scholarly journals A possible case of exfoliative dermatitis due to ibuprofen in an Eleven-month-old infant

2018 ◽  
Vol 7 (12) ◽  
pp. 2462
Author(s):  
Sudipto Chatterjee ◽  
R. Vijendra ◽  
Yashoda H. T. ◽  
Neil M. Salian
Keyword(s):  
Medical Practitioner ◽  
Medical Sciences ◽  
Drug Induced ◽  
Exfoliative Dermatitis ◽  
Center Hospital ◽  
The Face ◽  
Amoxicillin Clavulanic Acid ◽  
Topical Emollient ◽  
Assessment Scales ◽  
Inflammatory Action

Ibuprofen is a NSAID belonging to the class of propionic acid derivatives which is widely used for its analgesic, antipyretic and anti-inflammatory action. Well-known adverse effects of ibuprofen include gastric irritability leading to nausea and vomiting as well as allergic manifestations such as urticaria and skin rashes. Severe ADRs include renal papillary necrosis, SJS/TEN, and thrombotic events leading to myocardial infarction and stroke. Authors present a case of exfoliative dermatitis in an 11-month-old infant possibly due to ibuprofen. An 11-month-old infant was prescribed syrup ibuprofen by a local medical practitioner for unclear reasons. Three days after ibuprofen therapy, the infant developed erythematous, crusting exfoliative lesions predominantly over the face with a few lesions over the lower abdomen. Subsequently, the infant was admitted to Kempegowda Institute of Medical Sciences and Research Center Hospital, Bangalore. A diagnosis of drug-induced exfoliative dermatitis was made after ruling out other causes. Treatment was initiated with intravenous and topical dexamethasone along with saline compressions and amoxicillin + clavulanic acid for secondary bacterial infection as well as topical emollient cream applied over the affected areas. The lesions improved significantly with the above management and the infant recovered enough to be discharged from the hospital after 3 days. The reaction was assessed to be “possible” as per Naranjo and WHO-UMC causality assessment scales, “moderately severe” on modified Hartwig’s severity assessment scale and “not preventable” according to Schumock and Thornton criteria. Severe and serious reactions such as exfoliative dermatitis can be caused by commonly used drugs like ibuprofen.

scholarly journals Pattern of Adverse Cutaneous Drug Reactions (ACDR) to Systemic Drugs

2019 ◽  
Vol 47 (3) ◽  
pp. 32-36
Author(s):  
Abida Sultana ◽  
Mohammed Saiful Islam Bhuiyan ◽  
Md Mostaque Mahmud
Keyword(s):  
Drug Reaction ◽  
Medical Practitioner ◽  
Fixed Drug Eruption ◽  
Drug Induced ◽  
Exfoliative Dermatitis ◽  
Johnson Syndrome ◽  
Acneiform Eruption ◽  
Fixed Drug ◽  
Cutaneous Drug Reactions ◽  
Specific Reactions

Adverse cutaneous drug reaction (ACDR) is a common issue in dermatology practice and it is crucial for every medical practitioner to remain updated of its pattern. It was a hospital based crosssectional observational study, conducted over 130 patients with adverse cutaneous drug reactionin the outpatient department of dermatology of Bangabandhu Sheikh Mujib Medical University (BSMMU). Majority of reaction was developed within one week of taking drug. Fixed drug eruption (FDE) was present in 18.5% cases followed by  maculo-papular, Stevenson-Johnson-Syndrome-Toxic epidermal necrolysis (SJS- TEN), urticaria, urticaria + angioedema, lichenoid drug reaction, erythema multiforme, acneiform eruption, exfoliative dermatitis, pityriasiform, hyperpigmentation, acute generalized exanthematous pustulosis, drug induced hypersensitive syndrome, vasculitis, purpura, photosentivity, psoriasiform and other non-specific reactions. Anti convulsants (26.9%), NSAIDs (20.0%) and anti amtimicrobials (17.7%) are the most common drug group causing adverse cutaneous reaction.  Many of the ACDR caused by anticonvulsants, NSAID and antimicrobials are even life threatening. Bangladesh Med J. 2018 Jan; 47 (3): 32-36

scholarly journals A Challenge for Diagnosing Acute Liver Injury with Concomitant/Sequential Exposure to Multiple Drugs: Can Causality Assessment Scales Be Utilized to Identify the Offending Drug?

