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Resumen El exantema intertriginoso y flexural simétrico por fármacos (SDRIFE) es una toxicodermia que se presenta con exantema limitado a pliegues, sobretodo en región glútea y genital, y representa una reacción a la exposición sistémica a un medicamento sin sensibilización previa. Presentamos el caso de una paciente mujer adulta previamente sana, que consulta por este tipo de reacción medicamentosa asociada al uso de piroxicam intramuscular, manejada de forma exitosa con antihistamínicos, esteroides tópicos y sistémicos.
Abstract Symmetrical drug related intertriginous and flexural exanthema is a cutaneous drug eruption that is characterized by exanthema limited to creases, buttocks and the upper inner thighs. It represents a reaction to systemic exposure to a drug, without previous sensitization. We present the case of a woman, previously healthy, who consulted due to this drug reaction after being injected with piroxicam, who was successfully treated with antihistamines, topical and systemic corticosteroids.
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This paper reported a case of drug eruption in a male patient with first-episode schizophrenia. The patient received ziprasidone monotherapy， and experienced post-treatment remission of schizophrenic symptoms， while accompanied by drug eruption with fever and elevated white blood cell count. Even with antiallergic treatment， the eruption did not subside without discontinuation of ziprasidone， whereas the eruption resolved after discontinuation of ziprasidone. This case suggested that individual allergy history should be taken into account during the use of ziprasidone， and timely intervention of adverse skin reactions was essential to prevent the development of severe drug eruption.
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@#BACKGROUND: To explore the clinical manifestations, diagnosis, and treatment of patients with acquired immunodeficiency syndrome (AIDS) complicated with drug-induced erythroderma. METHODS: The clinical data of 12 AIDS patients with drug-induced erythroderma in our hospital were retrospectively analyzed. The general information, offending medications, complications, modified severity-of-illness score for toxic epidermal necrolysis (SCORTEN) scores, and disease outcome spectrums were analyzed. RESULTS: Drug-induced erythroderma was mostly caused by antiviral drugs, antituberculosis drugs, antibiotics, traditional Chinese medicine, and immune checkpoint inhibitors. The spectrum of sensitizing drugs was broad, the clinical situation was complex, and infections were common. The affected areas were greater than 40% body surface area in all patients. The modified SCOTERN score averaged 3.01±0.99. All patients were treated with glucocorticoids, and nine patients were treated with intravenous immunoglobulin (IVIG) pulse therapy at the same time. The average time to effectiveness was 7.08±2.23 days, and the average hospital stay was 17.92±8.46 days. Eleven patients were cured, and one patient died of secondary multiple infections, who had a modified SCORTEN score of 5 points. The mortality rate in this study was 8.3%. CONCLUSIONS: The clinical situation of AIDS patients with drug-induced erythroderma in hospitalized patients is complex and the co-infection rate is high. The use of modified SCORTEN score may objectively and accurately assess the conditions, and the use of glucocorticoid combined with IVIG therapy may improve the prognosis.
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Cefixime, a third generation cephalosporin and ornidazole, a nitroimidazole is used for a wide variety of conditions like urinary tract infections, otitis media, pharyngitis, uncomplicated gonorrhea and anaerobic infections. Fixed drug eruption (FDE) is commonly associated with anticonvulsants, antimicrobials and NSAIDs. Here we report a case of a rare cefixime and ornidazole combination induced fixed drug eruption. A 39 year old male developed hyper-pigmented patches over both forearms and left thigh after consuming fixed dose combination of cefixime and ornidazole tablet for the treatment of urinary tract infection.
