refractory disease and corticosteroid withdrawal syndrome. Methods Prior to referral, the patient had been treated since infancy with increasingly intensive standard of care, including high-dose topical and systemic corticosteroid and antibiotic therapy and was unable to tolerate further steroid treatment. The patient was administered a combination of oral and topical TCM for 17 months following discontinuation of his steroid regimen. His overall medical condition was assessed by SCORAD criteria and laboratory evaluations of serum IgE, absolute eosinophil count, and liver and kidney function tests. Results The patient showed rapid improvement of clinical measures of disease after starting TCM therapy, with marked improvement of sleep quality within the first week, complete resolution of itching, oozing, and erythema at 2 weeks, and a 79% and 99% decrease in his SCORAD values after one month and 3–6 months of TCM, respectively. Serum total IgE decreased by 75% (from 19,000 to 4630 (kIU/L), and absolute eosinophil counts decreased by 60% (from 1000 to 427 cells/μL) after 12 months of treatment. The patient did not require oral or topical steroids during the 17-month trial of TCM. TCM was tapered without complications. His dermatologic manifestations continued to be well-controlled 3 months after discontinuation. Conclusion This case study suggests TCM should be further evaluated in controlled clinical studies of patients with severe, refractory eczema and steroid withdrawal syndrome.

Minimal change disease

2018 ◽  
Author(s):  
Patrick Niaudet ◽  
Alain Meyrier
Keyword(s):  
Side Effects ◽  
Minimal Change Disease ◽  
Calcineurin Inhibitors ◽  
Oral Prednisolone ◽  
Minimal Change ◽  
High Dose ◽  
Second Line ◽  
Treatment Protocols ◽  
Resistant Disease ◽  
Steroid Dependent

Minimal change disease is characteristically responsive to high-dose corticosteroids. As this is the most common cause of nephrotic syndrome in children, and responses are usually prompt, response to 60 mg/m2/day of oral prednisolone (max. 80 mg) is often used as a diagnostic test. Adults respond more slowly and have a wider differential diagnosis, and often a high risk of side effects, so therapy is not recommended without confirmation by renal biopsy. Then first-line treatment is again prednisolone or prednisone, at 1 mg/kg/day (max. 60 mg). KDIGO and other treatment protocols recommend 6 weeks treatment at full dose then 6 weeks at half dose. Shorter protocols seem to increase the risk of relapse. Children frequently have a relapsing pattern of disease which may be managed by less extreme steroid exposure, but for which second-line therapies may be needed to avoid severe steroid side effects. This can arise in adults too. Some children and adults have steroid-dependent or steroid-resistant disease, leading to earlier initiation of treatment with second-line agents. These include levamisole, calcineurin inhibitors, mycophenolate mofetil, and anti-B cell antibodies. The evidence for these and recommendations for relapsing/resistant disease are given in this chapter.

Cutaneous genital complications of antiangiogenic agents

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e14568-e14568
Author(s):  
C. Mateus ◽  
C. Massard ◽  
G. Tomasic ◽  
J. Wechsler ◽  
V. Boige ◽  
...  
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Cell Cancer ◽  
Skin Lesions ◽  
Antiangiogenic Agents ◽  
Topical Steroids ◽  
Cancer Therapies ◽  
Cutaneous Side Effects ◽  
Treatment Interruptions ◽  
Vegfr Inhibitor

e14568 Background: Multikinase inhibitors targeting VEGFR, i.e. sorafenib and sunitinib are associated with various cutaneous side effects (1). Five cases of scrotal skin lesions were recently reported in male patients treated with sunitinib (2). Our observations of 8 patients presenting with genital inflammatory lesions during various anti-VEGFR therapies show that this side effect is linked to VEGFR blockade and not specifically to sunitinib and that it can also occur in women. Results: Six men and two women were seen for a genital eruption. They were treated with sorafenib (3 pts), sunitinib (5 pts), and a new pan-HER and VEGFR inhibitor (BMS 514, EVRI) (1 pt) for renal cell cancer (4 pts), hepatocellular carcinoma (2 pts), lung cancer (1 pt) and sarcoma (1 pt). Genital lesions occurred during the first six weeks of treatment. They appeared as a painful erythematous and squamous inguinal, intergluteal, and perianal rash rapidly involving all genital areas in 4 patients. Lesions became erosive in 3 cases. Four men presented more limited, pruriginous and lichenoid penile papules which were associated with a genital erythema for 3 of them. In one patient, penile inflammation resulted in a phimosis. One patient successively treated with sunitinib, sorafenib and once again with sunitinib experienced genital side effects with both agents. Patients taking sequential sunitinib treatment reported symptoms improvement during treatment interruptions and recurrences during the weeks on therapy. Microbiological samples were negative. Pathology of erythematous and squamous lesions showed a psoriasiform or a lichenoid aspect. Topical steroids were efficient for 5 patients but 3 patients had to interrupt anti-VEGF therapy because of their genital rash. Conclusions: Polymorphous genital inflammatory rash is a new skin side effect that can be associated with any cancer therapies targeting VEGFR in men and in women. Its frequency is unknown and probably underestimated because many patients might not report this side effect and its mechanism is still obscure. Physicians should be aware of this side effect and should inquire as to whether the patients have noticed such symptoms in order to avoid worsening thereof by symptomatic measures. No significant financial relationships to disclose.

