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An 87-year-old man with a history of osteoarthritis presented with worsening knee pain. He was prescribed acetaminophen with codeine. A few days later, he developed a rash on his right buttock and proximal thigh, similar to a rash he experienced in the past when he took over-the-counter (OTC) acetamenophen and an unknown lozenge to treat a presumed viral illness. A fixed drug eruption (FDE) was diagnosed and the patient was asked to avoid Tylenol and other OTC lozenges. Tylenol was entered as an allergy in the electronic medical records. However, since Tylenol, not acetaminophen was listed in the allergy profile, the order for acetaminophen and codeine did not generate an alert for the prescribing physician. Additionally, the dispensing pharmacist did not question the prescribing physician and the patient, unaware that acetaminophen in the pain medication is the same drug as Tylenol, took it and developed recurrent FDE.

Erythema multiforme (EM) is an immune-mediated epidermal reaction that develops in association with a variety of factors, including drugs and viral and bacterial infections. Cases with strong inflammation or blistering can develop into severe drug eruptions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). There are some reports of EM associated with anti-cancer agents, but no reports of EM associated with viral infection after concurrent chemoradiotherapy (CCRT). A 40-year-old man presented at the emergency outpatient department with neck swelling and redness, widespread limb dermatitis, and oral mucositis. He had undergone postoperative CCRT a month earlier for secondary cervical lymph node metastasis of tongue cancer. Our dermatologist performed a biopsy and a blood test and diagnosed EM major against the background of immunosuppression caused by the CCRT, most suspected cause was a virus infection. EM during the CCRT perioperative period should be recognized as an important adverse event in the course of malignant tumors and distinguished from severe drug eruption caused by anticancer drugs.

Background A variety of dermatoses have been reported in the growing number of patients treated with immune-checkpoint inhibitors (ICIs), but the current understanding of cutaneous immune-related adverse events (irAEs) is limited. Objective To determine the cumulative incidence, distribution, and risk factors of cutaneous irAEs after ICI initiation. Methods This was a retrospective cohort study of patients in a national insurance claims database including cancer patients treated with ICIs and matched controls. Results The study included 8637 ICI patients and 8637 matched controls. The overall incidence of cutaneous irAEs was 25.1%, with a median onset time of 113 days. The ICI group had a significantly higher incidence of pruritus, mucositis, erythroderma, maculopapular eruption, vitiligo, lichen planus, bullous pemphigoid, Grover disease, rash, other nonspecific eruptions, and drug eruption or other nonspecific drug reaction. Patients with melanoma and renal cell carcinoma and those receiving combination therapy were at a higher risk of cutaneous irAEs. Limitations Retrospective design without access to patient chart data. Conclusions This study identifies cutaneous irAEs in a real-world clinical setting and highlights patient groups that are particularly at risk. The results can aid dermatologists at the bedside in the diagnosis of cutaneous irAEs and in formulating management recommendations to referring oncologists regarding the continuation of ICI therapy.

Made available in DSpace on 2022-04-29T08:35:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: Fixed drug eruption is a drug reaction characterized by the recurrent occurrence of erosive or ulcerative lesions in skin or mucosa surfaces upon the use of a specific drug. The occurrence of fixed drug eruption in oral mucosa is rare and ill documented. Case report: A 37-year-old woman who presented with recurrent erosive lesions in the palatal marginal gingiva of the upper first molars for 3 consecutive months. In anamnesis and follow-up, the time association with the intake of piroxicam to treat menstrual pain led us to the diagnosis of fixed drug eruption. Conclusion: Piroxicam is a rare culprit drug to fixed drug eruption, especially in oral mucosa. Department of Stomatology AC Camargo Cancer Center Dental School Department of Conservative Dentistry Federal University of Rio Grande do Sul Department of Oral Diagnosis Piracicaba Dental School University of Campinas (UNICAMP) Oral Oncology Center School of Dentistry of Araçatuba São Paulo State University Serviço de Odontologia Oncológica Instituto do Câncer do Estado de São Paulo ICESP-FMUSP Faculdade de Medicina da Universidade de São Paulo Dental School University Brasil Oral Oncology Center School of Dentistry of Araçatuba São Paulo State University

This study aimed to document the dermatoses and their relationships with CD4+ T lymphocyte counts and clinical stages of disease among people living with HIV followed by our Clinical Department, to investigate the effect of antiretroviral therapy (ART) on findings and to compare with real-world data. Medical records of people living with HIV were analyzed retrospectively in our outpatient clinic from January 2005 to June 2017. A total of 500 patient files were examined. 179 patients with dermatoses were included in the study. Demographic data, clinical and laboratory findings, dermatological findings, type and distribution of lesions, serological and histopathological examinations, diagnosis, treatment, and follow-up of patients were transferred to data forms. 84.4% of the patients were male and the mean age was 38.65 ± 11.6 years. The median CD4+ T lymphocyte count was 253/mm3 (range:0–1067). At least one dermatosis was present in 69.3% of the patients. Compared with their median CD4+ T lymphocyte counts, the ratio of CD4+ T lymphocytes was significantly lower in the group with three or more dermatoses ( p = 0.019). Condyloma acuminatum (15.1%), drug eruption (13.4%), seborrheic dermatitis (11.7%), oral candidiasis (11.2%), dermatophytoses (11.2%), syphilis (8.4%), Kaposi’s sarcoma (8.4%), and telogen effluvium (8.4%) were the most common dermatoses. Kaposi sarcoma (KS), oral candidiasis, onychomycosis, and molluscum contagiosum were significantly higher in the CD4+ T lymphocyte + T lymphocyte threshold value was determined as 200/mm³. Compared with other TDF/FTC-containing regimens, a significantly higher proportion of alopecia was reported in patients receiving TDF/FTC/EVG/c ( p = 0.007). Dermatoses may be a good clinical marker for detecting clinical stage and diagnosing HIV infection; also, there may be a significant increase in the number of dermatoses in advanced stages. Although there are only a few studies in the literature, it should be kept in mind that ART-associated alopecia rates may increase nowadays when ART is targeted at everyone.

