Antihypertensives in dermatology Part II - Cutaneous adverse reactions to antihypertensives

Antihypertensive drugs are prescribed frequently and can cause cutaneous adverse reactions. The exact incidence and frequency of these reactions are unknown. Multiple antihypertensive drug consumption has contributed to a substantial increase in the number of cutaneous adverse reactions to them. Thus, there is a need for dermatologists and physicians to be aware of the wide range of available antihypertensives and the type of reactions that can be expected. This review article focuses on the various clinical presentations that have been implicated or associated with them. The diagnosis and management have been discussed in brief.

Chronic Graft-Versus-Host Disease Mimicking Psoriasis in a Patient with Hemophagocytic Lymphohistiocytosis

Graft-versus-host disease (GVHD) is a common complication of bone marrow transplantation (BMT) that can be classified as acute or chronic. Chronic GVHD, which usually occurs more than 3 months after BMT, includes typical lichenoid or sclerodermatous lesions. Psoriasiform eruption is a rare clinical manifestation of chronic GVHD, and there have been no reports of psoriasiform chronic GVHD associated with hemophagocytic lymphohistiocytosis. A 33-year-old woman who was diagnosed with hemophagocytic lymphohistiocytosis 10 years ago visited our outpatient clinic with psoriasiform eruption over her entire body. She underwent allogeneic BMT 7 months previously from her sibling. Skin biopsy was performed on the lesion, and the histological features suggested GVHD. The psoriasiform lesions improved with narrow-band ultraviolet B phototherapy, with secondary vitiligo remaining on the corresponding locations.

A Case of Psoriasiform Dermatitis Following Adalimumab Injection for Treatment of Ankylosing Spondylitis / 대한피부과학회지

Adalimumab (Humira(TM)) is the first fully humanized monoclonal TNF-alpha antibody that antagonizes the effects of TNF-alpha. Its use has been found in the treatment of various rheumatologic disorders, namely rheumatoid arthritis, Crohn's disease, and ankylosing spondylitis, as well as for various skin conditions such as psoriasis. As the use of this particular biologic agent is becoming more widespread, cutaneous adverse effects of the drug is now being reported at a steady rate. The authors herein report a case of 32 year-old female who presented with multiple psoriasiform eruptions on her trunk, back and lower extremities. She had a four-year history of ankylosing spondylitis, for which she was started on subcutaneous adalimumab injection monthly, three and a half years prior to her initial visit.

A Case of Psoriasiform Eruption Triggered by Tumor Necrosis Factor-alpha Antagonist Therapy / 대한피부과학회지

Tumor necrosis factor-alpha antagonists include monoclonal antibodies, infliximab, adalimumab, etanercept and golimumab. Clinical trials of these agents have shown that they are remarkably effective for psoriasis, but cutaneous adverse reactions of these agents including paradoxical aggravation of psoriasiform eruption have been also reported. We present a case of psoriasiform eruption triggered by golimumab therapy in a patient with rheumatoid arthritis. A 53-year-old woman presented with a skin lesion on the sole. She had been treated by golimumab every 4 weeks for rheumatoid arthritis from September 2006. 16 weeks after the treatment, she developed a erythematous and scaly patch on the sole. She had a history of palmoplantar pustulosis, but the skin lesions had not appeared for a long time, recurring when she started golimumab treatment. The skin lesion improved with topical steroid treatment, but as golimumab was re-administrated, the skin lesion exacerbated.