Esen Özkaya

Fixed drug eruption:state of the art

Fixed drug eruption (FDE) is a common type of cutaneous adverse drug reaction.There may be a genetic background as significant associations have been identified between HLA types and specific FDE.Systemic provocation is still the gold standard for establishing the offending agent in FDE,but topical provocation testing offers a promising alternative approach. A standardized method does not exist, and the approach must likely be varied for different agents. The mystery of site preference in FDE is still unresolved. Possible explanations include properties of the drug, trauma and viscerocutaneous reflex patterns.

Vancomycin-induced drug hypersensitivity syndrome.

© 2005 European Academy of Dermatology and Venereology JEADV (2005) 19, 638–659 given twice per day for 4 days with a 6-week pause. The ulcer was cured within 8 weeks by suppression of the monoclonal component and thus, elimination of hyperviscosity. This case is special from several points of view. Authors have not found any reference in the literature about leg ulcer originated from multiple myeloma associated with hyperviscosity until now. The incidence of multiple myeloma (MM) in Europe is 2.5–3/100 000. One percentage of malignancies and 10% of haematologic malignancies represent multiple myeloma (Kahler’s disease). The most frequent is echymosis without thrombocytopaenia (10%). Extramedullar plasmocytomas occur in 4% of patients. Amyloidosis was detected in 1% and even more rarely found was leucocytoclastic vasculitis proved with biopsy and histology.3 The main reason for the development of ulcer, as shown in our case report, is assumed to be the elevated plasma viscosity maintained by monoclonal gamma globulin-producing plasma cells. Indirect proof is that after the beginning of the adequate therapy for MM resulted wound sanation within a short period of time and the ulcer epithelization advanced in tight relation with the MM laboratory parameters (plasma viscosity, level of gamma globulin), which were monitored during the therapy. The patient has been free of symptoms for more than 3 years now. Her haematologic status is under control.

Oral mucosal fixed drug eruption: Characteristics and differential diagnosis

BACKGROUND Little is known about the characteristic features of oral mucosal fixed drug eruption (FDE). OBJECTIVE To present the clinical highlights and the differential diagnosis of oral mucosal FDE in a relatively large group of patients from Turkey. METHODS This was a methodological, retrospective, cross-sectional study of 61 patients with oral mucosal FDE. The causative drug was established mainly by oral provocation test. RESULTS The age range of 61 patients (38 females, 23 males) was 7 to 62 years. Naproxen and cotrimoxazole were the main inducers. Fourteen patients (23%) had a solitary oral lesion predominantly located on the dorsum of the tongue, or on the hard palate, the former statistically significantly associated with cotrimoxazole. Bullous/erosive (n = 47), aphthous (n = 12), and erythematous (n = 2) morphology were observed. A considerable number of patients were referred with a prior clinical diagnosis of herpes simplex and Behçets disease; some of them were already receiving long-term treatment with acyclovir and colchicine, respectively. LIMITATIONS The main limitation of the present study resides in its retrospective design. CONCLUSIONS Isolated oral lesions, aphthous lesions, severe bullous/erosive lesions, and the absence of residual pigmentation are the main features that may cause difficulties in the differential diagnosis. It is important to differentiate dysmenorrhea-related monthly attacks of oral FDE in female patients caused by nonsteroidal anti-inflammatory drugs from menstruation-triggered attacks of herpes simplex infection, and isolated orogenital aphthous FDE from Behçets disease, especially in countries with a high frequency of the disease in order to prevent irrelevant therapies.

An unusual case of triclosan-induced immunological contact urticaria.

A 44-year-old non-atopic Turkish woman presented with a 5-year history of pruritic reddish wheals on her skin/mucosa occurring immediately after contact with some soaps and topical products. Recently, use of the toothpaste ‘Colgate® Total’ had caused immediate swelling of her lips and tongue, leading to breathing difficulties. The condition resolved within 6 hr with systemic corticosteroids and antihistamines. Kissing her husband, who was using the same toothpaste, caused swelling of her lips within minutes. Kissing her friends, who were using certain topical products on their faces, also caused wheals on her face/lips. The suspected products, that is, a toothpaste (Colgate Total®), a moisturizer lotion (Excipial® Lipo), a corticosteroid cream (Hipokort® cream), a metronidazole cream (Roza® cream), and an antibacterial liquid soap (Protex® Ultra), contained triclosan at concentrations up to 0.2–0.5%. Early reading of chamber tests on the back with IQ Chambers® (Chemotechnique Diagnostics, Vellinge, Sweden) showed severe urticarial reactions to Roza® cream (‘as is’) and triclosan (2.0% pet.) within

Systemic allergic dermatitis from chromium in a multivitamin/multimineral tablet.