Steven Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute life threatening mucocutaneous drug reactions. Several therapies have been used in the treatment of SJS/TEN but none of them have been established as the gold standard treatment, until now. Studies showed that cyclosporine (CsA) can be used off-label in TEN/SJS and has shown promising therapeutic effectiveness in such diseases. Here we report a 38 year-old woman who presented to Ar Rustaq Hospital, Rustaq, Oman in 2019 with SJS/TEN overlap and was treated successfully with CsA along with supportive management. This case report also includes a literature review on use of CsA in the treatment of SJS/TEN. Keywords: Steven Johnson Syndrome; Toxic epidermal necrolysis; Epidermal necrolysis; cyclosporine; Drug eruption; case report; Oman

We report a clinical case of exfoliative dermatitis associated with a novel coronavirus disease. A patient with moderate COVID-19 and decompensation of insulin-dependent diabetes mellitus, hypertension and obesity developed a generalized drug eruption. Treatment of coronavirus infection included drugs associated with the frequent development of skin allergic reactions: third-generation cephalosporin and hydroxychloroquine. In this clinical case, the patient had a generalized form of exfoliative dermatitis with moderate COVID-19. Thus, the generalization of drug eruption occurred with a decrease in the viral pneumonia foci area and was accompanied by repeated deterioration of general condition of the patient. Skin rashes resolved in the correction of concomitant pathology. Erythroderma has a benign course in hemostatic disorders and the use of systemic glucocorticosteroids, hyperglycemia therapy. For managing such patients, it is important to use an integrated approach, providing both the treatment of the underlying disease and the correction of comorbidity and complications. This is relevant for both dermatologist-venereologist and specialists involved in the treatment of COVID-19. © 2021 Eco-Vector LLC. All rights reserved

Adverse drug reactions involving the skin are commonly known as drug eruptions. Severe drug eruption may cause severe cutaneous adverse drug reactions (SCARs), which are considered to be fatal and life-threatening, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). Although cases are relatively rare, approximately 2% of hospitalized patients are affected by SCARs. There is an incidence of 2 to 7 cases/million per year of SJS/TEN and 1/1000 to 1/10,000 exposures to offending agents result in DRESS. However, the mortality rate of severe drug eruptions can reach up to 50%. SCARs represent a real medical emergency, and early identification and proper management are critical to survival. The common pathogenesis of severe drug eruptions includes genetic linkage with HLA- and non-HLA-genes, drug-specific T cell-mediated cytotoxicity, T cell receptor restriction, and cytotoxicity mechanisms. A multidisciplinary approach is required for acute management. Immediate withdrawal of potentially causative drugs and specific supportive treatment is of great importance. Immunoglobulins, systemic corticosteroids, and cyclosporine A are the most frequently used treatments for SCARs; additionally, new biologics and plasma exchange are reasonable strategies to reduce mortality. Although there are many treatment methods for severe drug eruption, controversies remain regarding the timing and dosage of drug eruption. Types, dosages, and indications of new biological agents, such as tumor necrosis factor antagonists, mepolizumab, and omalizumab, are still under exploration. This review summarizes the clinical characteristics, risk factors, pathogenesis, and treatment strategies of severe drug eruption to guide clinical management.

Patients with a history of or a predisposition to autoimmune or collagen vascular diseases are inclined to develop drug-induced subacute cutaneous lupus erythematosus (SCLE) due to terbinafine therapy. Here, we report a case of terbinafine-induced SCLE in a male patient, although classic SCLE most commonly affects females, and he did not have a diagnosis of or a history suggestive of a predisposition to autoimmune or collagen vascular diseases. Although the mechanism for terbinafine-induced SCLE has not been fully elucidated, we suggest that there may be distinctive mechanisms of terbinafine-induced SCLE of patients with and without a predisposition to or history of autoimmune or connective tissue diseases, which should be a focus of future research.

BACKGROUND Linear lesions are fairly common in our daily practice. However, the appearance of these lesions can vary, thus complicating the diagnosis. AIMS To study the various clinical presentations, the demographic profile of patients and the clinicopathological correlations of dermatoses presenting with a linear distribution. METHODS We conducted an institution-based, cross-sectional, descriptive study of 281 consecutive patients with linear lesions attending dermatology clinics. MedCalc software (V11.6) was used for statistical analysis. RESULTS Patients were divided into eight groups: lesions along the lines of Blaschko (n = 136), lesions along blood vessels (n = 3), lesions along lymphatics (n = 3), Koebner phenomenon (n = 24), autoinoculation (n = 24), external factors (n = 45), infestations (n = 2) and 'other' (n = 44). The mean age at presentation was 24.50 ± 18.82 years and the male/female ratio was 1.32 : 1. The commonest symptom was itching/burning (56.94% of patients), while the commonest site was the arm (44.48%); followed by the leg (30.60%), trunk and abdomen (22.42%), head and neck (19.20%), and genitalia (0.35%). Apart from the common cases, there was a wide gamut of rare conditions (e.g. angiokeratoma circumscriptum naeviforme, porokeratotic eccrine ostial and dermal duct naevus, Blaschko-linear syringocystadenoma papilliferum, progressive cribriform and zosteriform hyperpigmentation, unilateral naevoid acanthosis nigricans, fixed drug eruption, discoid lupus erythematosus). CONCLUSION Linear lesions act as diagnostic clues to many dermatological conditions, therefore, the importance of meticulous examination in clinical dermatology cannot be overemphasized.

Graft-versus-host disease (GvHD) is a major complication following stem-cell or solid-organ transplantation. Accurate diagnosis of cutaneous GvHD is challenging, given that drug eruptions and viral rashes may present with similar clinical/histological manifestations. Specific markers are not available. We performed the histological examination of biopsy samples from acute GvHD (aGvHD; n = 54), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN; n = 27), maculopapular drug eruption (MDE; n = 26) and healthy controls (n = 26). Samples of aGvHD showed a decrease in Langerhans cells (LC, p = 0.0001) and an increase in macrophages (MΦ, p = 0.0001) compared to healthy skin. Compared to SJS/TEN, MDE and healthy skin, aGvHD biopsies contained greater numbers of CD4+ and CD8+ T cells. The majority of CD4+ T-helper cells were localized in the upper dermis, whereas cytotoxic CD8+ T cells were found in the epidermis. Increased numbers of CD56+ natural killer (NK) cells in the upper dermis of aGvHD skin (p = 0.007) were not observed in controls or SJS/TEN and MDE. There were no differences in elafin staining between aGvHD and the latter two conditions. Acute GvHD appears to have a distinct inflammatory cell profile (T cells/NK cells) that may aid establishing in a more accurate diagnosis, especially when used to rule out differential diagnoses such as SJS/TEN or MDE.

Background: Making the diagnosis of a drug-induced reaction requires familiarity with the clinical patterns as the current understanding of the disease processes is not enough to explain about apparently similar pathological mechanisms generating different clinical patterns. Therefore, it remains useful and relevant to overlay a pathological understanding with a clinical classification. This study concentrated on observing and documenting the clinical presentation of cutaneous adverse drug reactions (CADR) encountered in patients. The purpose of the study was to evaluate causality, severity and preventability of Dermatological ADRs. Objective: To study morphological types of CADR and their incidence in Indian population Method: A prospective, observational study was carried out over a period of one year at Out Patient Department of Dermatology, Government Medical College, Amritsar with diagnosed CADRs. The suspected ADRs were evaluated for causality by Naranjo’s Probability scale and severity by Hartwig and Siegel scale. Result: Total 54 patients were enrolled. The incidence of CADR was 0.09%. Most commonly manifested ADR was fixed drug eruption (FDE) i.e. 35.2%. Maximum incidence of dermatological ADRs were observed with antimicrobial agents (39%) followed by non-steroidal anti-inflammatory drugs (NSAIDS) (24%). Naranjo’s Probabilty scale showed most cases of probable (68.5%) ADRs were of moderate severity (90.7%). Conclusion: Awareness about CADR is essential for early detection, management of patients and drug safety. The healthcare system can promote the spontaneous reporting of dermatological ADR to Pharmacovigilance centers for ensuring safe drug usage and patient care. Keywords: Cutaneous adverse drug reactions, Drug safety, Pharmacovigilance.

