ABSTRACT
Anticonvulsivantes y estabilizadores del ánimo principalmente el ácido valproico, lamotrigina y carbamazepina, poseen una alta incidencia de reacciones adversas a medicamentos (RAM) severas, como eritema multiforme, Síndrome Stevens- Johnson y necrolisis epidérmica tóxica, asociadas. Existen signos de alarma para su sospecha diagnóstica precoz, que permiten indicar la temprana suspensión del fármaco sospechoso e iniciar la terapia de soporte únicas medidas que han demostrado una clara disminución en la mortalidad. La inmunoglobulina G intravenosa se recomienda por su seguridad, sin embargo, su rol en disminuir la mortalidad es contradictorio. Los corticoides no han demostrado cambios en la mortalidad comparados con la terapia de soporte exclusiva. Se ha intentado mantener el tratamiento con lamotrigina, por sus cualidades terapéuticas, pese a la aparición de RAM cutáneas. De hecho, en estudios recientes en pacientes que han desarrollado RAM leves a este producto se ha demostrado un éxito de reexposición de 85 por ciento-87 por ciento mediante una lenta titulación de la dosis.
Anticonvulsants and mood stabilizers mainly valproic acid, lamotrigine and carbamazepine are medications that have a high incidence of severe adverse drug reactions (ADRs), such erythema multiforme, Stevens- Johnson syndrome and toxic epidermal necrolysis. Early diagnosis based in systemic and cutaneous alarm signs have been described, allowing premature discontinuation of suspected drugs and start supportive therapy; these are the only measures that have that have shown clear reduction in mortality. The use of intravenous immunoglobulin G is recommended for their safety, but studies regarding their role in reducing mortality are conflicting. Corticosteroids have not proved changes in mortality compared with exclusive supportive care. Due to therapeutic quality Lamotrigine is used despite the incidence of ADRs. In fact in recent studies patients with mild ADRs to this drug have shown between 85 percent-87 percent of success, when patients are re-exposed through a slow increasing in dosage.
Subject(s)
Humans , Anticonvulsants/adverse effects , Drug Eruptions/etiology , Drug Eruptions/therapy , Psychotropic Drugs/adverse effects , Valproic Acid/adverse effects , Carbamazepine/adverse effects , Erythema Multiforme/etiology , Erythema Multiforme/therapy , Stevens-Johnson Syndrome , Stevens-Johnson Syndrome/etiology , Stevens-Johnson Syndrome/therapy , Triazines/adverse effectsABSTRACT
Los Inhibidores del Receptor del Factor de Crecimiento Epidérmico (EGFRI) son nuevos agentes terapéuticos para el manejo de cánceres como el de pulmón y colorrectal en etapas avanzadas. Pueden ser anticuerpos monoclonales contra el EGFR (Cetuximab, Panitumumab) o inhibidores tirosin-kinasa de bajo peso molecular (Gefitinib, Erlotinib). Estos agentes han demostrado tener un perfil toxicológico sistémico reducido, pero casi siempre producen efectos secundarios a nivel cutáneo. El propósito de este trabajo es revisar los principales efectos cutáneos de estos medicamentos, su fisiopatología y eventuales alternativas terapéuticas, para mejorar así la adherencia al tratamiento.
Epidermal Growth Factor Receptor Inhibitors (EGFRI) are new agents for the treatment of cancers, such as advanced stages of lung and colorectal cancer. They can be monoclonal antibodies against EGFR (Cetuximab, Panitumumab) or low molecular weight EGFR tyrosine kinase inhibitors (Gefitinib, Erlotinib). These agents have demonstrated to have reduced systemic toxicity, but almost always cause secondary dermatologic effects. We review the main cutaneous effects of these drugs, their pathophysiology and possible therapeutic alternatives, to improve patient compliance.
