Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis

The similarity between pustular psoriasis (PP) and acute generalized exanthematous pustulosis (AGEP) poses problems in the diagnosis and treatment of these two conditions. Significant clinical and histopathologic overlap exists between PP and AGEP. PP is an inflammatory disorder that has numerous clinical subtypes, but all with sterile pustules composed of neutrophils. AGEP is a severe cutaneous adverse reaction that is also characterized by non-follicular sterile pustules. Clinical features that suggest a diagnosis of PP over AGEP include a history of psoriasis and the presence of scaling plaques. Histologically, eosinophilic spongiosis, vacuolar interface dermatitis, and dermal eosinophilia favor a diagnosis of AGEP over PP. Importantly, PP and AGEP vary in clinical course and treatment. PP treatment involves topical steroids, oral retinoids, and systemic immunosuppressants. Newer therapies targeting IL-36, IL-23, IL-1, and PDE-4 have been investigated. The removal of the offending agent is a crucial part of the treatment of AGEP.

Clinico-pathological features of the drug reaction with eosinophilia and systemic Symptoms syndrome: A case study

Drug reaction with eosinophilia and systemic symptoms syndrome is a syndrome with a varied spectrum of clinical features. The cutaneous manifestations can be an urticarial, maculopapular eruption also including, vesicles, bullae, pustules, purpura, target lesions, facial edema, cheilitis, and erythroderma. Systemic manifestations include lymphadenopathy, fever, and leukocytosis (often with eosinophilia or atypical lymphocytosis), as well as hepatitis, nephritis, pneumonitis, myositis, and gastroenteritis, in descending order. Diagnosis can be made on the basis of the clinical picture and the RegiSCAR (Registry of Severe Cutaneous Adverse Reaction group) scoring system. Here, we present the case of a 40-year-old male with a history of herbal medicine intake after which he developed a diffuse skin rash.

A Rare Pediatric Case of Cefixime Induced Toxic Epidermal Necrolysis

Cefixime is a third-generation cephalosporin that has been used for the treatment of a wide range of infections in children and adults. The incidence of cefixime induced toxic epidermal necrolysis (TEN) is less than 2% in adults, but it is infrequent among pediatric patients. We report a rare case of cefixime induced TEN in a 7-year-old boy. In this case, the child presented with symptoms of TEN after 2 days of administration of cefixime. This case highlights the need to select structurally different antibiotics in case of antibiotic-induced severe cutaneous adverse reaction (SCAR) to avoid recurrence of SCAR. Furthermore, concluded that irrational use of antibiotics could be disastrous as it can result in TEN as the incidence of antibiotics induced TEN ranges from 29% to 42%.

PHẢN ỨNG DA NẶNG DO THUỐC

Phản ứng da nặng (Severe Cutaneous Adverse Reaction, SCAR) do thuốc là một nhóm các phản ứng dị ứng thuốc gây tổn thương nghiêm trọng đến da và niêm mạc, trong những trường hợp nặng có thể ảnh hưởng đến các cơ quan nội tạng, thậm chí gây tử vong. Ngoài thuốc, một số tác nhân nhiễm trùng như Mycoplasma pneumoniacũng có thể gây ra SCAR, đặc biệt ở trẻ em. Trong bài này, xin được tập trung vào SCAR do thuốc. SCAR bao gồm các hội chứng sau: Hội chứng Steven – Johnson (SJS) Hội chứng hoạt tử thượng bì nhiễm độc (Toxic Epidermal Necrolysis, TEN, trước đây còn được gọi là hội chứng Lyell) Hội chứng chuyển tiếp giữa SJS và TEN (SJS/TEN overlap) Hội chứng phản ứng với thuốc có triệu chứng toàn thân và tăng bạch cầu ái toan (Drug Reaction with Eosinophilia and Systemic Symtoms, DRESS). Ban mụn mủ toàn thân cấp tính (Acute Generalized Exanthematous Pustulosis, AGEP). Gần đây, phát ban cố định do thuốc thể bọng nước lan tỏa (Generalized Bullous Fixed Drug Eruption, GBFDE) cũng được một số bác sĩ xếp vào SCAR. Tuy nhiên GBFDE thường ít nguy hiểm hơn cũng như rất hiếm gặp ở trẻ em. Trong các hội chứng trên, SJS, TEN và hội chứng chuyển tiếp SJS/TEN được cho là cùng một bệnh với các mức độ nặng khác nhau. Trong bài này, chúng được kí hiệu chung là SJS-TEN

Long induction of tolerance to imatinib

Imatinib is used to treat several haematological and solid malignancies. Cutaneous side effects could often limit the use of this medication. We present a case of a 62-year-old woman with a history of a gastrointestinal stromal tumour that developed a delayed cutaneous adverse reaction 10 days after starting imatinib 400 mg daily. She developed the same symptoms with reintroduction at a dose of 100 mg and with an alternative tyrosine kinase inhibitor, nilotinib 50 mg/day. Given that imatinib was considered her best treatment, she underwent a long induction of drug tolerance (IDT) protocol to imatinib. Patient tolerated the medication without further reactions for 6 months and had improvement of her cancer per last imaging studies. IDT should be considered in delayed hypersensitivity reactions to imatinib after a failed reintroduction of the drug or when no other equally effective agents are available.

Self-medicated, satranidazole induced fixed drug eruption: a case report

Fixed drug eruption (FDE) is described as the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug; these reactions normally resolve with hyperpigmentation and may recur at the same site with re-exposure to the drug. Repeated exposure to the offending drug may cause new lesions to develop in addition to lighting up the older hyperpigmented lesions. Here we present an interesting case of satranidazole induced FDE with a past history of FDE to the same drug 5 months back. Since the eruption occurred in the same site on re-exposure to the same drug, a diagnosis of FDE was made and causality assessment by Naranjo adverse drug reaction probability scale showed a certain relationship between the cutaneous adverse reaction and the offending drug