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Roxanne Lim ◽  
Hassan Choudry ◽  
Kim Conner ◽  
Wikrom Karnsakul
Keyword(s):  
Liver Injury ◽  
Causality Assessment ◽  
Acute Liver Injury ◽  
Assessment Method ◽  
Medical Sciences ◽  
Cervical Lymphadenitis ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Multiple Drugs ◽  
Assessment Scales

Drug-induced hepatotoxicity most commonly manifests as an acute hepatitis syndrome and remains the leading cause of drug-induced death/mortality and the primary reason for withdrawal of drugs from the pharmaceutical market. We report a case of acute liver injury in a 12-year-old Hispanic boy, who received a series of five antibiotics (amoxicillin, ceftriaxone, vancomycin, ampicillin/sulbactam, and clindamycin) for cervical lymphadenitis/retropharyngeal cellulitis. Histopathology of the liver biopsy specimen revealed acute cholestatic hepatitis. All known causes of acute liver injury were appropriately excluded and (only) drug-induced liver injury was left as a cause of his cholestasis. Liver-specific causality assessment scales such as Council for the International Organization of Medical Sciences/Roussel Uclaf Causality Assessment Method scoring system (CIOMS/RUCAM), Maria and Victorino scale, and Digestive Disease Week-Japan were applied to seek the most likely offending drug. Although clindamycin is the most likely cause by clinical diagnosis, none of causality assessment scales aid in the diagnosis.

An update on HLA alleles as pharmacogenetic markers for antiepileptic drug-induced cutaneous adverse reaction

2019 ◽  
Vol 2 (2) ◽  
pp. 1-17
Author(s):  
Sue-Mian Then ◽  
Azman Ali Raymond
Keyword(s):  
Single Gene ◽  
Hypersensitivity Syndrome ◽  
Allelic Frequency ◽  
Stevens Johnson Syndrome ◽  
Case Control Studies ◽  
Drug Induced ◽  
Hla Alleles ◽  
Exfoliative Dermatitis ◽  
Johnson Syndrome ◽  
Systemic Symptoms

Epilepsy is a common neurological disorder affecting approximately 50 million people worldwide. Antiepileptic drugs (AEDs) are commonly used to treat the disease depending, mainly on the type of seizure. However, the use of AEDs may also lead to cutaneous adverse drug reactions (cADR) such as toxic epidermal necrolysis (TEN), Stevens–Johnson syndrome (SJS), exfoliative dermatitis (ED) and drug‐induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS), which are unwanted comorbidities in epilepsy. It was first discovered that the HLA-B*15:02 allele was strongly associated with carbamazepine (CBZ)-induced SJS/TEN among Han Chinese and this led to the discovery of other HLA alleles and cytochrome P450 (CYP) genes that were significantly associated with various AED-induced cADRs across various populations.  This mini review is an update on the latest findings of the involvement of various HLA alleles and CYP alleles in cADRs caused by CBZ, phenytoin (PHT), oxcarbazepine (OXC) and lamitrogine (LTG) in different case-control studies around the world. From our review, we found that CBZ- and PHT-induced cADRs were more commonly reported than the other AEDs. Therefore, there were more robust pharmacogenetics studies related to these AEDs. OXC- and LTG-induced cADRs were less commonly reported, and so more studies are needed to validate the reported association of the newer reported HLA alleles with these AEDs. It is also important to take into account the allelic frequency within a given population before drawing conclusions about the use of these alleles as genetic markers to prevent AED-induced cADR. Overall, the current body of research point to a combination of alleles as a better pharmacogenetic marker compared to the use of a single gene as a genetic marker for AED-induced cADR.

scholarly journals Chronic suppurative mandibular osteomyelitis presenting as soft tissue swelling and trismus: A case report

