Mucha-Habermann disease-like eruptions due to Tegafur

The first case of Mucha-Habermann disease-like drug eruptions due to Tegafur is reported. A 59-year-old man noticed various skin lesions after he had taken 300 mg of Tegafur daily for about 200 days. The patient had papulonecrotic eruptions on his trunk and extremities. The histology from a papular lesion revealed epidermal necrosis surrounded by spongiosis, perivascular inflammatory infiltrations composed of lymphocytes and erythrocytes, and endothelial swelling. The etiology of Mucha-Habermann disease is not known, but an immune mechanism may be supported by our case.     

Life-threatening eruptions due to infectious agents

Some infectious diseases may cause rapidly fatal eruptions that need to be diagnosed and treated in an early phase for patient survival. The main life-threatening eruptions of infectious etiology include Rocky Mountain spotted fever, meningococcemia, toxic shock syndrome, streptococcal toxic shock syndrome, and staphylococcal scalded skin syndrome.     

Therapeutic approach to selected neonatal eruptions

Management of numerous neonatal eruptions has been modified over the past 10 years. In this article, traditional and developing therapeutic insights are applied to both common and uncommon neonatal conditions.     

Fixed drug eruptions to tetracyclines.

We observed 11 cases of fixed drug eruption to tetracyclines. Two cases were in a mother and her adult son, and two patients experienced fading of their lesions while continuing to take 1 g of the drug per day. Several patients were cross-reactive to different salts.     

Drug eruptions to contrast media in Japan

BACKGROUND: In Japan, drug eruptions to nonionic iodinated contrast media have been reported since the products appeared on the market in 1986. OBJECTIVES: To evaluate this clinical finding, we analysed the number of patients with drug eruption to contrast media in our hospital from 1989 to 2003. METHODS: In total, 117 patients suspected of such drug eruptions were patch and intradermal tested with contrast media (as commercially sold). Those who tested positive were evaluated. RESULTS: Of the 117 patients, 69 patients (19 men; 50 women, mean +/- SD age 51.4 +/- 16.5 years, range 17-86) showed positive reactions to contrast media. The number was 6-13 annually from 1989 to 1995, and 1-4 annually from 1996 to 2003. CONCLUSION: Although our data suggest (but do not prove) that patients with drug eruption to contrast media decreased in number, this condition is still not rare in Japan. Higher annual exposure to contrast media, including pretesting, could play an important role in this observation.     

Chronic eczematous eruptions of the elderly are associated with chronic exposure to calcium channel blockers: results from a case-control study

It has been suggested that chronic eczematous eruptions of the elderly could be associated with chronic drug exposure. To determine the drugs associated with these eruptions, we conducted a case-control study on 102 cases and 204 controls. Cases were consecutive patients older than 60 years presenting with an eczematous eruption that had evolved continuously or recurrently for more than 3 months without a reliable cause. Two controls were matched to each case on age, sex, in/outpatient origin, and center. Information about drug exposure was obtained from patients and their pharmacists. Drug use for more than 3 months within the year preceding the eruption was compared between cases and controls. An association was found between calcium channel blockers (CCB) and eczema, with a matched OR (odds ratio) of 2.5 (95% CI (confidence interval): 1.3-4.6). To ascertain the course of patients after CCB withdrawal, two ancillary studies were performed on 74 patients with eczematous eruptions from our department before the case-control study period, and on 101 patients registered in the French "Pharmacovigilance" database. Healing of these eruptions after CCB withdrawal occurred in 83 and 68% of these cases, respectively. The long-term use of CCB is a risk factor for chronic eczematous eruptions of the elderly.     

Severe hydroa vacciniforme-like eruptions confined to sun-exposed areas

A 15-year-old boy presented with vesiculopapular eruptions confined to sun-exposed areas from the age of 3. Histopathological examination of biopsy specimens of repetitive UVA-irradiated areas revealed reticular degeneration of the epidermis, and dermal infiltrates in the photoinduced lesions showed a latent Epstein-Barr virus (EBV) infection. At the age of 21, the number of skin lesions had increased, and his anti-EBV antibody titers revealed an abnormal profile: an undetectable anti-EBV nuclear antigen antibody titer despite a detectable antiviral capsid antigen IgG antibody titer. No infectious mononucleosis-like symptoms, such as prolonged or intermittent fever, lymphoadenopathy, or liver damage were evident up till then. Severe hydroa vacciniforme (HV)-like eruptions were diagnosed considering the increased number of the skin lesions with increasing age and the unusual anti-EBV antibody titers, in addition to the histopathological findings. In the same year, he suddenly developed high fever and died from disseminated intravascular coagulation syndrome without any spontaneous regression of the skin lesions. In this patient with severe HV-like eruptions, the skin lesions had been confined to sun-exposed areas until his death, and the photo-provocation test showed a positive reaction. Severe HV-like eruptions may have clinical features suggestive of HV.     

Pityriasis rosea-like eruptions due to mustard oil application

A young man employed in a construction company, presented with cutaneous lesions clinically simulating pityriasis rosea. Satisfactory and complete response to corticosteroids and antihistamines was followed by recurrence. Multiple recurrences within a short span of time arose a suspicion of alternative diagnosis. Site visit helped us to rule out occupational contact dermatitis. Further history taking revealed that he was recently using mustard oil for body massage. Subsequent patch testing confirmed contact hypersensitivity to mustard oil. Avoidance of the contact with mustard oil arrested appearance of further skin lesions. We stress the importance of taking a good history in clinical practice in disclosing a possible contactant.     

Management of drug eruptions

In this second of two articles on adverse cutaneous drug reactions, the management of drug eruptions is reviewed. This necessitates, above all, a full history and may involve observation of the effects of drug elimination. Skin testing may be helpful in some circumstances, but is hampered by false positive and negative results, and lack of knowledge of the significant antigenic determinants for most drugs. In vitro tests are for the most part unreliable and are research tools. Challenge tests are safe in fixed drug eruption, but are absolutely contraindicated in Stevens–Johnson syndrome and toxic epidermal necrolysis. The approach to the treatment of the more serious adverse cutaneous drug reactions, including angioedema/anaphylaxis, exfoliative dermatitis erythroderma and toxic epidermal necrolysis is reviewed. For those patients who develop reactions to an essential medication for which there is no alternative, desensitization is possible.