ABSTRACT
BACKGROUND: Allergic contact dermatitis (ACD) from topical medication often occurs in occluded areas, for example, with wound treatment, but also in certain body locations, such as the anogenital area. OBJECTIVES: To investigate the demographics and specific lesion location of patients with ACD from topical drugs applied onto the (peri)anal/genital area, and to identify the respective causal topical pharmaceutical products and ingredients involved. METHODS: From January 2000 to December 10, 2018, 532 patients were tested with the baseline series, sometimes with additional series, and the topical medication used along with the ingredients. The relevant data were extracted from our electronic databases developed in-house. RESULTS: Forty-four patients (9%) out of 473 patients suffering from lesions in the (peri)anal/genital area had positive patch test results to topical drug preparations and/or their ingredients, sometimes in association with cosmetics for intimate hygiene. The most frequent sensitizing active principles were local anaesthetics and corticosteroids, while wool alcohols and to a minor extent benzoic acid were the most frequent culprits among the vehicle components and preservative agents, respectively. CONCLUSIONS: The local conditions (eg, occlusion, sweating, moist) in the anogenital area may favour skin sensitization to topical medication used to treat various skin diseases.
Subject(s)
Adrenal Cortex Hormones/adverse effects , Anesthetics, Local/adverse effects , Anus Diseases/chemically induced , Cosmetics/adverse effects , Dermatitis, Allergic Contact/etiology , Genital Diseases, Female/chemically induced , Genital Diseases, Male/chemically induced , Adolescent , Adult , Aged , Benzoic Acid/adverse effects , Child , Child, Preschool , Female , Humans , Hygiene , Infant , Lanolin/adverse effects , Male , Middle Aged , Preservatives, Pharmaceutical/adverse effects , Retrospective Studies , Young AdultSubject(s)
Anus Diseases/chemically induced , Drug Eruptions/etiology , Genital Diseases, Female/chemically induced , Genital Diseases, Male/chemically induced , Isotretinoin/adverse effects , Mucositis/chemically induced , Adolescent , Adult , Dyspareunia/chemically induced , Female , Hemorrhage/chemically induced , Humans , Isotretinoin/pharmacology , Male , Middle Aged , Sebaceous Glands/drug effects , Young AdultABSTRACT
We report a case of long-standing inexplicable perianal ulcers. After exclusion of an inflammatory, infectious or neoplastic origin, a thorough personal history revealed that for many years the patient had been using analgesic suppositories containing indomethacin, caffeine, and prochlorperazine dimaleate, four to five times a week, for migraine. On stopping the suppositories, there was complete healing within 12 weeks. We hypothesize that vasoconstriction and vascular damage were the pathogenetic mechanisms behind the perianal ulcers.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anus Diseases/chemically induced , Central Nervous System Stimulants/adverse effects , Indomethacin/adverse effects , Skin Ulcer/chemically induced , Aged , Caffeine/adverse effects , Chronic Disease , Dopamine Antagonists/adverse effects , Drug Combinations , Female , Humans , Prochlorperazine , SuppositoriesABSTRACT
mTOR inhibitors have a wide spectrum of therapeutic applications in adults and children. Little is known, however, about serious adverse effects in children undergoing mTOR inhibitor therapy. Oral ulcers are common and sometimes severe, but no other gastrointestinal involvement has been reported so far. Here we present a case of everolimus-associated perianal ulcers in an eight-month-old infant, 3 months after heart transplantation, which necessitated the drug's discontinuation. In a thorough series of diagnostic tests, we identified no other cause for the progressive perianal ulceration. The recognition and appropriate management of mTOR inhibitors' adverse effects in pediatric patients are essential and remain challenging.