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Objetivo: Identificar la producción del conocimiento en enfermería junto la técnica de administración de medicamentos por vía intramuscular, describa las diferencias, congruencias, y la ocurrencia de las complicaciones de la técnica y analizar las recomendaciones formuladas en la literatura con las mejores prácticas y las actualizaciones clínicas en enfermería. Método: Revisión sistemática sin meta-análisis. Búsqueda realizada en las bases de datos LILACS, PUBMED, MEDLINE, DEDALUS, Portal de Evidencia en Salud y Bibliotecas SciELO y Cochrane, en el período de 1993-2012, por un total de 16 estudios. Resultados: Estúdios mostraron diferencias en las variaciones en la demarcación de la región ventral glútea, la realización de la antisepsia y la aplicación de presión antes de la administración intramuscular. Consonancia en la aspiración del contenido de la jeringa después de la inserción de la aguja en el músculo, de ricino secuencias del sitio de aplicación para inyección IM, entre otras. Conclusión: La incorporación de la mejor evidencia permite la ejecución segura de la técnica intramuscular, proporcionando comodidad y la excelencia en la atención al paciente
Objective: The study's purpose has been to identify the production of nursing knowledge related to the medication administration technique by the intramuscular route. It was also aimed to describe the differences, similarities, and occurrence of complications of the technique and to analyze the recommendations described in literature with best practice and clinical updates in the nursing research field. Methods: This is a systematic review without meta-analysis. The research was performed through the following electronic databases, LILACS, PUBMED, MEDLINE, DEDALUS, Health Evidence Portal and Libraries SciELO and Cochrane, during the period from 1993 to 2012, then totaling 16 studies. Results: The findings have shown the different variations in the limit of the ventrogluteal region, conducting antisepsis, and applying pressure before intramuscular administration. They also showed consonances in the aspiration of the contents of the syringe after insertion of needle into the muscle, caster application site during sequences IM injections, among others. Conclusion: The incorporation of best evidence allows safe execution of intramuscular technique, providing comfort and excellence towards the patient care
Objetivo: Identificar a produção do conhecimento da enfermagem atrelado à técnica de administração de medicamentos pela via intramuscular; descrever as divergências, congruências e ocorrência de complicações acerca da técnica; e analisar as recomendações descritas na literatura com as melhores práticas e atualizações clínicas na enfermagem. Método: Revisão sistemática sem meta-análise. Realizada busca nas bases de dados LILACS, PUBMED, MEDLINE, DEDALUS, Portal de Evidência em Saúde e Bibliotecas SciELO e Cochrane, no período de 1993 a 2012, totalizando 16 estudos. Resultados: Os estudos evidenciaram divergências na variações de demarcação da região ventroglútea; realização de antissepsia; e aplicação de pressão antes da administração intramuscular. Consonâncias na aspiração do conteúdo da seringa após inserção da agulha na massa muscular, rodízio do local de aplicação durante sequências de injeções IM, dentre outros. Conclusão: A incorporação das melhores evidências permite a execução segura da técnica intramuscular, gerando conforto ao paciente e excelência na assistência
Subject(s)
Humans , Male , Female , Injections, Intramuscular/nursing , Injections, Intramuscular/instrumentation , Injections, Intramuscular/methodsABSTRACT
Anagen effluvium is an abrupt loss of hair in its growing phase due to an event that impairs the mitotic or metabolic activity of the hair follicle. Anagen effluvium is commonly associated with the administration of chemotherapy, radiation, and drugs as well as exposure to toxic chemicals. However, alopecia due to the administration of anti-tuberculosis drugs has rarely been reported in the literature. A 50-year-old female was diagnosed with intestinal tuberculosis and was started on anti-tuberculosis therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide. After starting the treatment, erythematous to brown patches appeared all over her body, which was followed by diffuse hair loss on the scalp and body. Hair examination showed intact inner and outer root sheaths with fully pigmented hair bulbs, and histopathological examination of a scalp biopsy showed vacuolar degeneration in the interfollicular epidermis and perifollicular infiltration of mononuclear cells and eosinophils. The condition was diagnosed as anagen effluvium with drug eruption, and a potent corticosteroid lotion was prescribed for scalp application twice a day. After complete hair loss, the anti-tuberculosis medications were withdrawn, and hair regrowth started 4 months later. Here, we report a rare case of anagen effluvium with generalized drug eruption due to anti-tuberculosis medication.
Subject(s)
Female , Humans , Middle Aged , Alopecia , Biopsy , Drug Eruptions , Drug Therapy , Eosinophils , Epidermis , Ethambutol , Hair , Hair Follicle , Isoniazid , Pyrazinamide , Rifampin , Scalp , TuberculosisABSTRACT
This article described the main classification of severe drug eruption and its clinical manifestations, summarized the treatment principle of severe drug eruption, including stopping sensitization drugs, hormone therapy, support treatment, anti-infection treatment, etc, and summarized nursing methods of severe drug eruption, including removal of allergens, preventing infection, condition observation, skin care, mucosal care, nutritional supporting, psychological care and health education to provide reference and guidance for the treatment and nursing of severe drug eruption.
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The epidemiology, clinical manifestations and appropriate diagnostic methods of drug eruption in children are still poorly understood.On the one hand, children′s adverse reactions to drugs are different from adults because of their weight and age characteristics.On the other hand, they can mimic many other skin diseases, especially viral exanthems, frequently appearing as a maculopapular or morbilliform rash sometimes indistinguishable from a cutaneous adverse drug reaction.Meanwhile, the tools used for drug eruption management in adults are applied also for children.Whereas this appears generally acceptable, some aspects of drug eruption and management differ with age.The pathogenesis of drug eruption in children is related to virus infection, immune state, drug and metabolic enzyme effect.Most reactions in children are still attributed to betalactams.The practicability and validity of skin test and other diagnostic procedures need further assessment in children.The key to treatment is early diagnosis, discontinuation of suspect drugs, assessment of prognosis, and specialist support.
