Kurtuluş Didem Yazganoğlu

Vascular involvement in Behçet's disease: a retrospective analysis of 2319 cases

Background  Vascular lesions can be the presenting sign of Behçets disease (BD) preceding classical symptoms. The aim of this study was to evaluate the prevalence and types of vascular involvement in BD.

Henna stone: a lesser‐known solid material from which to obtain black henna paste

As a contribution to the comprehensive review by de Groot (1), we would like to highlight a lesser-known commercially available solid material called ‘henna stone’ or ‘German stone’ in some countries. It is sold as ‘natural stone’ by local herbal sellers. In order to obtain a black henna paste for the purpose of temporary tattooing or hair dyeing, the stone is crushed into powder first and then mixed with natural henna, water, and hydrogen peroxide. In our recent study (2), qualitative and quantitative chemical analyses using gas chromatography–mass spectrometry were performed on six samples of commercially available ‘henna stones’ p-phenylenediamine (PPD) was found in all samples at concentrations ranging between 84.89% and 90.90%; these were significantly higher than previously reported PPD concentrations ranging between 2.35% and 64% in black henna samples (3–5). Additionally, the colour of henna stones, which is whitish grey to brown and black (Fig. 1a), is reminiscent of the colour of PPD crystals/powder, which is yellowish white to light purple, and darkens on exposure to air via oxidation, turning first red, then brown, and finally black (3). On the basis of our clinical observation of the physical appearance, the easy crushability of the stone into pieces, revealing yellowish white crystals (Fig. 1b), and the results of the chemical analyses, we propose that ‘henna stones’ contain high proportions of PPD. Fig. 1. A sample of whitish grey to brown and black ‘henna stone’ provided by one of the local herbal sellers in Turkey (a); the stone could be easily crushed into pieces, and whitish yellow crystals/powder (pink arrows) resembling p-phenylenediamine became visible (b).

The clinical spectrum of xanthomatous lesions of the eyelids

Yellowish papules, nodules, or plaques, namely “xanthomatous” lesions, may be seen on the eyelids in the course of various disorders. The prototype is “xanthelasma palpebrarum” (XP) that is localized only to the eyelids and may be associated with hyperlipidemia. On the other hand, different types of normolipemic disorders may also cause xanthomatous eyelid lesions. Among these, Langerhans cell histiocytosis, diffuse normolipemic xanthoma, and non‐Langerhans cell histiocytoses (papular xanthoma, juvenile xanthogranuloma, xanthoma disseminatum, adult‐onset xanthogranuloma, adult‐onset asthma and periocular xanthogranuloma, necrobiotic xanthogranuloma, Erdheim‐Chester disease, Rosai‐Dorfman disease, and reticulohistiocytosis) can be listed. The eyelid findings of this heterogeneous group of disorders are challenging to differentiate from each other due to common clinical aspects that may even sometimes mimic XP. Nodularity, induration, ulceration, diffuse eyelid involvement, and extension from eyelids to the neighboring skin may represent the clinical features of xanthomatous lesions other than XP. It is necessary to obtain a thorough history and exclude XP and then perform detailed dermatological and systemic examination, biopsy for histopathologic confirmation, and appropriate specific imaging screens. As some of the conditions may be associated with other systemic disorders, especially malignancies, the differentiation of xanthomatous eyelid lesions has a critical importance, and clinical signs can be guiding.

Adverse cutaneous drug reactions to cardiovascular drugs

Adverse cutaneous drug reactions to cardiovascular drugs / , Adverse cutaneous drug reactions to cardiovascular drugs / , کتابخانه دیجیتال جندی شاپور اهواز

Varenicline-induced acute generalized exanthematous pustulosis confirmed by patch testing: PATCH TEST-CONFIRMED VARENICLINE-INDUCED AGEP

Cutaneous side-effects of varenicline, a drug used to support smoking cessation, are relatively rare. Acute generalized exanthematous pustulosis (AGEP) is one of the most frequently reported adverse skin reactions to this drug (1–3). However, there are no previously published cases with varenicline-induced AGEP or other skin conditions and a positive patch test reaction (1–5). We herein present 2 patients with varenicline-induced AGEP, confirmed by patch testing in 1 of them.

Angiotensin II Receptor Blockers

The angiotensin II receptor blockers (ARBs) inhibit the activity of angiotensin II at the angiotensin II receptor level (AT-1, AT-2 receptors). Losartan potassium is the prototype of the ARBs. Others are candesartan, irbesartan, valsartan, telmisartan, olmesartan, eprosartan, and azilsartan.

Patch Testing in Drug Eruptions

Patch testing is a method carried out by dermatologists to evaluate type IV hypersensitivity reactions. It is the gold standard in the diagnosis of allergic contact dermatitis. Based on the recent knowledge on the involvement of different subtypes of type IV hypersensitivity reactions in the immunopathogenesis of drug eruptions (Table 1.1), patch testing is also of particular value in determining the responsible drug in certain drug eruptions such as eczematous eruption, maculopapular/morbilliform eruption, fixed drug eruption, photoallergic drug eruption, drug-induced Baboon syndrome (BS)/symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), and acute generalized exanthematous pustulosis (AGEP) as a first-step diagnostic method. It is also helpful in identifying the possible cross-reactive drugs and safe alternatives. Photopatch testing should be performed if there is suspicion of photoallergic drug eruptions.

Other Cardiovascular Drugs

Other cardiovascular drugs not classified in the former sections include alpha-1 adrenergic receptor blockers, sympathomimetics, adrenergic neuron and ganglionic blockers, and drugs that are classified under the section of miscellaneous drugs, i.e., antiarrhythmic drugs like adenosine and digitalis glycosides, pentoxifylline, aminocaproic acid, protamine sulfate, and newer antianginal drugs such as ivabradine, ranolazine, and trimetazidine.

Lipid-Lowering Drugs

Lipid-lowering drugs include 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins such as simvastatin, atorvastatin, pravastatin, fluvastatin, lovastatin, cerivastatin, rosuvastatin, pitavastatin), fibric acids (fibrates such as fenofibrate, clofibrate, gemfibrozil, bezafibrate, and ciprofibrate), bile acid sequestrants (resins) (cholestyramine, colestipol, and colesevelam), and others (nicotinic acid [niacin], nicotinic acid analogs like xanthinol nicotinate and acipimox, and cholesterol absorption inhibitor such as ezetimibe). Lipid-lowering drugs inhibit different steps in the cholesterol synthesis.

Class III Antiarrhythmic Drugs

Class III antiarrhythmic drugs include amiodarone, bretylium, dofetilide, ibutilide, azimilide, and dronedarone. Among these, amiodarone is the most reported one to cause adverse cutaneous reactions. Amiodarone is a lipid soluble agent which accumulates in peripheral tissues including the adipose tissue, and the skin is one of the excretion ways of the drug. It has a very long half-life, up to 6 months, so it is stated that toxic side effects may also be seen after the withdrawal of the drug. It is associated with many cutaneous side effects such as photosensitivity and pigmentation being the well-known ones.