Introduction Dermatologists play essential roles in providing dermatology consultations to inpatients admitted to hospital for care in another speciality ward. Data on dermatology consultations provided to inpatients admitted to general surgery wards are limited. The aim of this study was to analyze the reasons for and diagnoses of consultations provided by dermatologists to hospitalized patients in a general surgery ward and compare the provisional diagnoses by surgical residents and the final diagnoses by dermatologists. Methods Electronic health records were retrieved for patients admitted to a general surgery ward who received dermatology consultations while inpatients in Peking Union Medical College Hospital between 1 September 2015 and 31 August 2020. Sex, age, surgical diagnosis, reason for dermatology consultation, provisional diagnosis by surgical residents, and final diagnosis by dermatologists were reviewed. Results A total of 262 dermatology consultations for 251 patients (n = 251, 123 women and 128 men) were identified, of whom 240 (95.6%) required only one consultation and 11 (4.4%) required two. Dermatology consultations were classified into three categories: preoperative consultation (n = 45, 17.9%), postoperative consultation (n = 65, 25.9%), and consultation unrelated to general surgery diseases or treatments (including surgery) (n = 141, 56.2%). For consultations falling in the category preoperative consultation, common reasons for the consultation were: to evaluate whether the current treatment plan for previously diagnosed skin diseases needed to be changed; to evaluate and manage skin problems that emerged after admission; to evaluate syphilis; and to evaluate whether previously diagnosed skin diseases would affect surgical incision or wound healing. Drug eruption, dermatitis/eczema, infectious skin disorders, and urticaria were the most common skin diseases in the hospitalized general surgery patients. Only 32 (12.7%) provisional diagnoses were made, of which 25 (78.1%) were correct and seven (21.9%) were incorrect. Surgical residents mainly had difficulty distinguishing herpes zoster, drug eruption, and infectious skin disorders from dermatitis/eczema. Conclusion Our results facilitate the understanding of inpatient dermatology consultations in general surgery wards and may help in the design of future educational materials and/or management guidelines.

Programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have demonstrated their efficacy in the treatment of various malignancies. Despite their benefits, their immunomodulatory activities can cause unpredictable cutaneous adverse events (CAE). This study aimed to identify characteristics of CAE in patients treated with PD-1/PD-L1 inhibitors through the medical records, photographs, and pathology reports. Fifty CAE occurred in 47 (2.75%) of 1711 patients treated with PD-1/PD-L1 inhibitors. Pruritic, psoriasiform, urticarial, and acneiform eruptions were the four most common types. Melanoma patients showed CAE more frequently than other malignancies. Acneiform eruption occurred more often at ages under 60 years. Urticarial eruption appeared earlier, while keratoacanthoma appeared later after immunotherapy. The overall survival times were not significantly different between the two groups with and without CAE by Kaplan-Meier analysis (p = 0.055). Studies on CAE may provide more information to understand these drugs and to help manage the patients.

Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by recurrence of lesions at the same sites each time a specific drug is taken. Oral mucosal involvement is rare. Nonsteroidal anti-inflammatory drugs are one of the most common offending drug groups in FDE; however, selective cyclooxygenase-2 inhibitors, such as etoricoxib, are rarely implicated. We present a case of oral mucosal and cutaneous FDE induced by etoricoxib that, to the best of our knowledge, is the first reported case of this nature. We describe the diagnostic challenges and review the pertinent literature. The value of drug provocation testing and patch testing in FDE is also discussed.

This study aims to analyze the clinical characteristics of juvenile primary Sjogren’s syndrome (pSS) with cutaneous involvement. We investigated the clinical and immunological characteristics of 37 children with pSS. All the patients met the 2012 American College of Rheumatology Classification Criteria for Sjogren’s syndrome. The cutaneous involvement presented in 19 children (excluding drug eruption), 16 (84.2%) female patients, and 3 (15.8%) male patients, with a mean age of 11 ± 2.68 years, 17 of whom (89.5%) had cutaneous lesions as the first symptom, with a median time of 12 months (1 day to 4 years) before the diagnosis of pSS. The cutaneous lesions included 12 cases of palpable purpura (63.2%), 5 cases of urticaria (26.3%), 2 cases of xeroderma (10.5%), 1 case of skin ulcer, 1 case of erythema nodosum, 1 case of livedo reticularis, 1 case of Raynaud’s phenomenon, and 1 case of hard erythema. Children with cutaneous lesions had a higher prevalence of articular involvement (42.1% vs. 11.1%, P = 0.016), fever (47.4% vs. 5.6%, P = 0.004), ESR > 50 mm/h (47.4% vs. 11.1%, P = 0.016), and a lower prevalence of thrombocytopenia (0% vs. 27.8%, P = 0.013) and methylprednisolone pulse treatment (0% vs. 13.5%, P = 0.013), compared with pSS without cutaneous involvement. More than half (51.3%) of the children with juvenile pSS presented with cutaneous lesions; the main cutaneous involvement was palpable purpura. Children with cutaneous lesions were more likely to have fever and arthritis, were more likely to have stronger inflammatory response, and were less likely to have serious complications. In many cases, the cutaneous lesion could be the first symptom of juvenile pSS, which could easily lead to a misdiagnosis. The possibility of pSS should be considered for children with skin lesions such as palpable purpura and urticaria, and further examinations should be carried out.

Pityriasis lichenoides is a rare cutaneous disease that exists along a spectrum with acute and chronic features. The acute form, pityriasis lichenoides et varioliformis acuta (PLEVA), presents as a sudden onset scaly, erythematous, pruritic eruption while the chronic form, pityriasis lichenoides chronica, presents similarly but with a more indolent course. This inflammatory condition can have numerous triggers, including infections and medications. However, checkpoint inhibitors, despite being associated with a wide variety of cutaneous adverse events, have only rarely been associated with a pityriasis lichenoides-like eruption. We report a case of drug-induced pityriasis lichenoides-like eruption secondary to checkpoint inhibitor atezolizumab that was successfully treated with narrowband ultraviolet B (NBUVB) light. To our knowledge, this is the first case of an immune checkpoint inhibitor induced pityriasis lichenoides which responded well to NBUVB.