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This article described the main classification of severe drug eruption and its clinical mani-festations,summarized the treatment principle of severe drug eruption,including stopping sensitization drugs, hormone therapy,support treatment,anti-infection treatment,etc,and summarized nursing methods of severe drug eruption,including removal of allergens,preventing infection,condition observation,skin care,mucosal care,nutritional supporting,psychological care and health education to provide reference and guidance for the treatment and nursing of severe drug eruption.
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The epidemiology, clinical manifestations and appropriate diagnostic methods of drug eruption in children are still poorly understood. On the one hand,children′s adverse reactions to drugs are dif-ferent from adults because of their weight and age characteristics. On the other hand,they can mimic many other skin diseases,especially viral exanthems,frequently appearing as a maculopapular or morbilliform rash sometimes indistinguishable from a cutaneous adverse drug reaction. Meanwhile,the tools used for drug erup-tion management in adults are applied also for children. Whereas this appears generally acceptable, some aspects of drug eruption and management differ with age. The pathogenesis of drug eruption in children is related to virus infection,immune state,drug and metabolic enzyme effect. Most reactions in children are still attributed to betalactams. The practicability and validity of skin test and other diagnostic procedures need further assessment in children. The key to treatment is early diagnosis, discontinuation of suspect drugs, assessment of prognosis,and specialist support.
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Severe drug eruption is the most common skin drug adverse reaction in clinic. Immune‐mediated adverse drug reactions occur commonly in clinical practice and include mild,self‐limited cutaneous eruptions, IgE‐mediated hypersensitivity, and severe cutaneous adverse drug reactions. Severe cutaneous adverse drug reactions represent an uncommon but potentially life‐threatening form of delayed T cell‐mediated reaction. The spectrum of illness ranges from acute generalized exanthematous pustulosis to drug reaction with eosinophilia with systemic symptoms,to the most severe form of illness,Stevens‐Johnson syndrome and toxic epidermal necrolysis. Drug‐induced exfoliative dermatitis may be one of the manifestations of eosinophilia with systemic symptoms. Typical clinical manifestations,medication history,relevant physical examinations and related auxiliary examinations of patients are helpful to the early diagnosis of the disease. This article introduced in detail the research progress of acute generalized eruptive pustulosis and exfoliative dermatitis eruption.
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Lenalidomide is an immunomodulatory drug used for the treatment of multiple myeloma. Several cases of hematological, gastrointestinal, and cutaneous side effects have been reported for this drug. A 67-year-old patient with multiple myeloma had initially been treated with bortezomib, but the treatment was discontinued due to neurological side effects. The chemotherapeutic regimen of this patient was changed to lenalidomide. Ten days later, erythema and pruritus developed on the entire body. The lenalidomide dose was subsequently reduced and the patient was additionally treated with topical steroids. Because lenalidomide is supplied by the Korean Orphan Drug Center, physicians have limited experience with the drug, and hence, its side effects tend to be underestimated. In addition, the Korean literature lacks reports on such cases. We describe herein a case of lenalidomide-induced drug eruption presenting as a pruritic rash covering the whole body.
Subject(s)
Aged , Humans , Bortezomib , Drug Eruptions , Erythema , Exanthema , Multiple Myeloma , Orphan Drug Production , Pruritus , SteroidsABSTRACT
Fixed drug eruption (FDE) is an adverse drug reaction seen with various groups of drugs are antibiotics such as trimethoprim -sulphamethoxazle, pencillin, tetracyclines, non steroidal anti- inflammatory drugs like ibuprofen, aspirin etc. Doxycycline belongs to tetracycline groups of antibiotics. We herein present the case of Doxycycline induced fixed drug eruption. A 35-year - old man presented to our hospital, with a 2-day history of itching and hyperpigmentation over the chest. Patient developed skin lesion 2 days after and he started taking Doxycycline 100 mg twice a day for skin infections. Dermatological examination revealed multiple well defined hyperpigmented patches seen over the anterior aspect of the chest. Doxycycline was discontinued immediately, and the skin lesions resolved spontaneously within 2 weeks. Causality assessment by using Naranjo adverse drug reaction probability scale and WHO Uppsala monitoring scale categorize the reaction as Doxycycline was the probable cause for the adverse drug reaction. Severity assessment by using modified Hartwig and Siegel ADR severity assessment scale labelled the reaction as mild-level 2. The causative drug or drugs and cross reactants should be avoided in future to prevent recurrence of similar skin reactions.
