Osvaldo Correia

Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis.

Background Toxic epidermal necrolysis and Stevens–Johnson syndrome are rare, life-threatening, drug-induced cutaneous reactions. We conducted a case–control study to quantify the risks associated with the use of specific drugs. Methods Data were obtained through surveillance networks in France, Germany, Italy, and Portugal. Drug use before the onset of disease was compared in 245 people who were hospitalized because of toxic epidermal necrolysis or Stevens–Johnson syndrome and 1147 patients hospitalized for other reasons (controls). Crude relative risks were calculated and adjusted for confounding by multivariate methods when numbers were large enough. Results Among drugs usually used for short periods, the risks were increased for trimethoprim–sulfamethoxazole and other sulfonamide antibiotics (crude relative risk, 172; 95 percent confidence interval, 75 to 396), chlormezanone (crude relative risk, 62; 21 to 188), aminopenicillins (multivariate relative risk, 6.7; 2.5 to 18), quinolones (multivariate rel...

Risk of Stevens-Johnson syndrome and toxic epider mal necrolysis during first weeks of antiepileptic therapy: a case-control study

Summary Background There is still controversy about whether all antiepileptic drugs are associated with the severe cutaneous reactions Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We have studied the role of antiepileptic drugs in SJS and TEN, taking into account potential cofactors that might confound or modify the risk. Methods The case-control study in France, Italy, Germany, and Portugal identified cases of SJS/TEN that developed when the patient was not in hospital and were validated by an expert committee. Controls were patients admitted to the same hospital as the case for an acute illness or an elective procedure. Findings 73 (21%) of the 352 SJS/TEN cases and 28 (2%) of the 1579 controls reported intake of antiepileptic drugs. Among the 73 exposed SJS and TEN patients, 36 reported intake of phenobarbital, 14 of phenytoin, 21 of carbamazepine, 13 of valproic acid, and three of lamotrigine. Risk was highest in the first 8 weeks after onset of treatment. For individual antiepileptic drugs the univariate relative risk of SJS/TEN for 8 weeks or less of use was 57 (95% Cl 16–360; multivariate risk 59 [12–302]) for phenobarbital; 91 (26–∞) for phenytoin; 120 (34–∞) for carbamazepine; 25 (5·6-∞) for lamotrigine, and 24 (5·9-∞) for valproic acid. The result for valproic acid was based on four case users, all of whom reported concurrent use of other associate drugs. The univariate relative risk for more than 8 weeks of use was 6·2 (2·4-17·0; multivariate risk 2·1 [0·5-9·3]) for phenobarbital, 1·2 (0–5·4) for phenytoin, 0·4 (0·02-2·1) for carbamazepine, and 7·0 (2·4-21·0; multivariate risk 2·0 [0·3-15·0]) for valproic acid. Interpretation SJS and TEN are associated with short-term therapy with phenytoin, phenobarbital, and carbamazepine. The association with valproic acid seems to be confounded by concomitant short-term therapy with other causal drugs. Lamotrigine also has the potential for severe skin reactions. The period of increased risk is largely confined to the first 8 weeks of treatment.

Evidence- and consensus-based (S3) Guidelines for the Treatment of Actinic Keratosis - International League of Dermatological Societies in cooperation with the European Dermatology Forum - Short version

Actinic keratosis (AK) is a frequent health condition attributable to chronic exposure to ultraviolet radiation. Several treatment options are available and evidence based guidelines are missing.

An international collaborative case-control study of severe cutaneous adverse reactions (SCAR). Design and methods

A multicenter international case-control study has been designed to elucidate the etiology of Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). Although these diseases occur rarely, the morbidity is high and the mortality for TEN is of the order of 30%. These serious dermatologic conditions have often been linked to exposure to drugs. Infective and autoimmune diseases, as well as other non-drug risk factors, have also been postulated to be of importance in increasing the risk. The design and methods are described, with particular attention to the unique challenges for an epidemiologic study of these conditions.

Nail changes secondary to docetaxel (Taxotere).

Docetaxel is a new taxoid antineoplastic drug widely used for advanced breast cancer. Skin and nail toxicity are one of the more frequent nonhematologic adverse reactions. Besides dark pigmentations and Beau’s lines, subungual hemorrhage, orange discoloration, acute painful paronychia, onycholysis, subungual hyperkeratosis and transverse loss of the nail plate are described. The type of nail alteration is related with the number of cycles administered and there are no efficacious preventive measures to avoid its development. Clinicians should recognize the clinical picture of these adverse nail reactions because docetaxel is used for several neoplastic disorders.

