Enoxaparin induced eruptive angiokeratoma, an extremely rare side effect.

Enoxaparin is one of the most commonly used anticoagulants in the management of thromboembolic events. Herein we report a unique case of enoxaparin induced eruptive angiokeratomas in a patient with a history of ischemic cardiomyopathy who presented with acute decompensated heart failure and a new-onset generalized skin rash that bleeds on trauma, suggestive of angiokeratomas. Dermoscopic examination, as well as skin biopsy, were done upon clinical suspicion of eruptive angiokeratomas, to confirm the diagnosis. Dermoscopy showed dark lacunae surrounded by erythema, while skin biopsy revealed dilated congested capillaries lined by flat endothelial cells in the papillary dermis, both confirming the diagnosis of angiokeratoma. Enoxaparin induced eruptive angiokeratomas was suspected when the skin eruption showed spontaneous dramatic resolution upon withdrawal of enoxaparin followed by its substitution with warfarin, during the course of the patient's treatment. Enoxaparin induced eruptive angiokeratoma is an extremely rare side effect. Physicians should have a high index of clinical suspicion, and promptly discontinue the drug, as this is the only proven treatment for this condition.

An Epidemiological and Clinical Analysis of Cutaneous Adverse Drug Reactions Seen in a Tertiary Care Outpatient Clinic in Cairo, Egypt.

A cutaneous adverse drug reaction (CADR) is any undesirable change in the structure or function of the skin, its appendages, or mucous membranes caused by a drug. The frequency of CADRs is variable, with only few studies evaluating it. Our aim was to identify the clinical spectrum of CADRs and document the epidemiological data of different types of drug eruptions among Egyptian patients attending a tertiary care center. An observational hospital-based analytical study was planned for a period of six months (January-June 2015). All patients attending the outpatient Dermatology Clinic at Kasr El Aini hospital were examined to detect patients with CADRs, who were subjected to a detailed questionnaire with a detailed drug history. A skin biopsy was taken to confirm the diagnosis and to detect the type of CADRs. The primary incidence of CADRs reported in our study was 0.28% (78 patients) from a total number of 27,093 patients. The most common CADRs were SJS/TEN in 12 patients (15.3%) and lichenoid drug eruptions in 12 patients (15.3%), followed by exanthematous drug eruptions in 11 patients (14.1%) and vasculitic drug eruptions in 9 patients (11.5%). The most common drug incriminated was ibuprofen in 6 patients (7.6%), followed by penicillin in 4 patients (5.1%) and aspirin in 3 patients (3.8%). In conclusion, incidence of CADRs in our study was similar to incidence reported in different countries; however, the incidence of life-threatening reactions such as SJS/TEN was higher compared with studies conducted abroad.

Expression of angiopoietin-1, angiopoietin-2, and their receptor Tie2 in verruca vulgaris (common skin warts).

BACKGROUND: Angiogenesis and vasodilatation are reported associated with the development of verruca vulgaris, yet vascular endothelial growth factor overexpression was not detected in the lesions of common warts. Angiopoietins, as angiogenesis factors, have not been studied before in warts. OBJECTIVES: To assess tissue expression of angiopoietin 1 (Ang1), angiopoietin 2 (Ang2), and their receptor Tie2 in the lesions of common warts to try to identify their role as pro-angiogenic factors in the development of these lesions. PATIENTS AND METHODS: Fifty patients with common skin warts and 50 age- and sex-matched controls were included in this study. Four millimeter punch skin biopsies were taken from warts and from normal skin of controls for the detection of gene expression of Ang1, Ang2, and Tie2 using real-time polymerase chain reaction. RESULTS: The mean levels of Ang1, Ang2, and Tie2 were significantly higher in the lesions of common warts compared to the normal skin of controls (P < 0.001 for all). CONCLUSIONS: Upregulation of Ang1, Ang2, and Tie2 seems to play a possible role in the angiogenesis associated with common skin warts.

Prevalence of photosensitivity in chronic hepatitis C virus patients and its relation to serum and urinary porphyrins.

BACKGROUND & AIMS: HCV is a major cause of chronic liver disease in Egypt. The aim was to study the prevalence of photosensitivity among asymptomatic HCV-infected patients and its possible relation to porphyrins levels and whether it can be considered an alarm for early diagnosis of the disease, which is the most important goal in the management. METHODS: This study included 100 accidentally discovered HCV positive cases and 100 HCV negative healthy controls. All patients and controls were subjected to: Detailed history and clinical examination, dermatological examination including evaluation of reaction to solar exposure, measurement of serum AST, ALT, albumin, bilirubin, serum and urinary porphyrins levels. RESULTS: The prevalence of photosensitivity among HCV-positive cases (33%) was significantly higher compared to 10% in the control group. Serum porphyrins were positive in 46 cases (46%), twenty-three cases (23%) had positive urinary porphyrins, while only four controls (4%) showed positive serum porphyrins and one (1%) showed positive urinary porphyrins, the difference was statistically significant. Cases with photosensitivity showed significantly higher prevalence of serum and urinary porphyrins existence as well as serum porphyrins levels. Levels of viraemia showed statistically significant relation to levels of porphyrins. CONCLUSION: Asymptomatic chronic HCV infection cases showed significantly high prevalence of photosensitivity, which is related to the associated disturbance of porphyrins metabolism. Photosensitivity can thus be considered an early marker of HCV infection. Patients discovered to have recently acquired photosensitivity should be screened for HCV infection especially in endemic areas like Egypt.