2013 ◽  
Vol 2 (2) ◽  
pp. 197-199
Author(s):  
K Ahmad ◽  
S Ansari ◽  
K Dhungel ◽  
MK Gupta ◽  
MF Amanullah ◽  
...  
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Clinical Symptom ◽  
Rare Condition ◽  
Medical Sciences ◽  
Lower Jaw ◽  
Soft Tissue Swelling ◽  
The Face ◽  
Fascial Spaces ◽  
Experience Pain

Osteomyelitis of the mandible is a rare condition and it could be a serious complication of untreated odontogenic infection. Classically, patient with osteomyelitis of the mandible would experience pain and swelling over the affected side of the face. CT is usually indicated when there is extension of the infection into the adjacent soft tissue and fascial spaces which could be the presenting clinical symptom. Hereby, we present a case of mandibular osteomyelitis in an 11 year old girl who presented with pain and swelling in left lower jaw followed by extraction of tooth, diagnosed on CT followed by surgical management. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 197-199  DOI: http://dx.doi.org/10.3126/njms.v2i2.8978  

scholarly journals Scleromyxedema (Arndt - Gottron Syndrome) Developing Under Tenofovir Treatment for Hepatitis B: Unique Presentation in a Bulgarian Patient!

2019 ◽  
Vol 7 (5) ◽  
pp. 782-785 ◽  
Author(s):  
Ivanka Temelkova ◽  
James Patterson ◽  
Georgi Tchernev
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Hepatitis Virus ◽  
Histological Study ◽  
Drug Induced ◽  
Systemic Involvement ◽  
First Case ◽  
The Face ◽  
Hepatitis B Treatment

BACKGROUND: Scleromyxedema, also referred to as the Arndt-Gottron (S-AG) syndrome or the systemic form of Lichen myxedematosus (LM), is a cutaneous mucinosis with a chronic course and high lethality from systemic involvement of other organs and systems. Interesting in several aspects is the association between scleromyxedema and viral hepatitis about: 1) hepatitis virus infection as a possible etiological factor for the development of scleromyxedema, 2) antiretroviral therapy for the treatment of hepatitis as a method of reversing scleromyxedema and 3) antiviral drugs as inducers of scleromyxedema. CASE REPORT: We present a 53-year old patient who for nine months had been on tenofovir disoproxil 245 mg (0-0-1) therapy for chronic hepatitis B. Three months after the start of antiviral therapy (i.e. for a period of 6 months), the patient observed swelling, itching and hardening of the skin on the face, ears and hands, which subsequently spread throughout the trunk. Subsequent histological study of a skin biopsy revealed changes of scleromyxedema at an advanced stage, though immunoelectrophoresis of serum and urine excluded the presence of paraproteinaemia or para proteinuria. Systemic antihistamine and topical corticosteroid therapy were instituted. Bone involvement with possible plasmacytoma was excluded, and a myelogram showed evidence of an erythroblastic reaction of bone marrow. CONCLUSION: We believe that drug-induced scleromyxedema is a rare but possible phenomenon. We describe the first case of tenofovir-induced scleromyxedema within the framework of chronic hepatitis B treatment.

Skin diseases affecting the oro-facial region

2018 ◽  
Author(s):  
Max Robinson ◽  
Keith Hunter ◽  
Michael Pemberton ◽  
Philip Sloan
Keyword(s):  
Skin Diseases ◽  
Systemic Disease ◽  
Lymphatic Vessels ◽  
Medical Practitioner ◽  
Skin Tumours ◽  
Facial Region ◽  
Malignant Skin ◽  
Common Skin ◽  
The Face ◽  
Direct Inoculation