Generalized bullous fixed drug eruptions (GBFDEs) are rare in the paediatric population. We present the case of a 7-year-old girl with GBFDE believed to be secondary to oral ibuprofen, who experienced rapid resolution of lesions and cessation of blistering with a 3-week course of oral cyclosporine. To the best of our knowledge, this is the first report of a paediatric case of GBFDE treated with cyclosporine. In our report, we review published cases of GBFDE in children, and all adult cases managed with cyclosporine.

Background: Patch tests are used to diagnose nonimmediate T-cell‐mediated drug hypersensitivity reactions. The aim of this study was to evaluate the results of patch tests performed with suspect drugs in children. Methods: Patients < 18 years of age who had a drug patch test at the pediatric allergy outpatient clinic of our hospital between January 2014 and January 2020 were included in the study. Age, sex, culprit drug(s), reaction characteristics, and patch test results were recorded from the patients' files. Results: A total of 105 drug patch tests were performed on 71 patients during the study period. The patients' median age was 7 years (interquartile range, 4‐11 years), and 57.7% (n = 41) were boys. Twenty-three patients (32.3%) had severe cutaneous adverse reaction (Stevens-Johnson syndrome in 11, drug reaction with eosinophilia and systemic symptoms in 9, and acute generalized exanthematous pustulosis in 3 patients), 45 (63.3%) had maculopapular rashes, and 3 (4.2%) had fixed drug eruption. A total of 20 patch test results (28%) were positive: 18 of 44 patch tests (40.9%) with antiepileptic drugs and 2 of 48 patch tests (4.1%) with antibiotics. Positive results were obtained in 23% of the patch tests (6/26) in 20 patients with severe cutaneous adverse reactions and in 17.7% of the patch tests (14/79) in 51 patients with mild cutaneous reactions. No adverse reactions occurred during or after the patch tests. Conclusion: In our study, patch test positivity was more common with antiepileptic drugs and in patients with severe cutaneous drug reaction.

Fixed drug eruption (FDE) is characterized by the development of well-demarcated erythematous to violaceous plaques, within minutes to hours of the intake of an offending drug. It is known as “fixed” because subsequent exposure to the implicated drug leads to the development of lesions at the same sites that were involved at the time of the previous drug exposure. Fluconazole, a widely used antifungal agent, has a good safety profile, and limited data exist on the development of bullous FDE due to fluconazole. Herein, we report a series of two cases presenting with a generalized bullous FDE (GBFDE), following the consumption of fluconazole. A temporal correlation, typical morphological features, symptoms, and a past history of FDE due to fluconazole were essential clues to the diagnosis. Furthermore, we utilized the Naranjo adverse drug reaction probability scale for causality assessment. Discontinuation of the drug was followed by the resolution of lesions in 7–10 days. GBFDE is an uncommon entity and requires immediate diagnosis as well as prompt discontinuation of the offending agent to minimize the complications.

BACKGROUND/OBJECTIVE Autoimmune progesterone dermatitis (APD) is a rare autoimmune hypersensitivity reaction that occurs cyclically at the peak of endogenous progesterone production during the menstrual cycle in women. No study characterizing APD in the adolescent population is found; it appears likely to be underdiagnosed and undertreated. METHODS A retrospective, single-center, review of all adolescent and pediatric patients (

Fixed drug eruption (FDE) is one of the common types of cutaneous adverse drug reaction. This study was conducted to study the common types of drugs causing FDE and to find the management pattern of FDE in a tertiary care teaching hospital. In this study we found that orindazole (24%) and co-trimoxazole (20%) had higher incidence of FDE. Sixty eight percent of patients developed post inflammatory pigmentation. The most common clinical presentations was black patch in 44%, followed by bulla with erythematous patch in 20% of pigmented patches. Topical steroids, antihistaminic and oral corticosteroids were the common drugs used in the management of fixed drugs eruptions. The most common affected site was lip in 33.3% followed by trunk in 21%. The most common age group was 11-20 year followed by 21-30 year, fifty-one cases were seen in male. Keywords: Fixed drug eruption, Cutaneous Adverse drug reaction, Pigmentation.

Amac: Ilac reaksiyonlari medikal tedavinin onemli ve sik bir komplikasyonudur. Bu calismada ki amacimiz, kutanoz ilac reaksiyonu tanisi ile klinigimizde yatirilan olgularda, sorumlu ilaclar ve bu ilaclarin neden oldugu klinik tablolar literatur bilgileri esliginde incelemektir. Yontemler: Calismaya Ocak 2010-Aralik 2016 tarihleri arasinda kutanoz ilac erupsiyonu tanisi ile Haydarpasa Numune Egitim Arastirma Hastanesi Deri Ve Zuhrevi Hastaliklari Kliniginde yatirilarak tedavi edilen 164 olgu alinmistir. Hastalarin yasi, cinsiyeti, semptomlari, laboratuar tetkikleri, tani ve tedavi bilgileri hasta epikrizlerden incelenerek elde edildi. Demografik ozellikler, reaksiyonun tipi, reaksiyona yol actigi dusunulen ilac gruplari, multipl ilac kullaniminin varligi, ilac alimindan dokuntunun baslangicina kadar gecen sure gibi parametreler kayit edildi. Nedensellik iliskisi Naranjo algoritmasi ile degerlendirildi. KIE'ler, kesin, muhtemel, olasi ve yok olarak gruplandirildi. Butun degerler yuzdelik olarak ifade edilmistir. Ilacin yol actigi reaksiyonun siddeti Hartwig’s Ciddiyet Degerlendirme Skalasi ile degerlendirildi. Bulgular: Calismaya alinan 164 hastanin 104’u kadin (%63,4) ve 60’i erkek (%36,6) idi. Hastalarimizin yaslari 4 ile 97 arasinda degismekle birlikte yas ortalamasi 46,3 (18,8) idi. En sik reaksiyon tipi %42,1 oraninda saptadigimiz urtiker ve anjiyoodemdi. Bunu sirasiyla, %31.7 olarak saptanan makulopapuler ilac erupsiyonu izlemekteydi.kutanoz reaksiyonlara en sik yol acan NSAII’ler (%18,9), antibiyotikler (%15,2) ve bunlari izleyen NSAII ve antbiyotiklerin kombinasyonu idi (%9,8). Ilacin ilk alinmasindan dokuntunun baslangicina kadar gecen sure saatler ile aylar arasinda degismekteydi. Bu olgularin bir kismi da oykude gecmiste ilaclarla ilisikli benzer reaksiyonlar tanimlamaktadir. Sonuc: Kutanoz ilac Erupsiyonu ve ona neden olan ilaclarin ve prognostik faktorlerin bilinmesi klinisyenler icin buyuk onem arz etmektedir. Bu durumda hasta bilinclendirilmeli ve uyarici olarak yaninda daha once hangi ilaclarin reaksiyonlara sebep oldugunu gosteren alerji karti ya tasinmasi saglanmalidir. NSAII'ler, antibiyotikler ve bunlari iceren kombine ilac kullanimindan mumkun oldugunca kacinilmasi, antibiyotikler ve antiepileptikler konusunda dikkatli bir izlem yapilmasi, uzun sureden beri kullanilan ilaclarin da irdelenmesi gerektigi sonucuna varildi.