The Euromelanoma skin cancer prevention campaign in Europe: Characteristics and results of 2009 and 2010

Background  Euromelanoma is a skin cancer education and prevention campaign that started in 1999 in Belgium as ‘Melanoma day’. Since 2000, it is active in a large and growing number of European countries under the name Euromelanoma.

Euromelanoma: A dermatology-led European campaign against nonmelanoma skin cancer and cutaneous melanoma. Past, present and future

Euromelanoma is a dermatologist‐led skin cancer prevention programme conducting an annual screening and public education campaign in over 20 European countries. Within its 10‐year history, Euromelanoma has screened over 260 000 individuals across Europe, detecting a significant number of cutaneous melanomas and nonmelanoma skin cancers, identifying high‐risk individuals for further surveillance and promoting awareness on the suspicious features of melanoma and the hazardous effects of ultraviolet exposure. In this review article, we summarize the history of the Euromelanoma campaign, present its organizational structure and discuss the results of the campaign in individual countries and on a European scale. Euromelanoma has had a significant impact on melanoma prevention and early diagnosis in participating countries and, despite many challenges, has positively influenced public health attitudes towards regular mole examination and the implementation of preventive measures against skin cancer.

Nail matrix melanoma in situ: Conservative surgical management

Background: Nail unit melanoma (NUM) is a rare variant of acral lentiginous melanoma. The differential diagnosis is wide but an acquired brown streak in the nail of a fair-skinned person must be considered a potential melanoma. Dermatoscopy helps clinicians to more accurately decide if a nail apparatus biopsy is necessary. Methods: We report the case of a 61-year-old Caucasian woman with melanonychia occupying the central portion of the right thumbnail plate with 1 year of evolution. Dermatoscopy showed a brown pigmentation overlaid by longitudinal irregular lines. An excisional biopsy was performed, and pathological examination revealed melanoma in situ. For safety reasons, the nail unit was totally removed down to the phalangeal bone 3 weeks later, and a full-thickness skin graft taken from the arm was used for reconstruction. Conclusion: NUMs pose a difficult treatment challenge. Wide excision with phalanx amputation is not satisfactory for patients with in situ and early invasive melanoma. Full-thickness skin grafting after total nail unit excision is a simple procedure providing a good functional and cosmetic outcome.

CD8+ Lymphocytes in the Blister Fluid of Severe Acute Cutaneous Graft-versus-Host Disease: Further Similarities with Toxic Epidermal Necrolysis

Background: Graft-versus-host disease (GvHD) remains the major toxicity of allogeneic bone marrow transplantation (BMT). In the acute form of the disease, the differential diagnosis includes viral rash and drug eruptions. Methods: We report two patients with chronic myeloid leukemia submitted to allogeneic BMT who developed a severe form of acute cutaneous GvHD, with clinical and histological pictures mimicking toxic epidermal necrolysis (TEN). Results: We found a predominance of peripheral CD8+ T lymphocytes and, at the same time, studying the cellular profile of the blister fluid, just in the beginning of blister eruption, we also found a high proportion of CD8+ T lymphocytes, mainly CD8+CD57–. Conclusion: These data are in agreement with previous reports of the presence of CD8+ T cells in the blister fluid of patients with TEN, further emphasizing similar immunoinflammatory pathways in both diseases.

Multiple Eccrine Hidrocystomas – from Diagnosis to Treatment: The Role of Dermatoscopy and Botulinum Toxin

Background: Eccrine hidrocystomas are rarely described benign cystic lesions, mainly presenting in middle-aged women in the centrofacial area and usually associated with a chronic course, seasonal variability and no proved and consistently efficacious treatments. Case Report: We report 2 patients, a 45- and a 56-year-old woman, with multiple facial eccrine hidrocystomas suggested by dermatoscopy, confirmed by histology and treated with botulinum toxin A with excellent results. Conclusion: Our report stresses the role of dermatoscopy in the diagnosis and follow-up of these lesions, as well as the impact of repeated treatments with botulinum toxin A in eccrine hidrocystomas suggesting it as a first-line treatment for multiple eccrine hidrocystomas because it is easy to use and has no risk of scars.