A New Case of DRESS Syndrome Induced by Sulfasalazine and Triggered by Amoxicillin.

Drug Rash Eosinophilia Systemic Symptoms (DRESS) syndrome is a systemic hypersensitivity reaction characterized by exfoliative dermatitis and maculopapular rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and involvement of internal organs as liver, lung, heart, and kidney; the disorder starts within 2-6 weeks after taking a drug with an incidence that ranges from 1/1000 to 1/10000 exposures. Fatal cases are reported. The exact pathogenesis of DRESS syndrome is not completely understood, while it is reported that amoxicillin could trigger it in patients who are taking allopurinol, sulfasalazine, NSAIDs, carbamazepine, strontium ranelate, lisinopril, lansoprazole, and minocycline. Amoxicillin could act directly, inducing the reactivation of a viral infection (HHV 6 and EBV) with symptoms similar to DRESS syndrome or by reducing the patients' ability to detoxify the body from substances chronically taken. We describe a case of a patient admitted to our hospital for a DRESS syndrome flared after amoxicilline intake during treatment with sulfasalazine; this combination can activate severe reactions often with an insidious onset that can mimic an infectious disease.

Azithromycin: a new therapeutical strategy for acne in adolescents.

AIM: To study the efficacy, safety, and compliance of 500 mg azithromycin thrice weekly for 8 weeks to treat acne vulgaris in adolescents. METHODS: An open-label, non-comparative study was carried out for 8 weeks. Fifty-two teenagers with moderate to severe papulo-pustular acne vulgaris were enrolled. Azithromycin, 500 mg orally thrice weekly for 8 weeks, was prescribed. No topical treatment was permitted. At the baseline visit, patients were scheduled to return at two-weekly intervals for 8 weeks. Efficacy was gauged by the percentage clearance of papulo-pustular acne lesions. All patients were also evaluated at four months post-treatment. RESULTS: A majority of patients (47/52) showed remarkable improvement in the first 4 weeks with a more than 20 percent reduction of their inflammatory papulo-pustular lesions. Maximum clearance was observed in 32 patients at 8 weeks. Slow improvement with eruptions of new lesions was seen in 6 patients. Adverse events, such as heartburn and nausea, were reported by 3 patients. All patients completed the 8-week study period. The beneficial effect was maintained at 4 months after the conclusion of treatment. CONCLUSIONS: Azithromycin, 500 mg thrice weekly for 8 weeks, appears to be a safe and effective treatment for acne vulgaris in adolescents, with excellent patient compliance.

Allergic contact dermatitis in hairdressers: frequency and source of sensitisation.

Occupational skin diseases are very common among hairdressers. The aim of our study was to evaluate the frequency, the age distribution and the source of contact sensitization in a group of 209 hairdressers who consulted our Clinic from 1990 to 1999. One hundred and thirty-two patients showed one or more clinically relevant positive reactions to different allergens; 89 of them were positive to the hairdressers' series and 43 were positive to other allergens. Para-phenylenediamine base and para-toluenediamine sulphate caused the greatest number of positive reactions (77 and 29 respectively). Both glyceryl monothioglycolate and ammonium persulphate gave 25 positive patch tests. The allergens not included in the hairdressers' series which gave the greatest number of positive reactions were nickel sulphate and disperse dyes yellow 3, blue 124 and red 1. The allergens known as strong skin sensitizers have remained almost the same over the years. Preventive measures should be mandatory to protect hands and to improve the safety of this job.