Search

Background: Mammalian target of rapamycine (mTOR) inhibitors are being increasingly prescribed as antitumoural drugs, and associated adverse cutaneous effects are frequent but poorly described. The aim of this study was to describe such adverse effects and to assess the quality of life of patients experiencing them., Patients and Methods: Over a period of 18 months, 18 patients treated with mTOR inhibitors for renal carcinoma were included and 77 dermatological examinations performed. Wherever a cutaneous adverse event was present, quality of life was evaluated using the Skindex 30 questionnaire., Results: Fifteen of the 18 patients included presented adverse cutaneous events, consisting of buccal ulcers (61.1%), xerosis (55.5%), distal onycholysis (50%), acneiform eruption (38.8%), paronychia (22.2%) and pruritus (22.2%). Buccal ulcerations and perionyxis had an especially marked impact on quality of life, which was greatest in terms of physical score (19%), followed by emotional (9%) and functional (6%) scores., Conclusion: Cutaneous adverse effects of mTOR inhibitors are frequent and have a considerable impact on quality of life, particularly as regards physical scores. Dermatological examination appears useful to allow early management of cutaneous adverse effects and improve the quality of life of these patients., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: An association between herpes virus reactivations and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is accepted. We report six cases of DRESS with viral reactivation occurring within a single 1-month period. We attempted to find a common factor for these six cases and carried out clinical and virological examinations. Before and after this "epidemic", the mean number of cases of DRESS seen at the same centre was one per quarter, making the occurrence of six cases within a single month all the more remarkable and prompting us to seek an explanation., Patients and Methods: All six patients had taken a partly causative medication from different drug classes three to six weeks prior to the start of symptoms and herpes virus was detected in the blood of all of these subjects at the time of DRESS onset (four reactivations and two primary infections), and one patient subsequently displayed herpetic meningoencephalitis 95 days after the initial episode, associated with recurrence of DRESS., Discussion: There was no common denominator among these six DRESS patients in terms of either drug class or reactivation of a particular type of herpes virus, which raises the possibility of a single unidentified environmental agent. DRESS does not appear fully explainable in terms of a cellular response to drug antigens but seems rather to result from complex interactions between the drug-induced immune response, viral reactivation and antiviral immune response. Several investigators have reported sequential reactivation of herpes viruses in DRESS. A viral epidemic could thus cause a "DRESS epidemic" in patients on medication., Conclusion: These cases point to the possible existence of a shared initial environmental factor (infectious or not) that favours reactivation of herpes viruses and induces DRESS in patients on medication. Before and after this "DRESS epidemic", about one patient each quarter was admitted to hospital for DRESS., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Background: Skin tests are often used to explore adverse drug reactions. The sensitivity of skin tests appears to vary according to the drugs tested and the type of adverse reaction in question. There is no clear strategy to explore drug adverse reactions. The aim of this study was to determine the frequency of positive results for the different skin tests according to therapeutic class tested and type of adverse reaction. The secondary objective was to study response to the test drugs at different dilutions., Patients and Methods: We retrospectively selected all patients presenting a suspected adverse drug reaction investigated in our clinic by patch test (PT), prick test (pt) and intradermal test (IDT). The suspected drugs and a pre-established list of substances from the same therapeutic family were systematically tested. Medical records from patients with Lyell syndrome, fixed drug eruption, photosensitivity and Drug Eruption with Eosinophilia and Systemic Symptoms (DRESS) syndrome were excluded. Adverse drug reactions were divided into two groups: the U group (urticaria or angioedema) and the E group (maculopapular-rash, erythroderma and generalized eczema)., Results: Four hundred and twenty-nine adverse drug reactions in 319 patients were assessed: 200 in the U group and 229 in the E group. In total, 61.8% presented at least one positive test for the suspected therapeutic class: 67.5% in the U group and 56.8% in the E group. In the U group, patch tests were positive in 14% of cases for betalactams, 17% for NSAIDs and 6% for radio-contrast media (RCM); in the E group, PT were positive in 12% of cases for betalactams, 9% for NSAIDs and 2% for RCM. Prick-tests were positive in the U group in 73% of the betalactams explored, 40% for the NSAIDs and 40% for the RCM; in the E group, pt were positive in 51% for betalactams, 32 for NSAIDs and 35% for RCM. IDT were positive in the U group in 13% for betalactams, 10% for NSAIDs and 40% for RCM; in the E group, IDT were positive in 14% for betalactams, 7% for NSAIDs and 40% for RCM. In the U group, pt were positive in 50% of cases with a diluted aliquot and in 48% of cases for IDT; in the E group pt were positive in 3% of cases with a diluted aliquot and in 63% of cases for IDT. The main limitations of this study are due to its retrospective nature and to the absence of evaluation of the specificity and relevance of the positive tests., Conclusion: In patients presenting adverse drug reactions such as urticaria, angioedema, maculopapular rash, erythroderma and generalized eczema, the frequency of positive tests is high in general and for each therapeutic class (betalactams, NSAIDs, RCM). Diluted aliquots for pt remained sensitive and could be useful in exploring urticaria or angioedema, in the same way as diluted aliquots for IDT in both types of reaction. Better standardization of test procedures (including diluted aliquots) and of result reading would improve evaluation of the specificity and relevance of skin tests in adverse drug reactions., (Copyright © 2010. Published by Elsevier Masson SAS.)