Background Baboon syndrome is a rare, type IV hypersensitivity reaction causing a maculopapular rash. Tamoxifen is an antineoplastic agent, working as an estrogen receptor antagonist, also called a selective estrogen receptor modulator. A variety of rashes were reported with Tamoxifen use to‐date except baboon syndrome. The Tamoxifen‐induced baboon syndrome seems to be reversible, as discontinuation of the drug improves clinical outcomes. Aim Herein, we present the first case of Tamoxifen‐induced baboon syndrome which occurred 8 years after initiation of Tamoxifen use. Patients A 44‐year‐old woman presented with papulovesicular eruption on her body and erythema on her face for a duration of 6 months. There was no evidence of ocular or mucosal involvement. She was diagnosed with breast cancer and treated with tamoxifen 10 mg twice daily over the past 8 years. She was not taking other medications or over‐the‐counter supplements at the time of presentation. The patient underwent urgent skin biopsies of two lesions on her buttock and thigh. No organisms were seen on Gram stain. The patient's skin biopsy revealed extensive hyperorthokeratosis, minimal parakeratosis, hypergranulosis, and lichenoid interface dermatitis in the irregularly acanthotic epidermis supporting diagnosis of fixed drug eruption. Following a multidisciplinary discussion, the patient was diagnosed with baboon syndrome or symmetrical drug‐related intertriginous and flexural exanthema (SDRIFE) associated with Tamoxifen. Results Hence, Tamoxifen was immediately discontinued and treated with oral steroid along with topical agents. She showed improvement of clinical abnormalities within days after discontinuation of Tamoxifen. Conclusions Given the widespread use of Tamoxifen in the management of patients with breast cancer, it is important that healthcare professionals monitor for rare, however clinically significant, and potentially life‐threatening dermatological manifestations of Tamoxifen use, such as baboon syndrome.

Thermal burns can occur during seizure. This diagnosis can be difficult in case of atypical lesions, even more if the epilepsy is unknown and in case of seizures with loss of consciousness and/or an unwitnessed epileptic attack. We report two cases of cutaneous bullous lesions initially misdiagnosed as severe acute cutaneous adverse reactions (generalized bullous fixed drug eruption and Stevens–Johnson syndrome). In the two cases, the clinical aspect, necrotic evolution, and absence of obvious attributable medication allowed to revert to the diagnosis of burns due to boiling water revealing previously unknown epilepsy. For both, surgical management with skin graft was performed, and antiepileptic treatment was introduced. Facing unexplained burns, occult epilepsy should be investigated. Questioning of patient and relatives is crucial.

Drug allergy is characterized by hypersensitivity reactions to pharmacological agents, having an immune mechanism of development. In these reactions antibody and/or activated T cells are directed against medications or their metabolites. This problem is rather urgent for practical healthcare, as over 7% of people suffer from drug allergy. A 54-year old male presented at the emergency room Hospital Zainoel Abidin with redness and swelling of the bodies of a burning sensation, itching pain. In the detailed anamnesis taken from the patient, it was learned that 1 days previously he had consulted a nurse with the fever and 60 min after examination had been prescribed with acid mefenamic. Hypersensitivity immune reactions to medications, according to the present concepts, are divided into immediate reactions (within 1–6 h after starting the preparation manifesting with various forms—from mild to life-threatening symptoms of anaphylaxia), or delayed reactions (several hours to several days after the offending medication is started, manifesting clinically with exanthemas in the majority of cases). Drug allergy should be prevented.Steps to prevent allergic drug reactions include (1) a careful history to determine host risk factors, (2) avoidance of cross-reactive drugs, (3) use of predictive tests when available, (4) proper and prudent prescribing of drugs (especiallyantibiotics) that are frequently associated with adverse reactions,(5) use of oral drugs when possible, and (6) documentation of drug allergy in the patient’s medical record.

Chronic lymphocytic leukemia (CLL) is a malignant lymphoproliferative disease characterized by the accumulation of immature monoclonal B lymphocytes in blood cells, bone marrow, spleen and lymph nodes. This is the most common type of leukemia among the Caucasoid race. When CLL skin lesions occur in about 25% of patients, they are extremely diverse. These lesions can be divided into specific, including infiltration of the skin by leukemic cells and the skin form of Richter's syndrome, secondary skin tumors, nonspecific lesions and associated skin diseases.Leukemic infiltration of the skin in patients with leukemia is called specific skin lesions (SSL). Many authors associate the unfavorable prognosis with the transformation of CLL with specific infiltration of the skin into Richter syndrome, as well as the appearance of SSL before the diagnosis of CLL. The risk of developing various cancer pathologies in patients with CLL is three times higher than in healthy people identical in sex and age. It was found that the risk of skin cancer in these patients is eight times higher than in the healthy population. The most common secondary skin tumors in CLL are basal-cell carcinoma, squamous-cell carcinoma, melanoma, and Merkel tumor.Nonspecific skin changes are extremely diverse and occur in patients with CLL in 30-50% of cases. The most common secondary changes in the skin in CLL are those of infectious nature. There are also increased reactions to insect bites, generalized itching, exfoliative erythroderma, nodular erythema, paraneoplastic pemphigoid, bullous pemphigoid, drug eruption. Concomitant dermatoses in these patients are more severe and often torpid to the previously conducted therapy. There is no doubt that together with the clarification of the etiology and pathogenesis of CLL, particular issues related to the study of clinical and morphological changes in individual organs and systems, in particular the skin, formed at various stages of the development of this disease should be studied in detail. This can not only expand and clarify our understanding of this pathology, but also can help to clarify the essence of the disease.

To summarize the differential diagnosis and describe a clinical approach for the evaluation of target and targetoid lesions in hospitalized patients. Important diagnostic considerations for target and targetoid lesions in an inpatient setting include erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis, mycoplasma-associated rash and mucositis, fixed drug eruption, urticaria multiforme, subacute cutaneous lupus erythematosus, and Rowell syndrome. Less frequent diagnoses may include erythema migrans, arthropod bite, erythema gyratum repens, erythema annulare centrifugum, tinea concentricum, tinea corporis, Granuloma annulare, elastolytic giant cell granuloma, cutaneous T cell lymphoma, linear IgA syndrome, pigmented purpuric dermatosis of Majocchi, hobnail hemangioma, and acute hemorrhagic edema of infancy. Morphology can be a key in initially discriminating among these entities. Classic target lesions should be distinguished from targetoid, gyrate, and annular lesions. The differential diagnosis of target and targetoid lesions in hospitalized patients is broad; however, attention to additional morphologic features, location, concomitant symptoms, mucosal involvement, histopathology, location, and progression can aid in diagnosis. Clinical evaluation should also consider patient demographics and associated systemic symptoms to elucidate the correct diagnosis.