Examination of the face and hands can identify significant skin diseases and also provide clues to the presence of underlying systemic disease. Many patients ignore even malignant skin tumours because they are often painless, subtle in appearance, and may be slow-growing. Dental healthcare professionals should be aware of how to recognize malig­nant skin tumours. If suspicious, but unsure of the nature of the lesion, the patient should be referred to their general medical practitioner for further evaluation. If malignancy is obvious, then an urgent referral to an appropriate specialist (dermatologist, plastic surgeon, or oral and max­illofacial surgeon) should be made using the ‘2-week wait’ (2WW) path­way (Chapter 1). Benign lesions and inflammatory diseases are more common and are important considerations in the differential diagnosis of head and neck skin abnormalities. It is important that the dental healthcare professional should be able to recognize common skin infections involving the oro-facial region. Some infections, such as erysipelas, can mimic cellulitis associated with a dental infection. When infection is diagnosed, it is vital to consider the underlying or predisposing factors, as these may be not only important diagnoses, but also may require treatment to achieve an effective clin­ical outcome. The adage ‘infection is the disease of the diseased’ is a useful reminder when dealing with patients presenting with infection. Direct inoculation of Streptococcus into skin through minor trauma is the most common initiating factor for erysipelas, which occurs in iso­lated cases. Infection involves the upper dermis and, characteristically, spreads to involve the dermal lymphatic vessels. Clinically, the disease starts as a red patch that extends to become a fiery red, tense, and indurated plaque. Erysipelas can be distinguished from cellulitis by its advancing, sharply defined borders and skin streaking due to lymphatic involvement. The infection is most common in children and the elderly, and whilst classically a disease affecting the face, in recent years it has more frequently involved the leg skin of elderly patients. Although a clinical diagnosis can be made without laboratory testing, and treat­ment is antibiotic therapy, when the diagnosis is suspected in dental practice, referral to a medical practitioner is recommended.

scholarly journals Ezetimibe: An Unusual Suspect in Angioedema

2020 ◽  
Vol 2020 ◽  
pp. 1-3 ◽  
Author(s):  
Tiffany Lu ◽  
Tarundeep Grewal
Keyword(s):  
Clinical History ◽  
Prior History ◽  
African American Female ◽  
Drug Induced ◽  
Current Case ◽  
Normal Limits ◽  
Inhibitor Level ◽  
The Face ◽  
History Of ◽  
Esterase Inhibitor

We describe a case of new onset angioedema likely due to Ezetimibe therapy in an elderly patient with a prior history of drug-induced bradykinin reactions who had been on the medication for multiple years. This is the second reported incidence of Ezetimibe-associated angioedema in literature. A 90-year-old African American female presented with angioedema of the face and oral mucosa with associated difficulty speaking developing hours after taking Ezetimibe 10 mg PO. She denied adding any new or unusual foods to her diet. A thorough clinical history determined Ezetimibe was the likely culprit. Ezetimibe was immediately discontinued. The swelling subsided after administration of methylprednisolone 125 mg, epinephrine 1 mg/mL, injection 0.3 mL, diphenhydramine 25 mg, and famotidine 20 mg BID within 48 hours. The patient’s C1 esterase inhibitor level was measured to be within normal limits. Food panel allergy testing showed very low or undetectable IgE levels in all categories. Based on the limited reports in literature and our current case, we conclude that there is a likely association of angioedema with Ezetimibe. The mechanism, however, is unknown since it is not related to bradykinin or mast cell-mediated activation. Clinicians should advise patients taking Ezetimibe to report any swelling of the lips, face, and tongue and to immediately discontinue its use if these signs are present.

scholarly journals STARZ-DRP AS A TRIAGING TOOL FOR COMMUNITY PHARMACISTS: PERSPECTIVES AND EXPECTATIONS OF STAKEHOLDERS

2017 ◽  
Vol 9 (10) ◽  
pp. 81 ◽  
Author(s):  
Nazri Nordin ◽  
Mohamed Azmi Ahmad Hassali ◽  
Azmi Sarriff
Keyword(s):  
Community Pharmacy ◽  
Systematic Approach ◽  
Community Pharmacists ◽  
Medical Practitioner ◽  
Face To Face ◽  
Triage Decision ◽  
The Face ◽  
Almost All ◽  
Ideal Framework ◽  
Systematic Framework