Background: For the first time, 2 cases highlight the fact that, in the event of cutaneous adverse drug reactions under treatment associating 2 drugs, a positive test with one of the 2 does not authorize further readministration of the remaining drug without hospital surveillance., Patients and Methods: A man had urticaria during treatment with pristinamycin subsequently replaced by ceftriaxon. All the patch-tests with synergistins were positive, whereas patch-tests, prick-tests and intradermal tests with betalactams were negative. The oral challenge with ceftriaxon was positive. A woman taking spiramycin developed a maculopapular rash which was slowly regressive despite substitution with cefixim and corticotherapy. Patch-tests, prick-tests and intradermal tests with macrolides and betalactams were negative. An oral challenge with spiramycin was positive., Discussion: Sensitization to two antibiotics without shared chemical structures can occur during the same episode of a cutaneous adverse drug reaction, even without prior indication of sensitization to these drug classes. The mechanisms at play in this phenomenon are still debated, but this highlights the fact that reintroduction of any drug suspected at the time of a cutaneous adverse drug reaction must be performed under hospital surveillance, whatever the degree of imputability and even if skin tests with other drugs taken simultaneously were positive.

Introduction: Some cases of hyperhidrosis with beta-blocker therapy have been reported in the literature. We studied the prevalence of hyperhidrosis in a population treated by beta-blockers compared with an untreated control group., Patients and Methods: Patients attending the cardiologic consultation of the Nancy hospital were included. Past medical history and medication were collected. Interrogation assessed whether the patient felt hyperhidrosis, and defined a hyperhidrosis score., Results: Sixty-five subjects treated by beta-blocker and 100 controls were included. 36.9 p. 100 of treated patients and 38 p. 100 of controls experienced hyperhidrosis (p=0.88). 23.07 and 23 p. 100, respectively, had hyperhidrosis defined by a high score of sweating (p=0.99). Retrospectively, 8 of 24 patients experienced hyperhidrosis after the beginning of beta-blocker therapy., Discussion: We observed the same prevalence of hyperhidrosis in the two groups. However sweat gland innervation involved both cholinergic and adrenergic stimulations. Furthermore, experimental studies showed an increase in sweating on efforts with beta-blocker therapy.

Background: Drug-induced hypersensitivity syndrome is an uncommon drug reaction typically manifested by severe skin lesions, fever, nodal enlargement, blood eosinophilia and hepatitis., Case Report: A 16-year-old female patient with acne was treated with minocycline 100 mg/d for one month. She developed a hypersensitivity syndrome with a generalized pustulous eruption. Prick tests with minocycline diluted in vaseline were positive at 48 hours., Discussion: This case of minocycline-induced hypersensitivity illustrates that prick tests performed late after the initial event can reproduce the initial lesions. The causal role of several drugs, particularly anticonvulsants, has been demonstrated in drug-induced hypersensitivity syndrome. Several recent publications have implicated minocycline. Although such cases are uncommon, it would appear that cyclines, particularly minocycline, are the main cause of conditions such as drug-induced hypersensitivity syndrome, acute systemic lupus erythematosus, pulmonary eosinophil infiltration, and pseudo-serum sickness. Such secondary effects must be recognized. Patients should be advised to discontinue treatment and consult if signs such as fever, node enlargement, joint pain, or skin reactions reappear. It may be useful to perform prick tests with minocycline 4 to 6 weeks after an initial eruption.