Background Fixed drug eruption (FDE) is a characteristic form of intraepidermal CD8+ T cell-mediated drug reaction, with repeated appearance of isolated or multiple skin lesions in the same location after receiving the offending drug. Non-steroidal anti-inflammatory drugs (NSAID) are the most common cause. Selective inhibitors of inducible cyclooxygenase 2 (COX-2) provoke a lesser degree of allergic or idiosyncratic adverse reactions than conventional NSAID, but they can cause skin reactions of variable severity. Objective Etoricoxib has been related to a variety of unusual skin reactions, including several reports of FDE. Methods We perfomed epicutaneous test to diagnose patients with suspected etoricoxib fixe drug rash due to clinical features and reproducibility on at least two occasions. Results We present seven new cases of etoricoxib-induced fixed drug eruption, with a diagnosis based on clinical presentation. This diagnosis was confirmed by an etoricoxib-positive lesional patch test in six cases and by a positive low-dose oral challenge in the other one. Two patients showed negative patch tests with celecoxib (10% in pet.) on the residual lesions, and oral tolerance was confirmed in one. Conclusion To our knowledge, this is the largest series on FDE induced by etoricoxib reported to date.

Background Hydroxychloroquine is associated with myriad adverse dermatologic effects, most of which are poorly characterized by the literature, with unknown frequencies and risk factors. Objective To conduct a systematic review of the adverse dermatologic effects and predisposing factors of hydroxychloroquine toxicity. Results The review included 94 articles comprising 689 dermatologic adverse effects. A total of 21 unique dermatologic reactions were reported, most commonly drug eruption or rash (358 cases), cutaneous hyperpigmentation (116), pruritus (62), acute generalized exanthematous pustulosis (27), Stevens-Johnson syndrome or toxic epidermal necrolysis (26), hair loss (12), and stomatitis (11). Almost all underlying conditions were rheumatologic or autoimmune in nature, composed primarily of lupus erythematous (72% of all cases) and rheumatoid arthritis (14%). The range of reported mean cumulative dosages was wide, with some adverse reactions found after as little as 3 g or as much as 2500 g. Limitations Dermatologic adverse events and primary diagnoses related to the use of hydroxychloroquine may be under-reported as only case reports and clinical trials that reported at least 1 dermatologic adverse effect were included. Conclusion Although hydroxychloroquine is generally well tolerated, dermatologic adverse effects involving the skin, hair, or nails are a frequent and significant complication. Most of these reactions occurred after treatment of autoimmune conditions, often manifesting on the skin after a wide range of cumulative dosages.

Introduction Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a clinically very well-defined drug eruption, but the histopathological findings are still considered to be nonspecific. Objectives To characterize the histopathological and immunophenotypical features of SDRIFE. Material and methods We performed a retrospective study that identified 11 biopsies from 9 patients with SDRIFE. The histopathological features were analyzed in conjunction with the immunohistochemical findings. Results The most common histopathological feature was basal cell vacuolization, which was often associated with necrotic keratinocytes and focal spongiosis. TIA1+ T cells and neutrophils were frequently detected in the epidermis and at the dermoepidermal junction. The dermal inflammatory infiltrate was mixed, consisting of CD3+ T cells, macrophages, granulocytes, low numbers of CD20+ B cells, and plasma cells. A combination of histopathological patterns was observed in 5 cases. The most frequent combined histopathological patterns were interface dermatitis, spongiotic dermatitis, and psoriasiform dermatitis. Other histopathological patterns found in different combinations were pustular dermatitis, perivascular and interstitial neutrophilic dermatitis, and interstitial granulomatous dermatitis. In the other 4 cases, a single histopathological pattern predominated, such as psoriasiform dermatitis, vacuolar interface dermatitis of erythema multiforme-like type, or superficial and deep perivascular and interstitial dermatitis with eosinophils and neutrophils. Conclusions SDRIFE is characterized histologically by a vacuolar interface dermatitis induced by cytotoxic T lymphocytes and neutrophilic granulocytes. This pattern may be obscured by accompanying spongiotic, psoriasiform, or pustular features combined with a mixed superficial and sometimes deep dermal infiltrate.

Bullous drug eruptions are infrequent, but because they pose a challenge both to affected patients and to treating physicians they are considered to be the most severe cutaneous adverse reactions (SCAR). It is important to recognize these conditions and to differentiate them from other clinical entities involving blister formation. There may be early signs and symptoms that indicate a severe bullous drug eruption even before blisters and erosions of the skin and mucous membranes become obvious. Once the diagnosis is suspected, appropriate diagnostic procedures and adequate management must be initiated. The latter includes identification of the potentially inducing drug, although it should be taken into account that not all cases of bullous eruptions are drug-induced. In cases with drug causality the potentially culprit agent must be withdrawn, while in cases with other aetiology the underlying condition, e.g. an infection, must be treated appropriately. In addition to best supportive care, immunomodulating therapy may be considered.

Introduction: Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by recurrent well defined lesions occurring in the same sites each time the offending drug is taken. FDE typically presents 30 min to 8 h after drug exposure. An extensive list of medications are known to cause FDE and finding the underlying drug help in proper management of cases. Aim: To study and analyse the causes and clinical pattern of FDE. Materials and Methods: The study was performed in Silchar Medical College and Hospital, Silchar, Assam. A total of 50 cases of FDE were studied. Cases of FDEs encountered between July 2018 to June 2019 during routine pharmacovigilance activities were analyzed. Result: Among 50 patients, 34 were male and 16 were female. Majority of patient were between the age of 18-40 years, mean age being 33.4 years. In 31 cases there was previous history of drug intake. Commonly affected sites include genitals and lips, palms and soles followed by extremities and other sites. Most common causative drug was due to antimicrobial followed by NSAIDs. Conclusion: Although clinical presentation of most of the patient was similar a detailed history, physical examination and drug provocation test helped us to reach most of the diagnosis. Keywords: Fixed drug eruption, Provocative tests.

Autoimmunity Related Neutrophilic Dermatoses (ARND) is a recently described entity characterized by urticarial papules and plaques with histology showing a neutrophilic perivascular and interstitial infiltrates with leukocytoclasis, along with variable vacuolar interface dermatitis. We report a 38 year old Caucasian female with a ten year history of lupus who presented with pruritic urticarial papules and plaques on the face, trunk, upper extremities and thighs. The onset occurred 10 days after she started a calcium channel blocker (CCB), diltiazem. Histopathology revealed scattered dyskeratotic keratinocytes, vacuolar interface dermatitis, and a sparse perivascular and interstitial mixed infiltrate of neutrophils within the dermis. There was focal leukocytoclasis, dermal edema, and rare eosinophils. The patient initially improved with prednisone taper, but flared again upon starting a different CCB, verapamil. Exposure to certain medications such as CCB in the setting of autoimmune connective tissue disorder may be the inciting trigger for a neutrophilic dermatoses. Future studies may provide further information on the pathogenesis of ARND and cutaneous drug eruption in the setting of SLE.