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Fixed drug eruption (FDE) is a type of drug-induced cutaneous disorder that characteristically presents with recurrence of similar lesion at the same skin or mucosal site as a result of systemic exposure to a drug. Paracetamol is commonly prescribed analgesic-antipyretic agent in all age group of patients. FDE due to paracetamol is not very common but it is well reported in literature for all age groups. We report a case of a 7-year-old male with FDE due to paracetamol involving upper eyelid and presenting as an eyelid skin necrosis.
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Background: Fixed drug eruption is a common cutaneous adverse drug reaction which is characterised by sharply demarcated skin lesions with recurrences at the same site with each subsequent exposure to the culprit drug. The causative drugs for fixed drug eruption (FDE) in any population changes depend on many factors. The knowledge of peculiar clinical features of FDE helps the treating physician to recognise at early stage and avoidance of mismanagement of such cases. Material and method:In this context, we did a descriptive-analytical study of patients who were diagnosed with FDE in single center between Feb 2013 to Sep 2017 from central India. Results: Ninety seven patients who developed FDE were studied in the study with 65% males and 35% females. Mean age at presentation in males and females were 34.95±16.90 and 37.12±12.98 years, respectively. Multiple lesions were present in 80.4% of patients. Seventy four percent of patients gave the history of prior episodes. In 68% patients, symptoms started and lesions developed within <24 hours of the drug exposure. Mucosal lesions were seen in 46.4% and skin lesions (non-mucosal) were seen in 36.1% and in rest 17.5% patients both mucosal and skin lesions were present. Antibiotics and NSAIDS were the most common group of medications to cause FDE. Thirty two percent of patients were caused by Fixed Dose Combinations of antibiotics and anti-protozoals. Conclusion: In conclusion, FDE is a common acute cutaneous drug eruption that if not diagnosed timely leads not only to recurrences but also causes apprehension and morbidity.
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No abstract available.
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Humans , Acneiform Eruptions , Dasatinib , Drug Eruptions , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Pleural EffusionABSTRACT
BACKGROUND: Drug eruptions are common in hospitalized patients. Rapid and accurate diagnosis is essential but often difficult. OBJECTIVE: This study defined the clinical features and causative drugs among inpatients presenting with drug eruptions. METHODS: We retrospectively analyzed the clinical and laboratory data of inpatients who sought consultations with the Dermatology Department for a diagnosis of drug eruptions. RESULTS: A total of 228 patients were diagnosed with drug eruptions, and this study included 139 patients. The highest incidence of drug eruptions was observed in patients in their 50s (22.3%). The most common latent period was up to 1 week (57.6%). The most common drug eruptions were exanthematous eruptions (59.7%), acneiform eruptions (10.8%), and urticaria (9.3%). The most common causative drugs were antibiotics (53.2%), followed by anticancer drugs (19.4%), and contrast media (6.5%). Laboratory abnormalities included eosinophilia (15.8%), abnormal liver function tests (7.9%), leukopenia (4.3%), an elevated serum creatinine level (2.2%), and leukocytosis (0.7%). CONCLUSION: In descending order, the most frequent drug eruptions were exanthematous eruptions, acneiform eruptions, and urticaria, and the most common causative drugs were antibiotics, anticancer agents, and contrast media. Prompt diagnosis and discontinuation of the causative drug are important in this context. Clinicians should be aware of cutaneous adverse drug reactions.
Subject(s)
Humans , Acneiform Eruptions , Anti-Bacterial Agents , Antineoplastic Agents , Contrast Media , Creatinine , Dermatology , Diagnosis , Drug Eruptions , Drug-Related Side Effects and Adverse Reactions , Eosinophilia , Incidence , Inpatients , Leukocytosis , Leukopenia , Liver Function Tests , Referral and Consultation , Retrospective Studies , UrticariaABSTRACT
Fixed drug eruption is a commonly reported mucocutaneous drug eruption. A 61-year-old male presented to our clinic with a complaint of an itchy round erythematous patch on the left hand dorsum with myalgia. On taking medical history, the patient correlated the episode with the intake of an oral sexual enhancer that he had obtained over the counter. We found the medicine contained tadalafil and sildenafil in combination with herbal ingredients. A short course of oral corticosteroid therapy resulted in the complete resolution of the lesion leaving residual hyperpigmentation of the skin involved. Various sexual enhancers with fancy names and attractive packaging are available without requiring a doctor's prescription. Most contain phosphodiesterase-5 inhibitors in various concentrations, often with herbal additions. These drugs are used erratically by the lay public, and often produce side effects. Herein, we report a case of fixed drug rash related to a sexual enhancer, which we believe to be the first report in Korea.