Schwere Komplikationen nach glutealer Silikoninjektion

Silicone has a broad range of medical applications and plays an important role, for example, in plastic reconstruction. The use of silicone, however, may result in unpredictable consequences for the patient. These range from swelling and erythema at the site of injection and regional lymphadenopathy to the development of disseminated granulomas distant from the administration site. We report a woman who developed extensive distally-spreading ulcerations in both buttocks several years after gluteal silicone injection. Potential systemic reactions of silicone include intrapulmonary granulomas, embolism and related pneumonitis. Moreover, an association with the development of autoimmune diseases and neoplasias has been discussed. Therapeutic options include surgically removing the silicone and topical or systemic anti-inflammatory drug therapy. However, due to the diffuse dissemination of silicone, the former is often not completely possible and for the latter empirical data are limited and follow-up studies are missing. Liquid silicone is no longer authorized in Europe or in the U.S.A. When silicone implants are used, the decision should be weighed carefully and the patient adequately counseled. In addition, follow-up care on a regular basis is mandatory for both those with implants and those who obtained injections of liquid silicone in the past.     

Schwere arzneimittelinduzierte Hautreaktionen

Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) are characterized by extensive blistering of the skin and mucosa; they are considered as one disease entity with varying severity. They are rare but potentially life-threatening and accompanied by high mortality. A clear clinical diagnosis is needed to direct specific therapy, but supportive therapy remains most important. In order to identify and withdraw the inducing drug, a very detailed and thorough medication history has to be obtained. Among the highly suspected (strongly associated) agents are allopurinol, antibacterial sulfonamides, non-steroidal anti-inflammatory drugs of the oxicam type, various anti-epileptics and nevaripine. Together they account for more than half of the cases of SJS/TEN. Although a drug is not always the cause, it is considered very like in approximately 75% of cases. Infections have also to be considered as etiologic factors.     

Diagnostisches Vorgehen bei Verdacht auf Soforttypallergie auf Penicilline

Ohne Zusammenfassung     

Schwere Arzneimittelreaktionen der Haut

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are severe drug-induced bullous skin reactions. They are rare, but often life-threatening and have a high mortality rate. Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction, but after the suspected drug is withdrawn, the skin heals rapidly and mortality is low. The clinical pattern, histology and inducing drugs differ substantially between AGEP and the SJS/TEN group.     

Sklerrodermie nach Radietberapie

Ohne Zusammenfassung     

Talgstauung nach Dermatitis

Ohne Zusammenfassung     

Tod nach Bienenstich

A ten-year-old girl collapsed on the street with the signs of acute anaphylaxis. Cardiopulmonary resuscitation was unsuccessful. At the autopsy a thorn-like object was found sticking in the tongue and was later identified as the stinger of a honey bee. Witnesses reported that the girl had drunk some ice tea from a box and then had complained about pains in the mouth. Postmortem blood tests revealed increased total IgE level as well as increased levels of specific IgE against bee and wasp poisons. Cause of death was a bronchospasm caused by an allergic reaction due to a sting of a honey bee.     

Dermatitis nach Siegellack

Ohne Zusammenfassung     

Gianotti-Crosti-Syndrom nach Impfung

Es wird über 4 Kleinkinder berichtet, bei denen ein Gianotti-Crosti-Syndrom (GCS) mit einer Latenz von 6–8 Tagen nach Impfung auftrat. Nachfolgende Auffrischungsimpfungen wurden problemlos vertragen. W?hrend das Auftreten eines GCS in Assoziation mit einer Virusinfektion gut dokumentiert ist, liegen über das Auftreten eines GCS im Anschluss an eine Impfung nur wenige Mitteilungen vor. Auf einen derartig m?glichen Zusammenhang sollte jedoch bei Vorstellung dieses Krankheitsbildes (GCS) im Rahmen der Anamneseerhebung unbedingt eingegangen werden.     

Hautinfektionen nach Transplantation

Skin infections after transplantation are frequent and of special importance because they may be quite severe. The spectrum of dermatologic infections in transplant recipients includes bacterial, mycotic and viral diseases. Pyoderma, herpes virus 6/7, herpes simplex virus, varicella-zoster virus, cytomegalovirus and candida infections predominate. Rare pathogens must be also considered. Cutaneous infections can be divided into three phases following transplantation. Diagnosis and adequate early therapy together with specific prophylaxis and follow-up of transplant patients should be strived for to avoid life-threatening complications.     

