Cutaneous reactions associated with vitamin K1

BACKGROUND: Vitamin K1 (phytonadione) is a fat-soluble, naturally occurring vitamin used to treat certain coagulation disorders. A review of the adverse cutaneous reactions to Vitamin K1 is important because this diagnosis can be easily overlooked. This is due to their low incidence and because the presentation and morphology can vary considerably. OBJECTIVE: The objective of this article is to summarize the different morphologies, the natural history, and the treatment of the cutaneous reactions reported to Vitamin K1. METHODS: A case of a patient who developed a localized eczematous plaque at the site of a vitamin K1 injection is outlined. A review of the English medical literature focused on the adverse cutaneous reactions associated with intramuscular or subcutaneous use of vitamin K1. RESULTS: Our patient developed a localized eczematous reaction to subcutaneous vitamin K1. The eruption developed within 7 days of her dose of vitamin K1. The eruption persisted for 18 months despite treatment with topical and intralesional steroids. There are three distinct types of cutaneous reactions to vitamin K1: localized eczematous, localized morphea-form, and, very rarely, diffuse maculopapular eruption. The eczematous type (32 cases) appears at the site of injection, and the median number of days between injection and appearance of the eruption is 13 days. The dose range required to initiate the reaction is broad (10 to 410 mg). Thirteen of 32 cases took more than 2 months to resolve. The morphea-form type (7 cases) is a localized morphea-form patch that appears at the site of injection. The average delay before presentation of morphea-form changes was 8.5 months (range: 5 weeks-1.5 years). The dose range is broad (30-2080 mg), and the prognosis for resolution very poor. CONCLUSION: The diagnosis of an adverse cutaneous reaction to vitamin K can be made if the possibility is considered. Many of these reactions are very slow to clear up and some may persist as a chronic sclerodermoid change. Managing these reactions may be frustrating for both the patient and the clinician.     

Cutaneous reactions to vitamin K

In four patients the development of erythematous plaques after vitamin K injections was apparently due to delayed hypersensitivity reactions. The 36 cases described in the literature indicate that most patients with the reaction received vitamin K injections for liver disease and that a late sclerodermatous reaction develops rarely.     

表皮生长因子受体抑制剂的皮肤反应及治疗

表皮生长因子受体抑制剂在临床治疗肿瘤方面获得良效,但此类药物也常伴有皮肤相关的毒性反应,如痤疮样药疹、皮肤干燥、皲裂、毛细血管扩张、色素沉着、毛发改变、甲沟炎等.积极治疗皮疹,选择适当的药物,将对患者继续接受抗肿瘤治疗有重要意义.为此,概述近年来有关表皮生长因子受体抑制剂导致的皮肤毒性反应的临床表现及治疗现状,以进一步探讨治疗新策略.     

表皮生长因子受体抑制剂的皮肤反应及治疗

表皮生长因子受体抑制剂在临床治疗肿瘤方面获得良效,但此类药物也常伴有皮肤相关的毒性反应,如痤疮样药疹、皮肤干燥、皲裂、毛细血管扩张、色素沉着、毛发改变、甲沟炎等.积极治疗皮疹,选择适当的药物,将对患者继续接受抗肿瘤治疗有重要意义.为此,概述近年来有关表皮生长因子受体抑制剂导致的皮肤毒性反应的临床表现及治疗现状,以进一步探讨治疗新策略.     

Eczematous reactions in atopic patients caused by epicutaneous testing with inhalant allergens

To determine whether inhalant allergens could induce eczematous lesions we studied 17 patients with atopic eczema (with or without allergic rhinitis), 13 patients with allergic rhinitis without atopic eczema and 10 healthy control subjects. The allergens, birch pollen (Betula verrucosa) and house dust mite (Dermatophagoides pteronyssinus), were applied in aluminium chambers for 48 h on clinically normal skin. In 17 patients with atopic eczema, six epicutaneous test reactions of the delayed type to birch pollen and three to house dust mite were seen at 48 or 72 h. In 13 patients with allergic rhinitis without eczema there was one delayed reaction to birch pollen and none to house dust mite. No delayed type test reactions to either allergen were seen in the controls. Biopsies of the positive test sites revealed an eczematous reaction with epidermal spongiosis and microvesiculation. Immunostaining of cryostat sections showed dermal cell infiltrates consisting of mainly T lymphocytes (ratio of T4:T8, 2-6:I) and to a lesser degree Langerhans and indeterminate T6+ cells. 50-90% of the cells were Ia+. The numbers of basophils and mast cells did not exceed 10-15%.     

嗜麦芽窄食单胞菌致皮肤感染的研究进展

嗜麦芽窄食单胞菌是自然界和医院环境广泛存在的非发酵型需氧的革兰阴性杆菌,目前已成为重要的机会致病茵,好发于免疫力低下的人群.该菌可引起多个系统感染,包括皮肤黏膜感染,多为血液播散和皮肤黏膜直接接触感染.临床表现多样,包括:原发性蜂窝织炎、转移性结节或蜂窝织炎、坏疽性深脓疱病和皮肤溃疡等.该菌的致病性已引起广泛的关注.     

Skin infection caused by Mycobacterium avium

A patient with skin infection due to Mycobacterium avium is reported. A 9–year–old female had 10 subcutaneous nodules and two ulcers on the abdomen and legs. She had no medical history of systemic disease, skin disease or immunosuppressive therapy. Cultures of a biopsy specimen and of aspirated seropurulent fluid in nodules showed acid–fast bacteria, identified as M. avium by the DNA–DNA hybridization method. We treated her with a combination of surgery and the antibiotics, cycloserine, isoniazid and clarithromycin.