Subject(s)
Anus Diseases/chemically induced , Everolimus/adverse effects , Heart Transplantation , Immunosuppressive Agents/adverse effects , Ulcer/chemically induced , Anus Diseases/diagnosis , Humans , Infant , Male , Ulcer/diagnosisSubject(s)
Antibodies, Monoclonal, Murine-Derived/adverse effects , Anus Diseases/chemically induced , Anus Diseases/drug therapy , Crohn Disease/chemically induced , Crohn Disease/drug therapy , Granulomatosis with Polyangiitis/drug therapy , Rituximab/adverse effects , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Anus Diseases/pathology , Azathioprine/therapeutic use , Biopsy, Needle , Crohn Disease/pathology , Drug Therapy, Combination , Female , Follow-Up Studies , Granulomatosis with Polyangiitis/diagnosis , Humans , Immunohistochemistry , Infliximab/therapeutic use , Male , Middle Aged , Rituximab/therapeutic use , Treatment Outcome , Young AdultSubject(s)
Antifungal Agents/adverse effects , Anus Diseases/chemically induced , Clotrimazole/adverse effects , Dermatitis, Allergic Contact/etiology , Drug Eruptions/etiology , Fluconazole/adverse effects , Preservatives, Pharmaceutical/adverse effects , Vulvar Diseases/chemically induced , Adult , Female , Humans , Patch Tests , Thiazoles/adverse effectsABSTRACT
Everolimus, a mammalian target of rapamycin inhibitor, is an emerging drug, which is being increasingly applied in oncology and solid organ transplantation. Oral ulcers are a frequent side effect associated with this immunosupressor. We report the case of a renal transplant recipient who developed disfiguring oral and perianal ulcers secondary to everolimus's toxicity. This is probably the first report of perianal involvement. Dermatologists need to be aware of the potential mucocutaneous adverse effects related to these new drugs that are becoming evermore common in our clinical practice.
Subject(s)
Anus Diseases/chemically induced , Everolimus/adverse effects , Immunosuppressive Agents/adverse effects , Kidney Transplantation/adverse effects , Skin Ulcer/chemically induced , Stomatitis/chemically induced , Adult , Anus Diseases/pathology , Female , Humans , Immunocompetence/immunology , Mouth/pathology , Skin Ulcer/immunology , Skin Ulcer/pathology , Stomatitis/immunology , Stomatitis/pathology , TOR Serine-Threonine Kinases/antagonists & inhibitorsABSTRACT
Everolimus, a mammalian target of rapamycin inhibitor, is an emerging drug, which is being increasingly applied in oncology and solid organ transplantation. Oral ulcers are a frequent side effect associated with this immunosupressor. We report the case of a renal transplant recipient who developed disfiguring oral and perianal ulcers secondary to everolimus's toxicity. This is probably the first report of perianal involvement. Dermatologists need to be aware of the potential mucocutaneous adverse effects related to these new drugs that are becoming evermore common in our clinical practice.
.Subject(s)
Adult , Female , Humans , Anus Diseases/chemically induced , Everolimus/adverse effects , Immunosuppressive Agents/adverse effects , Kidney Transplantation/adverse effects , Skin Ulcer/chemically induced , Stomatitis/chemically induced , Anus Diseases/pathology , Immunocompetence/immunology , Mouth/pathology , Skin Ulcer/immunology , Skin Ulcer/pathology , Stomatitis/immunology , Stomatitis/pathology , TOR Serine-Threonine Kinases/antagonists & inhibitorsABSTRACT
A 61-year-old woman presented with a progressive perianal ulcer which had developed 4 months ago. Upon further examination, another ulcer of the rectum was detected. Anorectal malignancies, viral infections or primary inflammatory bowel disease were not found. It could be demonstrated that the ulcers were induced by paracetamol and codeine suppositories. After discontinuation of these suppositories, the perianal ulcers healed almost completely within 3 weeks. The pathogenesis of paracetamol-induced ulcers is unknown. However, dose-dependent vasoconstriction is a possible explanation.
Subject(s)
Acetaminophen/poisoning , Anus Diseases/chemically induced , Codeine/poisoning , Rectal Diseases/chemically induced , Skin Ulcer/chemically induced , Substance-Related Disorders/complications , Acetaminophen/administration & dosage , Anus Diseases/diagnosis , Anus Diseases/prevention & control , Codeine/administration & dosage , Female , Humans , Middle Aged , Rectal Diseases/diagnosis , Rectal Diseases/prevention & control , Skin Ulcer/diagnosis , Skin Ulcer/prevention & control , SuppositoriesABSTRACT
A 42-year-old man receiving anti-tumour necrosis factor α (anti-TNFα) therapy with adalimumab due to psoriatic arthritis presented with a 2-month-old anal ulcer. An apical right lung infiltrate was found in his chest X-ray, although he had no pulmonary symptoms. Two biopsies of the ulcer were taken and reported as granulomatous, necrotising, with chronic inflammation (first), and as hyperplasic epidermis with linfocitary infiltrate and the presence of plenty of plasmatic cells (second). Histochemical techniques, including Ziehl-Neelsen, Grocott and periodic acid-Schiff stains, and PCR for Mycobacterium tuberculosis on both biopsies were negative. Serology for HIV, syphilis and hepatitis were also negative. In the second biopsy culture, moderate colonies of M. tuberculosis finally grew. The patient started a four-drug antituberculosis regimen. Adalimumab was discontinued and etanercept introduced after 2â months of antituberculosis therapy. The patient remained on therapy for 9â months with complete ulcer resolution.