A 43-year-old non-atopic lawyer presented with a 10-year history of recurrent vesicular eczema on his hands, wrists, feet, ankles, and lower legs mainly after wearing leather gloves, shoes, or boots. Wearing dark coloured socks worsened his foot eczema. He was aware of no other aggravating factor. Patch testing was performed with the extended European baseline series, and with series of preservatives, emulsifying excipients, fragrances, and leather including leather dyes (Brial Allergen, Greven, Germany) using IQ-Chamber® (Chemotechnique Diagnostics, Vellinge, Sweden). Using International Contact Dermatitis Research Group (ICDRG) criteria, a +++ positive reaction developed to potassium dichromate (0.5% pet.), a ++ positive reaction to cobalt chloride (1% pet.), and a + reaction to nickel sulfate (5% pet.), chromium sulfate (0.5% pet.), ammoniated mercury (1% pet.), and phenylmercuric acetate (0.01% pet.) on D2, D3, and D4. The metal and mercury compounds were of past relevance; the former having caused eczema on contact areas of metals such as eyeglass frame or wrist watch, and the latter from use of mercurochrome in the past. He had had no exposure to these for at least a year and he had never used wet cement. In spite of further avoidance of contact with metals, leather, dark coloured textiles, dyes, and a low chromate and nickel diet for the next 1 month, the lesions failed to improve. At that point, the patient reported the daily use of 1–2 multivitamin/multimineral tablets (ONE-A-DAY® Men’s, Leiner Health Products, USA, imported by Bayer Türk Kimya San. Ltd. Şti., Istanbul, Turkey) for the previous 2–3 months. The preparation contained 150 μg chromium chloride as well as 9 μg vitamin B12 (cyanocobalamin) but no nickel. Within 10 days after discontinuation of the tablets and treatment with topical corticosteroids, his eczema resolved completely. After an eczema-free interval of 3 months, systemic challenge with the multivitamin/multimineral tablets one daily orally for three consecutive days resulted in recurrence of acute vesicular eczema on previously involved sites within 2D. A flare in the previous patch test sites was not observed. The tablets were stopped again, and lesions resolved within 10D. Additional patch testing with chromium chloride could not be performed. There was no recurrence of the eczema during a 6-month follow-up.

Allergic contact cheilitis from a lipstick misdiagnosed as herpes labialis: Subsequent worsening due to Zovirax® contact allergy

A 29‐year‐old Turkish woman with allergic contact cheilitis from a lipstick was misdiagnosed as herpes labialis and subsequently worsened with the application of Zovirax® cream. Patch tests were positive to Zovirax® cream, propylene glycol, the patients favourite lipstick and propyl gallate. No reaction was seen with Zovirax® ophthalmic ointment and Zovirax® tablet. The propylene glycol component of the Zovirax® cream and the propyl gallate component of the lipstick were regarded as the responsible contact sensitizers. The differential diagnosis was challenging due to concomitant contact sensitization with these agents.

Axillary Fox-Fordyce-like disease induced by laser hair removal therapy.

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Aquagenic urticaria and syncope associated with occult papillary thyroid carcinoma and improvement after total thyroidectomy.

funda, and linear scleroderma. Regarding progressive systemic sclerosis, renal disease accounts for early mortality, but pulmonary disease is the most substantial long-term cause of morbidity and mortality. Treatment techniques have included physical therapy, avoidance of cold and smoking, vasodilating drugs, cyclophosphamide, methotrexate, and phototherapy. Hematopoietic stem-cell transfusion is still experimental, and initial attempts were associated with nearly 10% to 20% mortality. Currently, 3 ongoing randomized trials are investigating the use of autologous transplants for scleroderma. Vitiligo has been reported to occur after allogeneic bone-marrow transplant, in response to melanoma, and after lymphocyte infusions from patients with known vitiligo. We know of no reports of vitiligo occurring after autologous bone-marrow transplants. Regarding vitiligo after allogeneic bone-marrow transplant, T cells have been implicated, either by direct transfer from the donor or de novo creation of melanocyte-specific T cells. In the case of our patient, it seems unlikely that autogeneic transplant was the cause of his vitiligo and more likely that either the patient’s immunosuppressive medications or his underlying propensity for autoimmune disease were the inciting factors for the developments of his vitiligo. A third possibility is that vitiligo is a cutaneous phenotype of chronic GVHD (in addition to sclerodermalike and lichen planus–like eruptions) that is as yet unreported. Although rare, there are a few reports of scleroderma and vitiligo occurring simultaneously. Though the coexistence of these 2 diseases in the same patient could be merely coincidental, the proposed autoimmune nature of both diseases might suggest a relationship between them.

Ceftriaxone-induced fixed drug eruption: first report.

Fixed drug eruption (FDE) is an unusual type of cutaneous adverse drug reaction that is characterized by recurrent site-specific lesions each time the drug responsible is taken. FDE from cephalosporins has been rarely reported, and to the best of our knowledge there is no published report of ceftriaxone-induced FDE in the literature. We report the first case of a 54-year-old Turkish woman who presented with ceftriaxone-induced FDE. Topical provocation with ceftriaxone sodium salt (1% in water [aq.], 5% aq., 10% in petrolatum [pet.], 20% pet.) remained negative both at previously affected sites and in the unaffected skin of the back. Therapeutic re-exposure with intravenous ceftriaxone 1 g confirmed the diagnosis. The patient tolerated amoxicillin and cefazolin, suggesting that the sensitizing portion was not the β-lactam ring. Identification of the antigenic determinants of FDE-inducing drugs will make predicting safe alternatives in patients with FDE an easier task.

Interstitial granulomatous drug reaction due to thalidomide

© 2008 The Authors JEADV 2009, 23, 441–496 Journal compilation