Quality-by-Design Enabled Chitosan Nanoparticles for Antitubercular Therapy: Formulation, Statistical Optimization, and In vitro Characterization

2020 ◽  
Vol 15 ◽  
Author(s):  
Manasi M. Chogale ◽  
Sujay S. Gaikwad ◽  
Savita P. Kulkarni ◽  
Vandana B. Patravale
Keyword(s):  
Side Effects ◽  
Treatment Regimen ◽  
Research Work ◽  
Chitosan Nanoparticles ◽  
In Vitro Release ◽  
Antitubercular Therapy ◽  
Prolonged Treatment ◽  
High Dose ◽  
Average Size

Background: Tuberculosis (TB) continues to be among the leading causes for high mortality among developing countries. Though a seemingly effective treatment regimen against TB is in place, there has been no significant improvement in the therapeutic rates. This is primarily owing to the high drug doses, their associated sideeffects, and prolonged treatment regimen. Discontinuation of therapy due to the severe side effects of the drugs results in the progression of the infection to the more severe drug-resistant TB. Objectives: Reformulation of the current existing anti TB drugs into more efficient dosage forms could be an ideal way out. Nanoformulations have been known to mitigate the side effects of toxic, high-dose drugs. Hence, the current research work involves the formulation of Isoniazid (INH; a first-line anti TB molecule) loaded chitosan nanoparticles for pulmonary administration. Methods: INH loaded chitosan nanoparticles were prepared by ionic gelation method using an anionic crosslinker. Drugexcipient compatibility was evaluated using DSC and FT-IR. The formulation was optimized on the principles of Qualityby-Design using a full factorial design. Results: The obtained nanoparticles were spherical in shape having an average size of 620±10.97 nm and zeta potential +16.87±0.79 mV. Solid state characterization revealed partial encapsulation and amorphization of INH into the nanoparticulate system. In vitro release study confirmed an extended release of INH from the system. In vitro cell line based safety and efficacy studies revealed satisfactory results. Conclusion: The developed nanosystem is thus an efficient approach for antitubercular therapy.

scholarly journals TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Freja Lærke Sand ◽  
Simon Francis Thomsen
Keyword(s):  
Side Effects ◽  
Chronic Urticaria ◽  
Treatment Options ◽  
Significant Proportion ◽  
Response Duration ◽  
Immunosuppressive Drugs ◽  
Tnf Alpha ◽  
High Dose ◽  
Duration Of Treatment ◽  
Durable Response

Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects.

Bilateral dysthyroid compressive optic neuropathy responsive to teprotumumab

2021 ◽  
pp. 112067212199104
Author(s):  
Catherine J Hwang ◽  
Erin E Nichols ◽  
Brian H Chon ◽  
Julian D Perry
Keyword(s):  
Side Effects ◽  
Optic Neuropathy ◽  
Surgical Decompression ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
High Dose ◽  
Compressive Optic Neuropathy ◽  
Traditional Management ◽  
Immune Mediated ◽  
Orbital Radiation

Thyroid eye disease is an auto-immune mediated orbitopathy which can cause dysthyroid compressive optic neuropathy. Traditional management of active thyroid eye disease includes temporizing high-dose steroids, orbital radiation and surgical decompression, which each possess significant limitations and/or side effects. Teprotumumab is an IGF-IR inhibitor recently FDA-approved for active thyroid eye disease. The authors report reversal of bilateral dysthyroid compressive optic neuropathy managed medically utilizing teprotumumab.

scholarly journals Current Nanocarrier Strategies Improve Vitamin B12 Pharmacokinetics, Ameliorate Patients’ Lives, and Reduce Costs

Nanomaterials ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 743
Author(s):  
Marco Fidaleo ◽  
Stefano Tacconi ◽  
Carolina Sbarigia ◽  
Daniele Passeri ◽  
Marco Rossi ◽  
...  
Keyword(s):  
Side Effects ◽  
Vitamin B12 ◽  
Memory Performance ◽  
Oral Route ◽  
High Dose ◽  
Human Beings ◽  
Inborn Errors ◽  
Essential Nutrient

Vitamin B12 (VitB12) is a naturally occurring compound produced by microorganisms and an essential nutrient for humans. Several papers highlight the role of VitB12 deficiency in bone and heart health, depression, memory performance, fertility, embryo development, and cancer, while VitB12 treatment is crucial for survival in inborn errors of VitB12 metabolism. VitB12 is administrated through intramuscular injection, thus impacting the patients’ lifestyle, although it is known that oral administration may meet the specific requirement even in the case of malabsorption. Furthermore, the high-dose injection of VitB12 does not ensure a constant dosage, while the oral route allows only 1.2% of the vitamin to be absorbed in human beings. Nanocarriers are promising nanotechnology that can enable therapies to be improved, reducing side effects. Today, nanocarrier strategies applied at VitB12 delivery are at the initial phase and aim to simplify administration, reduce costs, improve pharmacokinetics, and ameliorate the quality of patients’ lives. The safety of nanotechnologies is still under investigation and few treatments involving nanocarriers have been approved, so far. Here, we highlight the role of VitB12 in human metabolism and diseases, and the issues linked to its molecule properties, and discuss how nanocarriers can improve the therapy and supplementation of the vitamin and reduce possible side effects and limits.

scholarly journals Skin lesions, differential diagnosis and practical approach to potential survivors of torture

2019 ◽  
Vol 33 (7) ◽  
pp. 1232-1240 ◽  
Author(s):  
K. Clarysse ◽  
M. Grosber ◽  
J. Ring ◽  
J. Gutermuth ◽  
C. Kivlahan
Keyword(s):  
Differential Diagnosis ◽  
Skin Lesions ◽  
Practical Approach ◽  
Survivors Of Torture
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