Severe skin reactions, mostly following medication use, are rare and can be associated with high mortality. A suitable treatment approach that is able to reduce mortality is needed. Recent publications on this topic were reviewed and evaluated. In the case of the self-limiting diseases acute generalized exanthematous pustulosis (AGEP) and generalized bullous fixed drug eruption (GBFDE), there is no clear indication for systemic immunomodulating treatment, and supportive care remains the gold standard. The situation is less clear in the case of drug reaction with eosinophilia and systemic symptoms (DRESS); nevertheless, primarily in the case of severe organ involvement, systemic glucocorticosteroids are recommended. This is associated with complications and often also with virus reactivation, which may delay healing. The evidence on various immunomodulating therapies in Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is controversial. Recent publications favor steroid pulse treatment, the tumor necrosis factor (TNF)-α inhibitor etanercept, as well as the calcineurin inhibitor cyclosporine A, with the latter representing the most promising approach. The rarity and unpredictability of the reactions make a randomized double-blind therapeutic trial extremely difficult. Using meta-analyses, it is possible to trace a trend in the use of systemic treatment options. Supportive care remains the most important treatment strategy for all clinical entities.

Background Lichenoid granulomatous dermatitis (LGD) is an uncommon reaction pattern for which clinical correlates can be difficult to establish. LGD combines vacuolar degeneration with variable types of granulomas. Objective To determine clinical correlates of LGD. Methods The laboratory information systems at the University of Florida, the Medical College of Wisconsin, and Inform Diagnostics Research Institute were queried to identify 56 cases of LGD. Cases were reviewed for information regarding eosinophils, plasma cells, deep perivascular infiltrates, granuloma subtype, parakeratosis, epidermal atrophy, psoriasiform epidermal changes, pseudoepitheliomatous hyperplasia, periadnexal inflammation, vasculitis, and red blood cell extravasation. Results The most common clinical correlates were drug eruption (39.3%, n = 22) and lichenoid keratosis (19.6%, n = 11). Tattoo reaction, postherpetic dermatitis, and scabies or postscabietic dermatitis each accounted for 7.1% (n = 4) of cases. Pigmented purpuric dermatosis and lichen striatus each accounted for 5.4% (n = 3) of cases. Dermal eosinophils (P = .005) and psoriasiform epidermal changes (P = .055) were associated with drug hypersensitivity. Perineural (P = .049) and perifollicular (P = .003) inflammation were associated with tattoo reaction and postherpetic dermatitis. Red blood cell extravasation was helpful in cases of pigmented purpuric dermatosis (P = .049). Limitations This study is limited by its retrospective nature and statistical power. Conclusion Dermal eosinophilia, psoriasiform epidermal changes, periadnexal inflammation, and red blood cell extravasation might aid in the clinical diagnosis of patients with LGD.

ObjectiveEnzalutamide is the most frequently prescribed compound for treating metastatic castration-resistant prostate cancer (mCRPC). Common adverse drug events of enzalutamide are febrile neutropenia, hot flashes, hypertension, and fatigue.MethodsWe present a case of a patient with mCRPC who received enzalutamide and developed Stevens-Johnson syndrome (SJS). The culprit drug was confirmed using the Naranjo Adverse Drug Reaction Probability Scale. Clinical characteristics and management principles were analyzed in combination with literature reports.ResultsSJS occurred within two weeks of enzalutamide therapy. Supportive care such as steroid treatment led to a complete resolution of skin lesions and improved clinical symptoms after three weeks.ConclusionMost cutaneous adverse events occur early during enzalutamide therapy, and close observation should be given within two weeks of starting treatment.

*Çorum Şirin, Serpil ( Aksaray, Yazar ) *Kemeriz, Funda ( Aksaray, Yazar ), A 65-year-old woman was referred to our clinic with multiple erythematous plaques on the trunk and arms (Figure 1). The eruption occurred three days after starting a 75 mg daily dose of gabapentin prescribed by a physical medicine and rehabilitation specialist for neuropathic pain in her arm. The skin lesions were accompanied by a fever of 38.3°C. The laboratory investigations revealed a white blood count of 18.820/mm3 and neutrophilic leukocytosis with a percentage of 89.4%. Further investigations revealed no infectious condition.

Summary Background Mogamulizumab is a humanized antibody against chemokine receptor type 4. It was recently approved by the US Food and Drug Administration for relapsed or refractory mycosis fungoides (MF) and Sézary syndrome (SS). The most commonly reported adverse event in the phase III licensing trial was drug eruption (28%), now termed mogamulizumab-associated rash (MAR). Clinical recommendations about MAR and its treatment differ between the current package insert and postapproval insights reported from two single-centre studies that focused on its characterization, but less so on outcomes and clinicopathological differentiation from cutaneous T-cell lymphoma (CTCL). Objectives To describe our experience in the diagnosis of MAR and treatment of patients with CTCL with mogamulizumab. Methods This is a single-centre retrospective case series study. Results We found a higher incidence of MAR in patients with CTCL (17 of 24, 68%) than previously reported. MAR development is associated with complete (11 of 17) or partial (four of 17) responses, with an overall response rate of 88%, compared with 29% (two of seven) in patients without MAR. Diagnosis of MAR may be obscured by its ability to mimic key CTCL features both clinically and histologically, but an absence of T-cell-receptor clonality and relatively decreased CD4 : CD8 ratio compared with baseline lesions strongly favour MAR over recurrent disease. Conclusions MAR has the potential to create a significant management problem for patients on mogamulizumab. Misidentification of MAR as recurrent CTCL may detrimentally result in the premature discontinuation of mogamulizumab in patients whose disease is historically hard to treat. Thorough clinicopathological investigation of new lesions during treatment with mogamulizumab is required to inform ideal treatment decisions and achieve better outcomes.

We report a case of fixed drug eruption in a 58-year-old lady treated for diabetes with four pharmacologically different anti-diabetic agents that were used at separate times of therapy. Skin manifestations, including erythema, blisters, and ulcers, developed over the right leg each time after the initiation of metformin, gliclazide, vildagliptin, and empagliflozin; and disappeared following the discontinuation of the drugs. Magnesium stearate was the common excipient identified in the four agents. This is an extremely rare case of fixed drug eruption caused by structurally dissimilar drugs.

A 74-year-old Thai male presented with a rash appearing 25 hours after receiving the first dose of the adenoviral-vectored COVID-19 vaccine, ChAdOx1 nCoV-19 vaccine (Oxford-AstraZeneca). These lesions abruptly appeared without any accompanying symptoms. The patient's medical history included end stage renal disease, atrial fibrillation, and ischemic stroke. The patient denied taking any new drugs, supplements or food that had not previously consumed prior to this cutaneous eruption.