Subject(s)
Humans , Drug Eruptions/etiology , Drug Eruptions/therapy , ErbB Receptors/antagonists & inhibitors , ErbB Receptors , Antineoplastic Agents/adverse effects , Antibodies, Monoclonal/adverse effects , Diagnosis, Differential , Drug Eruptions/diagnosis , Drug Eruptions/pathology , Protein Kinase Inhibitors/adverse effects , Skin/pathology , Severity of Illness IndexABSTRACT
Cutaneous adverse drug reactions [ADRs] affect 2-3% of hospitalized patients. These reactions can arise as a result of immunologic or non-immunologic mechanisms. Extremes of age, female sex, previous history of ADRs and environmental factors are the major risk factors. The severity of the cutaneous ADRs may vary from a mild itching to a life threatening Stevens-Johnson syndrome [SJS]. In general, most are usually mild and respond to topical treatment. Different skin diseases and cutaneous manifestation of systemic diseases should be ruled out before diagnosing a cutaneous ADR. In order to establish the causal relationship between the offending drug and the reaction, causality assessment should be carried out. The Naranjo algorithm is widely used to determine the causality of an ADR. The cessation of the offending agent, along with the use of systemic and topical steroids, antipruritic agents and oral antihistamines may be helpful in the management. Patients with extensive skin involvement should be cared for as burns patients. High risk patients should be counseled regarding the possibility of developing a cutaneous ADR during the course of treatment and the strategies to be followed upon occurrence of a cutaneous ADR. This is a review article
Subject(s)
Humans , Pharmaceutical Preparations , Review , Algorithms , Risk Factors , Drug Eruptions/diagnosis , Drug Eruptions/therapy , Urticaria , Exanthema , Erythema Multiforme , Stevens-Johnson Syndrome , Dermatitis, Contact , Dermatitis, Exfoliative , Angioedema , Lichenoid EruptionsSubject(s)
Child , Humans , Erythema Multiforme/diagnosis , Erythema Multiforme/etiology , Drug Eruptions/diagnosis , Drug Eruptions/etiology , Drug Eruptions/therapy , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/etiology , Urticaria/diagnosis , Urticaria/etiology , Diagnosis, Differential , Drug Hypersensitivity , Photosensitivity Disorders , Serum Sickness , Stevens-Johnson SyndromeABSTRACT
La incidencia de reacciones adversas a drogas en pacientes HIV positivos es elevada. Las drogas más frecuentemente involucradas so: sulfonamidas y amoxilina-cluvanato. Diferentes tipos de reacciones son vistas, entre ellas:eritema polimorfo y la necrólisis epidérmica tóxica, que pueden llegar a comprometer la vida del paciente.Los mecanismos que provocan estas reacciones son desconocidos,sin embargo las las evidencias sugieren que la afectación podría deberse a la capacidad disminuida para la detoxificación de metabolitos intermediarios de las drogas con capacidad reactiva. Otras reacciones menos severas sondescriptas como erupciones máculo-pápuloerimatosas generalizadas asociadas a la administración de trimetoprima-sulfametoxazol;hiperpigmentación de uñas asociada a zidovudina y menos frecuentemente,erupción exantemática severa en aproximadamente el 1 por ciento de los pacientes que reciben zidovudina.La observación de de dos pacientes con eritema polimorfo como reacción adversa al cotrimoxazol y amnoxilina-clovanato y otros pacientes con otras reacciones a diferentes drogas motivan esta publicación
Subject(s)
Humans , Male , Adult , Drug Eruptions/therapy , Acquired Immunodeficiency Syndrome/therapy , Ampicillin/adverse effects , Substance-Related Disorders , Zidovudine/therapeutic useABSTRACT
Os autores fazem uma revisão bibliográfica da fisiopatogenia, diagnóstico e principais expressões dermatológicas das erupções cutâneas provocadas por drogas, bem como seu tratamento
Subject(s)
Humans , Drug Eruptions/physiopathology , Drug Eruptions/diagnosis , Drug Eruptions/therapySubject(s)
Humans , Infant , Female , Albuminuria/etiology , Albuminuria/therapy , Drug Eruptions/etiology , Drug Eruptions/therapy , Homeopathy/adverse effects , Mercury Poisoning/classification , Mercury Poisoning/etiology , Mercury/antagonists & inhibitors , Penicillamine/therapeutic use , Respiratory Tract Infections/therapyABSTRACT
4 casos de farmacodermia com fator desencadeante e concomitante representado por analgesicos, sao tratados segundo a lei do semelhante, sem considerar a etiologia na prescricao