Search

Abstract: The management of patients who have developed a contact dermatitis due to topical drugs requires to stop the suspected drug application, to declare, if severe, the adverse drug reaction to a center for drug safety, to treat the patient with corticosteroid ointments, to perform dermatoallergological investigations e.g. drug patch tests in case of contact eczema and diluted prick tests in case of contact urticaria in order to determine whether the adverse drug reaction was due to excipients or to the drug itself. It is also absolutely necessary to advise the patient concerning the avoidance of topical but also systemic readministration of the responsible molecule. An excipient responsible in inducing a contact sensitization to a topical drug can also be found in cosmetics, the name of the responsible excipient has to be given to the patient under the common name but also under the INCI and/or CFTA name. When the drug itself is responsible in inducing a contact allergy it is necessary to determine if cross reactions with other drugs can occur and if the responsible molecule can induce systemic cutaneous adverse drug reactions if the drug is systemically readministred. Among NSAID there is no cross reactions between bufexamac and diclofenac, between salicylamide, glycol salicylate, salicylic acid and acetylsalicylic acid. In case of photosensitization 1) to ketoprofen or 2) piroxicam the topical and/or systemic administration of the following molecules are contraindicated with respectively 1) ketoprofen, tiaprofenic acid, fenofibrate, oxybenzone or 2) piroxicam, thimerosal. A patient sensitized to corticosteroid ointment has to be tested in order to determine which corticosteroid classes are sensitizing. The topical and systemic administrations of molecules belonging to the sensitizing classes (A, B, C, D1 or D2) have to be forbidden. In general, a contact dermatitis due to an antimicrobial drug induces a contraindication in further topical or systemic uses of the drug and to all the molecules belonging to the same class. In most of the cases there is no risk in systemically administering iodine, sulfites or excipients in a sensitized patient who had developed a contact dermatitis to topical medications. [Copyright &y& Elsevier]

Abstract: Occupational dermatitis (irritant dermatitis, contact urticaria and contact eczema) is frequent among healthcare workers. Irritant hand dermatitis, the most common occupational dermatitis, occurs often in individual who work in a humid environment, who handle disinfectants, and who are required to wash their hands frequently; atopic dermatitis is a risk factor for this condition. Natural rubber latex present in rubber gloves is the most common cause of contact urticaria. Contact eczema can be induced by rubber accelerators (for example, thiurams) present in gloves, and also by disinfectants (glutaraldehyde, dodecyldimethylammonium), disinfectants and detergents, hand creams, acrylates (in dentists), and echography gels. Nurses sometimes develop contact dermatitis to drugs they handle; these allergies should be diagnosed by appropriate skin testing because sensitized individuals may develop a severe, generalized cutaneous adverse reaction if they are subsequently exposed systemically to the sensitizing drug. [Copyright &y& Elsevier]

Résumé Le drug reaction with eosiniphilia and systemic symptoms (DRESS) est une réaction adverse médicamenteuse pouvant mettre en jeu le pronostic vital du patient. Les signes cliniques sont polymorphes et les atteintes viscérales variées. De plus, son délai d’apparition est long après la prise médicamenteuse responsable ; le diagnostic est donc particulièrement difficile en réanimation. Nous rapportons le cas d’une patiente atteinte de DRESS dans les suites opératoires d’une chirurgie intracrânienne compliquée d’une infection nosocomiale. Drug reaction with eosinophilia ans systemic symptoms (DRESS) is a severe medication-induced adverse reaction, which can threaten patient's life. Clinical symptoms and organ failures present wide variability. Furthermore, the latency period is long, so that diagnosis could be a real challenge in the intensive care unit. We report the case of a woman developing a DRESS after neurosurgery complicated by a nosocomial infection. [ABSTRACT FROM AUTHOR]

Abstract: Drug-induced hypersensitivity syndrome or DRESS is an uncommon but potentially severe cutaneous adverse drug reaction. This cutaneous drug adverse reaction has some particular characteristics: a small number of culprit drugs, long delay (three to six weeks) for development after the first drug intake, responsibility of some viruses, especially Human Herpesvirus 6 (HHV6). The awareness of this cutaneous adverse reaction has increased during the last years with a better knowledge including the relationship between some drugs and reactivation of Herpesviruses, antiviral immune response, and genetic background. The identification of DRESS is important for rheumatologist who is often using drugs at risk for DRESS (allopurinol, salazopyrine, antiépileptiques…). This recognition enables a rapid diagnosis and a proper management of this syndrome. [Copyright &y& Elsevier]

Introduction. – Malassezia are lipophilic yeasts, saprophytic on human skin. For the past 20 years, Malassezia were thought to be involved in the pathogenesis of certain forms of head and neck dermatitis (HND). The aim of the present study was to investigate the role of this organism in HND. We also studied possible cross-reactivity with two other yeasts, Candida albicans and Saccharomyces cerevisiae.Patients and methods. – Fifty-three subjects were included: 25 patients with HND, 10 patients with generalized atopic dermatitis (AD) and 18 healthy controls. The 25 patients with HND had yeast cultures taken for Malassezia, and all 53 subjects had patch tests, skin prick tests and IgE antibody assays for Malassezia, C. albicans and S. cerevisiae. The HND patients were then treated with ciclopiroxolamine, a topical antimycotic.Results. – We found no statistically significant relationship between the results of yeast cultures, skin tests and the serological results or the results of the antimycotic treatment in these subjects. We did find increased sensitivity to Malassezia in patients with AD compared to the healthy controls, but there was no statistical difference between HND patients and patients with generalized AD. Nevertheless, for the entire group of patients, there was a significant relationship between results of skin prick tests and specific antibodies for Malassezia, C. albicans and S. cerevisiae, suggestive of possible cross-reactivity between these three yeasts.Conclusion. – The results lead us to propose two hypotheses: (1) Patients may be sensitized to yeast proteins but have no signs of an allergy requiring antifungal treatment, i.e. HND. (2) Patients with HND might be sensitized to several yeasts, and they would need systemic antifungal treatment that is active on Malassezia and C. albicans and, in addition, a S. cerevisiae-free diet. [Copyright &y& Elsevier]

Objectifs Le DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) peut survenir après un long délai d’exposition médicamenteuse. L’objectif est de rapporter des effets indésirables rares, difficiles à diagnostiquer, pouvant mettre en jeu le pronostic vital. Sujet Une enfant de 2 ans reçoit la chimiothérapie d’induction pour une LAL, compliquée à J17 d’ une septicémie à pneumocoque, traitée par Bétalactamines et Glycopeptides. A J45, en rémission complète, elle présente: rash, fièvre à 40°, adénopathies, splénomégalie, œdèmes associés à une insuffisance rénale et hépatique avec éosinophilie. Résultats principaux Le score du groupe Regiscar confirme le DRESS certain, sans réactivation virale. L’éviction des drogues (Bétalactamines-Glycopeptides-Sulfamétoxazole) et une corticothérapie prolongée normalisent la défaillance d’organes en 3 semaines et l’atteinte cutanée en 2 mois. La rémission se maintient et la chimiothérapie est reprise. Conclusions Les atteintes d’organes font la gravité du DRESS qui doit être identifié précocement pour contre-indiquer les médicaments impliqués. Ici, le rôle des antibiotiques parait certain, celui de l’infection plus discutable. La thérapeutique est adaptée à la situation clinique et biologique; une surveillance prolongée est nécessaire. [ABSTRACT FROM AUTHOR]