Subject(s)
Anti-Inflammatory Agents/adverse effects , Antibodies, Monoclonal, Humanized/adverse effects , Anus Diseases/chemically induced , Arthritis, Psoriatic/drug therapy , Tuberculosis/chemically induced , Adalimumab , Adult , Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Anus Diseases/diagnosis , Humans , Male , Tuberculosis/diagnosisABSTRACT
Perianal actinomycosis infection is a very rare occurrence and is challenging to diagnose. Nicorandil is a potassium channel agonist, which is used in the treatment of ischaemic heart disease. Its usage is associated with perianal ulceration and delayed surgical wound healing. We report a case of actinomycosis complicating a chronic perianal ulcer, which was associated with long-term nicorandil usage. It raised the suspicion of malignancy and required over six months of antimicrobial treatment to achieve satisfactory healing. Perianal actinomycosis results in chronic infection which spreads across tissue planes and can resemble an ulcerated malignancy. Nicorandil usage can result in perianal ulceration and produces conditions which are conducive to actinomycosis infection. In such cases, nicorandil therapy should be discontinued, if possible, and long-term systemic antibiotics form the mainstay of treatment.
Subject(s)
Actinomycosis/complications , Anus Diseases/chemically induced , Myocardial Ischemia/drug therapy , Nicorandil/adverse effects , Ulcer/chemically induced , Vasodilator Agents/adverse effects , Actinomycosis/diagnosis , Aged , Anus Diseases/complications , Anus Diseases/diagnosis , Humans , Male , Treatment Outcome , Ulcer/complications , Ulcer/diagnosis , Wound HealingABSTRACT
BACKGROUND: In patients with vulval or anogenital dermatitis, irritant contact dermatitis is more common than allergic contact dermatitis. The reported frequency and relevance of contact sensitivity in anogenital dermatitis varies greatly. OBJECTIVE: To determine the frequency and relevance of contact sensitization in a Dutch group of female patients with chronic anogenital complaints. METHODS: We reviewed patch test results of 53 women with chronic anogenital complaints, with sole vulval symptoms in 29 women and sole perianal in 5, in whom inflammatory skin diseases like lichen sclerosus, lichen planus, psoriasis, as well as infectious diseases were unlikely or excluded as a cause of their symptoms. All women were tested with the European baseline series plus additional test series according to their personal history. RESULTS: Thirty-five patients (66%) showed one or more positive test reactions. Seven of these patients (20%) had one or more clinically relevant positive reactions, most often to flavours and spices. CONCLUSION: A considerable number of patients with anogenital dermatitis have a contact sensitization. Clinically relevant reactions were mainly found to spices and flavours. This is in contrast to the data reported in the literature that shows most contact allergies in vulval patients to ingredients of topical medication.
Subject(s)
Allergens , Anus Diseases/chemically induced , Anus Diseases/diagnosis , Dermatitis, Allergic Contact/diagnosis , Genital Diseases, Female/chemically induced , Genital Diseases, Female/diagnosis , Spices/toxicity , Adult , Anus Diseases/epidemiology , Dermatitis, Allergic Contact/epidemiology , Dermatitis, Allergic Contact/etiology , Female , Genital Diseases, Female/epidemiology , Humans , Male , Middle Aged , Patch Tests/methods , Reproducibility of ResultsSubject(s)
Anus Diseases/chemically induced , Hemorrhoids/therapy , Rectal Diseases/chemically induced , Sclerotherapy/adverse effects , Aged, 80 and over , Anus Diseases/pathology , Anus Diseases/surgery , Humans , Male , Necrosis , Rectal Diseases/pathology , Rectal Diseases/surgery , Treatment OutcomeABSTRACT
BACKGROUND: Nicorandil is a potassium-channel activator used in the treatment of angina pectoris. The first cases of anal ulcerations induced by nicorandil were published in 2002. CASE REPORT: A 71-year-old man presented with a 2-year history of anal ulcerations occurring within a few months of initiation of treatment with Nicorandil. Histological tests on a biopsy sample showed granulation tissue with non-specific chronic inflammation. Nicorandil was stopped and this resulted in complete healing of the ulcers after three months. DISCUSSION: Nicorandil can induce chronic and extensive anal ulcerations. The pathogenesis is unknown. Patients are usually treated with high doses of nicorandil. Dermatologists should be aware of this rare side-effect which heals after withdrawal of the drug.
