Cutaneous reactions to non-steroidal anti-inflammatory drugs

We retrospectively reviewed the records of 195 patients with suspected cutaneous reactions from NSAIDs. Two hundred and six different non-steroidal anti-inflammatory drugs (NSAIDs) were suspected of causing cutaneous reactions, and the most frequent suspected causative NSAID was ibuprofen (25.7%). Angioedema and/or urticaria were the most frequent cutaneous reactions (54.4%), and the foremost suspected causative drug for these reactions was ibuprofen. The second most frequently found cutaneous reaction was maculopapular eruption (26.2%), and celecoxib was the most commonly suspected causative NSAID for it. The primary suspected NSAIDs causing fixed drug eruption were in enolic acid group. Furthermore, drug hypersensitivity syndrome was diagnosed in five patients, and Stevens-Johnson syndrome and toxic epidermal necrolysis were detected in five patients.     

Mosquito allergy: clinical features and natural course

Mosquito bite allergic reactions are due to sensitization to mosquito salivary proteins. The purpose of our study was to assess the clinical features of Thai patients with mosquito allergy, and to define the natural desensitization course. Seventy patients with mosquito allergy were enrolled. Most patients were female. Half of the patients had a personal history of atopy. The average age of onset of mosquito reaction was 5.7 years old (range 2-58). Four patients were in the desensitization phase in which clinical symptoms disappeared within 9.5 years (median). The common cutaneous lesions were erythematous papules (68.6%) and immediate wheals (67.1%). The most common area of involvement was the leg. Forty of 50 patients (80%) had positive skin prick testing to mosquito allergen (Culex quinquefasciatus) and 31 of 42 patients (73.8%) had positive immunoglobulin E antibodies against allergens in C. quinquefasciatus saliva proteins.     

Acute urticaria: etiologies, clinical course and quality of life

One hundred patients with acute urticaria were prospectively studied over a 2-year period with respect to etiology, clinical features and outcome, including the patient's quality of life using a Thai version of the Dermatologic Life Quality Index (DLQI). Twenty-one patients (21%) turned out to have chronic and 79 acute urticaria. Itchy sensations had the highest mean DLQI score translating to the highest negative impact on the quality of life. In more than half of the patients, the cause of the acute urticaria could not be identified. The most common identified causes of acute urticaria were infections (36.7%), followed by drugs, foods and insect bite reactions. Among those with acute urticaria, sixteen percent had co-existing angioedema, and one fourth had systemic symptoms, the most common being dyspnea. Patients with extensive wheals tended to have co-existing angioedema and also a statistically significant higher percentage of systemic symptoms, higher mean pruritus and mean DLQI scores than those with less body surface area involvement. Fifty-six percent of the patients with acute urticaria had complete remissions within 1 week; 78.5%, within 2 weeks and 91.1%, within 3 weeks.     

Chronic idiopathic urticaria: prevalence and clinical course

The purpose of our study was to assess the prevalence and clinical course of patients with chronic idiopathic urticaria (CIU), as well as possible causes or associated findings, laboratory findings and the duration of the disease in patients with chronic urticaria (CU). We retrospectively reviewed the 450 case record forms of patients with CU and/or angioedema who attended the Department of Dermatology, Siriraj Hospital, during the period 2000-2004. Of 450 patients with CU, 337 patients (75%) were diagnosed as CIU. Forty-three patients (9.5%) had physical urticaria, while 17 patients (3.8%) had infectious causes. Other possible causes were food, thyroid diseases, atopy, drugs, dyspepsia and collagen vascular diseases. In eighty-nine percent of patients, no abnormalities were detected at the time of physical examination. The most common abnormal laboratory finding was minimal elevation of the erythrocyte sedimentary rate (42%). In 61 patients, autologous serum skin tests had been done. Fifteen patients (24.5%) had positive results i.e. autoimmune urticaria. Anti-thyroglobulin and anti-microsomal antibodies were positive in 16 % and 12% of CIU patients respectively. After 1 year from the onset of the symptoms, 34.5% of CIU patients were free of symptoms and after 1.2 years from the onset of the symptoms, 56.5% of autoimmune urticaria patients were free of symptoms. The median disease duration of CIU and autoimmune urticaria were 390 days and 450 days respectively. Our study provided an overview of CU and CIU in a large series of Thai patients, based on etiological aspects and clinical courses.     

Moisturizers for Acne: What are their Constituents?