Urticaria nach penicillin

Ohne Zusammenfassung     

Immunsuppressiva nach Transplantation

Immunosuppressive therapy keeps rejection in check following solid organ transplantation. Drug reactions, inflammatory and infectious skin conditions frequently follow. Specific side effects can be avoided by switching individual agents. In addition to UV light, immunosuppressants are the most important driver for squamous cell carcinoma of the skin (SCC). Beyond immunosuppression, cyclosporine A promotes carcinogenesis by TGF beta and VEGF, while mTOR inhibitors are antiproliferative. Azathioprine photosensitizes to UVA and enables UVA to damage DNA directly. To fight skin cancer, global reduction of immunosuppression is the most effective measure. Switching calcineurin inhibitors to mTOR inhibitors is probably to be recommended, while omitting azathioprine may potentially be advisable in recurrent SCC.     

DNS-Repair von Lymphocyten nach 8-MOP + UVA und nach UVC

Zusammenfassung 8-MOP wird durch UVA-Bestrahlung (PUVA-Bedingungen) kovalent an die 5=6 Doppelbindung von Thymin in der DNS gebunden. Es handelt sich teilweise um dieselben Stellen, die durch UVC-Bestrahlung Cyclobutandimere bilden und durch Reparaturvorgänge eliminiert und ersetzt werden (Excisionsrepair). Es stellt sich die Frage, ob 8-MOP-DNS Bindungsstellen ebenfalls Repairvorgänge auslösen und ob dabei Wechselwirkungen auf die UVC-induzierte Dimerexcision zu beachten sind.An Lymphocyten von 20 Psoriatikern wurde während der oralen PUVA-Therapie der Einbau von ³H-Thymidin in die DNS und von T-5-Uridin in die RNS flüssigkeitsszintigraphisch gemessen. Dabei zeigen die Lymphocyten nach 8-MOP plus UVA (PUVA) eine signifikant erhöhte unprogrammierte DNS-Synthese gegenüber den Leerkontrollen und solchen mit 8-MOP allein.An Lymphocyten von 9 gesunden Versuchspersonen wurden unter in vitro PUVA-Bedingungen (8-MOP 1g/ml + 500 mJ UVA) und Kontrollen die unprogrammierte DNS-Synthese durch flüssigkeitsszintigraphische Messung des ³H-Thymidineinbaus in die DNS bestimmt. Hemmung der Replikation durch Zugabe von Hydroxyharnstoff 2×10^-3 M. Eine Repairaktivität konnte nach PUVA-Bedingungen nachgewiesen werden, nicht aber nach 8-MOP oder UVA allein.Die PUVA induzierte Repairaktivität ist vergleichbar mit derjenigen, die durch UVC-Bestrahlung induziert wird, ist aber zeitlich verzögert. Die Kombination von PUVA-Bedingugen und UVC-Bestrahlung zeigt keine Steigerung der Repairaktivität. Es scheint, daß 8-MOP-DNS-Bindungsstellen und UVC-induzierte Dimere mindestens teilweise dieselben Thyminmoleküle der DNS besetzen und beide durch Repair-Excision eliminiert werden können. Allerdings ist die unprogrammierte DNS-Synthese nach PUVA-Schäden verzögert gegenüber derjenigen nach UVC-Bestrahlung.     

Anaphylaktischer Schock nach Galette-Verzehr

A 37-year-old woman twice developed a life-threatening anaphylactic reaction after eating galettes, a special French pancake from Brittany. She had tolerated ordinary pancakes and crepes for many years. The allergological work-up revealed a Type I allergic reaction to buckwheat contained in the galettes. A prick test to buckwheat was positive and specific IgE antibodies to buckwheat were found in her serum. In contrast to wheat, buckwheat is not a cereal but a gluten-free knot-grass, initially from Asia. Whenever a patient suffers from allergic reactions due to pastries, a buckwheat allergy should be considered.