Subject(s)
Anti-Arrhythmia Agents/adverse effects , Anus Diseases/chemically induced , Nicorandil/adverse effects , Ulcer/chemically induced , Aged , Humans , MaleSubject(s)
Anus Diseases/chemically induced , Nicorandil/adverse effects , Ulcer/chemically induced , Anus Diseases/diagnosis , Colonoscopy , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Humans , Intestinal Mucosa/drug effects , Intestinal Mucosa/pathology , Male , Myocardial Ischemia/diagnosis , Myocardial Ischemia/drug therapy , Nicorandil/therapeutic use , Risk Assessment , Sampling Studies , Severity of Illness Index , Ulcer/diagnosisABSTRACT
A 63-year old man developed severe perianal and palmar contact dermatitis caused by sensitization to iodopropynyl butylcarbamate in moist sanitary wipes. Iodopropynyl butylcarbamate is increasingly employed as preservative in common cosmetic formulations and moist sanitary wipes as substitute for the previously frequently used sensitizers isothiazolinones and methyldibromoglutaronitrile. The allergic potential of diverse preservatives is a serious problem for the cosmetic industry, since truly hypoallergenic preservatives are not available but products such as moist sanitary wipes in large packages definitely require some form of protection.
Subject(s)
Allergens , Anus Diseases/chemically induced , Carbamates/immunology , Dermatitis, Allergic Contact/etiology , Hand Dermatoses/chemically induced , Household Products/adverse effects , Paper , Preservatives, Pharmaceutical/adverse effects , Anti-Allergic Agents/administration & dosage , Anti-Allergic Agents/therapeutic use , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Anus Diseases/drug therapy , Carbamates/adverse effects , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/drug therapy , Hand Dermatoses/drug therapy , Humans , Male , Middle Aged , Mometasone Furoate , Pregnadienediols/administration & dosage , Pregnadienediols/therapeutic use , Skin Tests , Time FactorsABSTRACT
PURPOSE: Ergotamine tartrate suppositories are used for treatment of migraine headache attacks. Chronic abuse may lead to severe anorectal complications such as ulceration, stricture, and rectovaginal fistula. These complications are rare, and only sporadic reports may be found. Nevertheless, awareness of this entity on the part of prescribing physicians and treating colorectal surgeons is essential for a successful outcome, because withdrawal of this medication is an inherent part of treatment. PATIENTS: Five female patients were referred for treatment of symptomatic strictures of the anal canal and lower rectum. All of these patients admitted prolonged, nearly daily use of three to seven ergotamine tartrate suppositories. RESULTS: Three patients with severe stenosis of the anal verge and anal canal were treated by Y-V anoplasty, and two patients with circular stricture of the lower third of the rectum had balloon dilatations. In all patients the use of ergotamine suppositories was stopped, and alternative medication was instituted. Long-term follow-up (3-12 years) showed complete resolution of symptoms. CONCLUSION: In view of the availability of new effective drugs for treatment of migraine headache (serotonin agonists) and considering the potentially severe complications of chronic use of ergotamine, the use of this medication should be abandoned.
Subject(s)
Adrenergic alpha-Agonists/adverse effects , Anus Diseases/chemically induced , Ergotamine/adverse effects , Rectal Diseases/chemically induced , Adrenergic alpha-Agonists/administration & dosage , Ergotamine/administration & dosage , Female , Follow-Up Studies , Humans , Middle Aged , Migraine Disorders/drug therapy , Suppositories , Time FactorsABSTRACT
Quinine by intramuscular or intrarectal injection has been found to be the best treatment for malaria in Niger, particularly in field health centres where the use of solutions can pose problems. There have been several reports of complications following injections, usually due to technical error or to the toxic side effects of quinine. In our hospital, we treated two such rare complications consisting of a case of coxal osteoarthritis induced by intramuscular injection and a case of anorectal necrotising induced by intrarectal injection. The occurrence of such life-threatening events could be reduced in frequency by teaching health personnel about techniques of quinine administration as well as its dangers.