Acne is a chronic inflammatory disease of the pilosebaceous unit that affects almost all teenagers. Different treatments offer different modes of action, but aim to target acne pathology. Topical therapies, such as benzoyl peroxide, retinoids, antibiotics with alcohol-based preparations, and salicylic acid, can cause skin irritation resulting in a lack of patient adherence. Some physicians recommend patients use moisturizers as adjunctive treatment of acne, especially when either topical benzoyl peroxide or a retinoid is prescribed. Furthermore, some evidence shows that moisturizers can contribute independently to improve signs and symptoms of acne. Moisturizers contain three main properties, which are occlusive, humectant, and emollient effects. Currently, many moisturizers claim to be suitable for acne treatment. This article aims to provide a review of the active ingredients and properties of those moisturizers. Fifty-two moisturizers for acne were included for analysis. Most of the products (92%) have anti-inflammatory properties apart from occlusive, humectant, and emollient effects. Anti-acne medications, including salicylic acid, benzoyl peroxide, and retinol, were found respectively in 35, 10, and 8 percent of the moisturizer products containing anti-inflammatory properties. More than half of the products contain dimethicone and/or glycerin for its moisturizer property. Aloe vera and witch hazel are botanical anti-inflammatories that were commonly found in this study. Scientific data regarding some ingredients are discussed to provide a guide for physicians in selecting moisturizers for acne patients.Acne is a chronic inflammatory disease of the pilosebaceous unit that affects almost all teenagers between the ages of 15 and 17 years.1 Clinical features include oily skin, noninflammatory lesions (open and closed comedones), inflammatory lesions (papules and pustules), and various degrees of scarring. Increased sebum production under androgen control, alteration of the keratinization, follicular colonization by Propionibacterium acnes, and inflammation are four main processes in the pathogenesis of the disease.Different treatments of acne offer different modes of action, but aim to target the four aspects of acne pathology. Topical therapies, such as benzoyl peroxide (BP), retinoids, antibiotics with alcohol-based preparations, and salicylic acid (SA), can cause skin irritation resulting in a lack of patient adherence. Similarly, oral isotretinoin, which is the most effective medication for acne, usually causes dry skin, cheilitis, and photosensitivity.1 Dryness or skin irritation may cause barrier disruption of the stratum corneum leading to increased transepidermal water loss (TEWL) and production of inflammation.2 Thus, some physicians recommend patients use moisturizers as adjunctive treatment of acne, especially when either topical BP or retinoid is prescribed.3 Furthermore, some evidence shows that moisturizers can contribute independently to improve signs and symptoms of acne.1Moisturizers contain three main properties, which are the occlusive, humectant, and emollient effects. The occlusive ingredients physically block TEWL by forming a hydrophobic film on the skin surface and within the superficial interstitium between corneocytes.4-5 Occlusive agents, such as petrolatum, lanolin, mineral oil, paraffin, squalene, and silicone derivatives (dimethicone, cyclomethicone), are usually greasy.4 Silicone derivatives are often used in combination with petrolatum, which make them greasy. However, silicone derivatives that have not been combined with other ingredients are not greasy. The second property of moisturizers is humectant, which attracts water from the dermis to epidermis. Examples of humectants are glycerin (glycerol), sodium lactate, ammonium lactate, hyaluronic acid, sorbitol, urea, and alpha hydroxyl acids.1,4 The other property of moisturizers is emollient, which smooths skin by filling space between skin flakes with a droplet of oil.1 Emollients include a vast array of compounds ranging from esters to long chain alcohols, such as isopropyl isostearate, caster oil, propylene glycol, octyl stearate, and dimethicone.1 One ingredient of moisturizers can have more than one property, such as dimethicone, which has both occlusive and emollient properties. Other ingredients including topical medications for acne and botanical antiinflammatory substances are sometimes added to moisturizers for acne.Currently, many moisturizers that are available either over the counter or online claim that they are suitable for acne treatment. The current study was designed to investigate the active ingredients and properties of those moisturizers.     

Drug-induced urticaria: causes and clinical courses

The authors retrospectively reviewed medical records of patients who were diagnosed as having drug-induced urticaria at Siriraj Hospital of Mahidol University (Bangkok, Thailand) between October 2004 and April 2007. One hundred and forty-seven drugs were presumed as causing acute urticaria. Females were affected more commonly than males. The most frequent drug groups were antibiotics, followed by non-steroidal anti-inflammatory drugs (NSAIDs). The most common culprit drugs were ceftriaxone, cephalexin, amoxicillin and diclofenac, respectively. The median duration of onset and of clinical remission were 18 hours and 24 hours, respectively. Antibiotics were the most frequent causes of drug-induced urticaria, of which cephalosporins were the most common causative drugs. Oral NSAIDs significantly had the shortest median onset of urticaria. After discontinuing the culprit drugs, the reactions usually disappeared within a few days.