Gabriel Serrano

Piroxicam-induced photosensitivity: In vivo and in vitro studies of its photosensitizing potential

A 36-year-old woman developed a photolocalized erythematous papulovesicular eruption while taking piroxicam. Histologic study revealed a superficial and deep spongiotic dermatitis. Phototesting with ultraviolet B (UVB) and ultraviolet A (UVA) was abnormal at the time the patient was seen and after oral challenge with the drug for 5 days. A modified lymphocyte transformation test was positive. The photosensitizing potential of the drug was evaluated in vivo and in vitro. In vivo studies consisted of phototesting twelve medical students before and after intake of piroxicam during 5 consecutive days. No lowering of the minimal erythema dose (MED) values or abnormal reactions to UV and visible light were observed in these students. In vitro studies by the Candida plate method and by photohemolysis showed negative results. Our studies suggest a systemic photoallergy mechanism requiring wavelengths in the UVA range for the reaction. This drug should be avoided in patients receiving photochemotherapy.

Photosensitivity induced by fibric acid derivatives and its relation to photocontact dermatitis to ketoprofen

BACKGROUND Photosensitivity reactions to fibric acid derivatives are not well understood and have been rarely reported. OBJECTIVE The aim of this study was to describe two cases of photosensitivity, one induced by fenofibrate and one by bezafibrate; to study the in vivo photosensitizing potential of these drugs; and to evaluate the possibility of cross-reactivity between fenofibrate and ketoprofen. METHODS Patch and photopatch tests with fibric acid derivatives and ketoprofen were performed in the patients, in 12 normal volunteers, and in 7 patients with photopatch-proven photocontact dermatitis to ketoprofen. Phototesting studies were performed both while the patients were taking the drugs and after withdrawal of them, as well as in a group of 18 hyperlipemic volunteers without history of photosensitivity who were taking therapeutic doses of fenofibrate or bezafibrate for 2 to 3 months. RESULTS Positive photopatch test responses to ketoprofen and to fenofibrate were obtained only in the first patient, who also had a weaker positive ordinary patch test response to the latter. Five patients photosensitized to ketoprofen also had a positive patch test to fenofibrate. Phototesting studies were abnormal in both patients but normal in all volunteers. CONCLUSION An association between systemic photosensitivity to fenofibrate and photocontact sensitivity to ketoprofen seems to exist. The structural similarities of these chemicals favor cross-reactivity.

Riehl's melanosis: Pigmented contact dermatitis caused by fragrances

We report a case of a 27-year-old woman with a patchy, dark brown hyperpigmentation on the face. Patch tests were positive to lemon oil, geraniol, and hydroxycitronellal. A compact face powder that the patient used contained two of these chemicals. Hyperpigmentation disappeared within 6 months after the patient avoided contact with cosmetics containing these fragrances.

Partial Lipodystrophy Associated with Juvenile Dermatomyositis: Report of Two Cases

Abstract: A 27‐year‐old woman and a 13‐year‐old girl diagnosed with juvenile dermatomyositis in childhood developed clinical findings of partial lipodystrophy 10 years after diagnosis. Exhaustive clinical and laboratory examinations showed an association with other abnormalities: hy‐pertrichosis, steatohepatitis, and an abnormal insulin response to the glucose loading test in the first patient. Hypertrichosis, steatohepatitis, insulin‐resistant diabetes mellitus, and acanthosis nigricans were observed in the second patient. Renal function was normal in both patients. Although a localized form of lipodystrophy has been reported associated with connective tissue disease (connective tissue lipoatrophy), the partial form has been infrequently described in association with juvenile dermatomyositis.

Piroxicam-induced photosensitivity and contact sensitivity to thiosalicylic acid

A photocontact dermatitis developed in three patients after the application of gel containing 0.5% piroxicam. Patch tests were positive to thiomersal and thiosalicylic acid. Photopatch tests with piroxicam at several concentrations were positive in the three patients but negative in 62 normal volunteer subjects. Patch tests performed on 14 patients with proved systemic photosensitivity to piroxicam were positive for thiomersal and thiosalicylic acid. Nine of 12 patients previously sensitized to thiosalicylic acid and with no history of exposure to piroxicam showed positive photopatch test reactions to this chemical. These results support a relation between piroxicam-induced photosensitivity and contact sensitivity to thiosalicylic acid. Contact allergic sensitivity to the latter is a marker for patients with a high risk of developing photosensitivity reactions to piroxicam. These reactions may be due to photoproducts of the drug rather than metabolites.

Oxicam-induced photosensitivity: Patch and photopatch testing studies with tenoxicam and piroxicam photoproducts in normal subjects and in piroxicam-droxicam photosensitive patients

BACKGROUND The mechanism of piroxicam-induced photosensitivity is unknown. It was first attributed to metabolites of the drug produced in vivo but further photochemical studies disclosed that piroxicam was not stable to light, forming at least two photoproducts. Photosensitivity reactions to droxicam and tenoxicam have been not reported. OBJECTIVE The aim of this study was to determine whether piroxicam photoproducts contribute to the light reactions induced by this drug, to describe a case of droxicam-induced photosensitivity and to study the in vivo photosensitizing potential of tenoxicam. METHODS Patch and photopatch tests with two major photoproducts of piroxicam, with different preparations of UVA-preirradiated piroxicam, and with low and high concentrations of tenoxicam were performed in normal volunteers and in piroxicam-photosensitive patients. Phototesting studies were also performed before and after the oral administration of tenoxicam in both groups of subjects. RESULTS Positive patch test responses were obtained in piroxicam-photosensitive patients only with the preirradiated piroxicam preparations. Phototesting studies with tenoxicam were normal in both groups. CONCLUSION Minor or intermediate piroxicam photoproducts are more likely to be responsible for the photosensitivity reactions induced by this drug.

Reactive perforating collagenosis responsive to PUVA.

A woman presented in January 1983 with a 10-year history of asymptomatic keratotic papules mainly appearing on the exposed areas of her arms, legs, and feet. They developed after Insect bites and scratches during the winter and almost invariably improved in the summer months. Lesions started as discrete or group, pinhead-sized, pinkish-red papules, which after 7-12 days increased their size, developing a central umbilication and a small crust (Fig. 1). These lesions persisted for 6-8 weeks Snd regressed completely, leaving a thin atrophjc scar or temporary hypopigmentation. There was no personal or family history of skin diseases. On examination, there were a few small crusted papules on the dorsum of hands and feet, legs, and knees.

Photodistribution of varicella exanthem: report of two cases

Abstract: Two children were seen who had cutaneous lesions of varicella localized to sunburned and suntanned skin. Atypical features were observed in both cases. Based on certain hypotheses, we concluded that sun exposure may modify the clinical picture of varicella.

Perforating Granuloma annulare and Vitamin D

The case of a 10-year-old boy who developed lesions of perforating granuloma annulare on the dorsum of both hands which was related to oral administration of vitamin D is presented.

Contact allergy to resorcinol in acne medications: Report of three cases

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