Bupropion is an oral antidepressant that is commonly used to treat various mood disorders. Its therapeutic mechanism of action results from inhibiting the reuptake of norepinephrine and dopamine. Bupropion is generally well-tolerated and patients usually experience no side effects or mild adverse events. Rarely, hypersensitivity reactions to bupropion, such as urticaria, have been observed. However, the prevalence of delayed onset bupropion-associated urticaria may not be properly reflected in the literature due to misdiagnosis of the condition caused by its atypical presentation. We report a 20-year-old man with delayed onset bupropion-associated urticaria; he had been on bupropion for three weeks and subsequently developed new severely pruritic, erythematous wheals on his abdomen, bilateral flanks, and upper extremities. The clinical features of this rare adverse reaction to bupropion are also summarized.

Objective: The present study aimed to evaluate the epidemiological and clinical features, causative drugs, and diagnostic challenges of Fixed drug eruption (FDE) in elderly patients. Material and Methods: In this single-center, retrospective, cross-sectional study, we evaluated data of all consecutive adult patients (aged >18 years) with an established diagnosis of FDE between 1996-2018 in our tertiary referral center in Turkey. Elderly patients who were aged ≥60 years at the time of diagnosis were allocated to the study. Results: Among 182 adult FDE patients, 14 (7.7%) patients (male/ female=1/1.8) were in the elderly group (mean age=66.1±6.9 years). Fix drug eruption was induced by intermittently taken drugs in all patients, 50% of whom had polypharmacy (concurrent use of ≥5 medications). Trimethoprim-sulfamethoxazole (42.9%) and non-steroidal anti-inflammatory drugs (35.7%) were the main causative drugs, while ornidazole was a remarkable novel FDE inducer since 2011. Fix drug eruption was mostly located on the trunk and extremities. Mucosal involvement was less frequent. Ten (71.4%) patients had bullous FDE (BFDE). There were no statistically significant differences between the gender and mean ages of the patients with and without BFDE. Conclusion: Our long-term experience demonstrated that FDE may also affect elderly patients. Most of the patients had BFDE raising the question of whether the bullous type is a more common clinical phenotype in these patients. Among the important diagnostic challenges of FDE in this age group, e.g., polypharmacy, multimorbidity, recall problems, cognitive disorders, frailty, and immunosenescence, BFDE should also be kept in mind as it may clinically mimic Stevens-Johnson syndrome/toxic epidermal necrolysis, and autoimmune bullous diseases., Amaç: Bu çalışmanın amacı, yaşlı hastalarda fiks ilaç erüpsiyonunun (FİE) epidemiyolojik ve klinik özelliklerinin, etken ilaçlarının ve tanısal zorluklarının değerlendirilmesidir. Gereç ve Yöntemler: Tek merkezli, retrospektif kesitsel çalışmamızda, Türkiye’de üçüncü basamak bir referans merkezi Alerji kliniğinde, 1996-2018 yılları arasında FİE tanısı konulmuş olan erişkin hastaların (>18 yaş) dosyaları incelenmiştir. FİE tanısı konulduğu sırada 60 yaş ve üzerinde olan yaşlı hastalar çalışmaya dahil edilmişlerdir. Bulgular: Toplam 182 erişkin FİE hastası arasından, 14 (%7,7) hasta (erkek/kadın=1/1,8) yaşlı grubundaydı (ortalama yaş=66,1±6,9). Fiks ilaç Erüpsiyonu, hastaların tümünde aralıklı olarak kullanılan ilaçlara bağlı gelişmişti. Bu hastaların %50’ sinde polifarmasi (eş zamanlı ≥5 ilaç kullanımı) mevcuttu. Fiks ilaç Erüpsiyonunun en sık etkenleri, trimetoprim-sülfametoksazol (%42,9) ve nonsteroidal antienflamatuvar ilaçlar (%35,7) olmakla birlikte 2011 yılından itibaren ornidazol de yeni ve dikkat çekici bir Fiks ilaç Erüpsiyonu etkeni olarak karşımıza çıkmıştı. Fiks ilaç Erüpsiyonu lezyonları sıklıkla gövde ve ekstremitelerde yerleşmekteydi. Mukozal tutulum daha nadirdi. On (%71,4) hastada büllü FİE (BFİE) saptandı. Büllü FİE olan ve olmayan hastalar arasında cinsiyet ve ortalama yaş açısından istatistiksel olarak anlamlı farklılıklar saptanmadı. Sonuç: Uzun-dönem klinik tecrübemiz ışığında, FİE yaşlı kişilerde de görülebilen ve hastaların büyük bir çoğunluğunda büllü morfolojinin (BFİE) eşlik ettiği bir ilaç döküntüsü olarak karşımıza çıkmıştır. Bu durum, BFİE’nin bu yaş grubunda sık görülen bir klinik fenotip mi olduğu sorusunu akla getirmiştir. BFİE’nin klinik olarak Stevens-Johnson sendromu/toksik epidermal nekroliz veya otoimmün büllü hastalıklar ile ayırıcı tanıya girmesi tanıda zorluklara yol açabilmektedir. Fiks ilaç Erüpsiyonu şüphesi olan yaşlı hastalarda polifarmasi, multimorbidite, hafıza problemleri, kognitif bozukluklar, kırılganlık ve immün sistemin yaşlanması (immunosenescence) gibi tanıyı güçleştirebilecek durumlar arasında BFİE de akla gelmelidir.

Apalutamide, an oral androgen receptor signaling inhibitor, is approved for the treatment of non-metastatic castration-resistant prostate cancer and metastatic prostate cancer. In the international randomized placebo-controlled clinical trials, apalutamide was associated with a higher rate of rash than placebo. However, given that reports from a dermatological perspective are limited, the skin manifestations and histopathology of the skin lesions caused by apalutamide are largely unknown. Here, we report a case of apalutamide-induced drug eruption. A 66-year-old man developed itchy maculopapular erythema on the trunk and extremities 10 weeks after starting apalutamide for progressive prostate cancer. A biopsy specimen showed interface dermatitis with perivascular lymphocytic infiltration in the upper dermis. The lymphocyte transformation test was positive for apalutamide. The skin manifestations improved after discontinuation of apalutamide and treatment with topical corticosteroids and systemic prednisolone. A review of the dermatology literature on apalutamide-induced drug eruption yielded only six cases, including our case. Dermatologically, there were four cases of maculopapular rash and two of toxic epidermal necrolysis and histopathologically, there were three cases of interface dermatitis, two of epidermal necrosis, and one of spongiotic dermatitis. Four patients had peripheral eosinophilia. A lymphocyte transformation test was performed in three cases and was positive for apalutamide in all cases. Except for the two cases of toxic epidermal necrolysis, which were fatal, the skin eruptions appeared 10 weeks after starting apalutamide. Considering the increasing number of patients with prostate cancer being treated with apalutamide, cases of apalutamide-induced drug eruption need to be accumulated and analyzed.