Objective:  To investigate perspectives and expectations of stakeholders of community pharmacists’ (CPs) roles and the use of STARZ-DRP as a structured and systematic framework to help CPs to extend their role to make an accurate triage decision in community pharmacy settings.Methods: Individuals who were in high positions in the Ministry of Health (MOH), pharmacy, medical and consumer associations and individuals who were a private medical practitioner and retail pharmacist were invited via mail to participate in the face to face interview. The interviews were audio-taped and transcribed verbatim to identify themes as many as possible.Results: Eight stakeholders had responded to the invitation. Mean (± standard deviation) age (years) of stakeholders was 56.50 ± 11.82. Five themes were noted which were: (i) CPs are focusing more on business-oriented, (ii) CPs should perform patient-oriented services, (iii) responsibilities to triage customers, (iv) a systematic approach for triaging activities, (v) STARZ-DRP as a systematic approach to making triage decision.Conclusion: CPs are paying particular attention on business-oriented than patient-oriented services. All stakeholders point out that CPs should intensify their current practice and all of them have the same opinion that CPs should take the responsibilities to make an accurate triage decision for self-care customers. Almost all stakeholders agree that STARZ-DRP is an ideal framework to help CPs to make an accurate triage decision in community pharmacy settings. 

scholarly journals Dapsone induced exfoliative dermatitis: A case report

1970 ◽  
Vol 6 (2) ◽  
pp. 64-66 ◽  
Author(s):  
Rajat Roy ◽  
Anil Bhattarai ◽  
Prativa Shrestha ◽  
Upama Paudel ◽  
Sudip Parajuli
Keyword(s):  
Case Report ◽  
Key Words ◽  
Supportive Therapy ◽  
Lower Extremities ◽  
Lepromatous Leprosy ◽  
Medical Sciences ◽  
Exfoliative Dermatitis ◽  
History Of

One 11 year old female attended dermatology OPD of College of Medical Sciences, Bharatpur. She was undergoing treatment with Dapsone for one month for Borderline lepromatous leprosy. There was history of dry scales for 3 weeks over trunk, buttock, face, back and lower extremities suggestive of Exfoliative Dermatitis. The patient was treated with Prednisolone with supportive therapy for one month. Recovery is good. Key words: Dermatology; lepromatous leprosy; exfoliative dermatitis. DOI: 10.3126/jcmsn.v6i2.3621 Journal of college of Medical Sciences-Nepal, 2010, Vol.6, No-2, 64-66

scholarly journals Lacosamide-Induced Dyskinesia in Children With Intractable Epilepsy

2020 ◽  
Vol 35 (10) ◽  
pp. 662-666
Author(s):  
Nadine Madani ◽  
Jennifer A. O’Malley ◽  
Brenda E. Porter ◽  
Fiona M. Baumer
Keyword(s):  
Upper Extremity ◽  
Pediatric Patients ◽  
Focal Epilepsy ◽  
Intractable Epilepsy ◽  
High Dose ◽  
Drug Induced ◽  
Potential Side Effect ◽  
Increased Risk ◽  
The Face ◽  
Dose Dependent

Lacosamide, an antiepileptic drug prescribed for children with refractory focal epilepsy, is generally well tolerated, with dose-dependent adverse effects. We describe 4 children who developed a movement disorder in conjunction with the initiation and/or uptitration of lacosamide. Three patients developed dyskinesias involving the face or upper extremity whereas the fourth had substantial worsening of chronic facial tics. The patients all had histories suggestive of opercular dysfunction: 3 had seizure semiologies including hypersalivation, facial and upper extremity clonus while the fourth underwent resection of polymicrogyria involving the opercula. Onset, severity, and resolution of dyskinesias correlated with lacosamide dosing. These cases suggest that pediatric patients with dysfunction of the opercular cortex are at increased risk for developing drug-induced dyskinesias on high-dose lacosamide therapy. Practitioners should be aware of this potential side effect and consider weaning lacosamide or video electroencephalography (EEG) for differential diagnosis, particularly in pediatric patients with underlying opercular dysfunction.

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