Pemphigus foliaceus: an adverse reaction to lisinopril

Lisinopril is an angiotensin converting enzyme inhibitor used in the treatment of cardiovascular disease. We report a case of pemphigus foliaceus in a 66-year-old male treated with lisinopril for hypertension and a previous myocardial infarction. The drug-induced variant of pemphigus is caused by a wide variety of drugs and is most frequently associated with captopril and penicillamine. It has not previously been reported in this commonly used drug.     

Cutaneous adverse reaction to Bio-Alcamid implant

In the last years new and numerous materials for the correction of defects and wrinkles have been developed. One of these materials is Bio-Alcamid, a non reabsorbable gel polymer constituted by meshes of poly-alkyl-imide, without known adverse effects. We report a 34-year-old woman that had Bio-Alcamid implants for acne scars and several months after presented nodular lesions together with a painful inflammatory nodule. The nodule was drained and culture of the purulent material yielded Streptococcus viridans. A cytology and a cellular block of that material showed a granulomatous inflammatory reaction together with a foreign body. The different types of reactions to implants and their pathogenic mechanism are discussed. It is important to know these possible reactions to filler materials given their increasing use and the potential medico-legal consequences.     

Delayed adverse reaction to sodium ioxaglic acid-meglumine

A patient had a maculopapular rash, fever, hepatic cytolysis, rhabdomyolysis, eosinophilia and raised total IgEs after coronarography with ioxaglic acid-meglumine (Hexabrix). Intradermal test to ioxaglic acid-meglumine was positive 48 hrs later. Histological examination revealed perivascular lymphocytic infiltration, with predominantly CD45Ro+ and CD8+ T cells and apoptotic basal keratinocytes. This case documents a late hypersensitivity reaction to ioxaglic acid-meglumine.     

A peculiar adverse reaction to blue pigment tattoo

The practice of tattooing dates back to 5000 years ago and is currently constantly growing. The most common pigment associated with tattoo complications is the red one. Another pigment, which could be associated with adverse reactions, even if less frequently than red, is blue. Traditionally, blue pigment contains cobalt, which causes allergic reactions. Here, we report a case of blue pigment granulomatous reaction in a 37‐year‐old male patient.     

Severe adverse cutaneous reaction to insulin due to cresol sensitivity

We present the case of an 80-year-old lady known to be sensitive to chlorocresol (4-chloro-3-methyl phenol) who developed severe erythrodermic exfoliative dermatitis with atypical features 2 weeks after commencing subcutaneous insulin. All medications except insulin were stopped, without major improvement. It was noted that the insulin contained m-cresol (m-methyl phenol) so a parabens-based insulin was substituted. There was a significant improvement in her clinical condition within 72 hr. Further patch and intradermal testing to the insulin and m-cresol was planned, but she developed a nosocomial infection and died. We hypothesize that the adverse cutaneous reaction was a systemic manifestation of cresol sensitivity, given the rapid clinical resolution on changing insulins and the previously demonstrated sensitivity to chlorocresol, particularly as cross-reactivity between different low molecular weight methyl phenols is documented. Local injection site reactions and systemic side-effects including nausea, diarrhoea and vomiting have previously been reported with cresol-containing insulins, although to our knowledge, this is the first reported case of a severe cutaneous reaction. It is important to be aware of m-cresol as a potential allergen, as it is contained in most commercially available insulins.     

Photo recall phenomenon: an adverse reaction to taxanes

Taxanes are a new group of chemotherapeutic agents, which share some pharmacological characteristics with methotrexate. Methotrexate has previously been reported to cause a photo recall phenomenon which develops 3-5 days after UV radiation, suggesting that taxanes can induce a similar reaction. This should be added to the list of cutaneous side-effects of this class of chemotherapeutic agents. We report a case of photo recall phenomenon in a 55-year-old Chinese woman with metastatic breast cancer who was undergoing chemotherapy with taxanes.     

Palmoplantar keratoderma: an adverse reaction to influenza vaccination

Acquired palmoplantar keratoderma (PPK) is a rare group of conditions with a number of aetiologies, including adverse reactions to drugs. Herein, we report a case of acquired PPK in association with influenza vaccination, confirmed by rechallenge.     

Sensitization to acrylates is a common adverse reaction to artificial fingernails

BACKGROUND: Although precise figures for adverse reactions to nail-care products are not available, it is thought that one of the main risks from artificial nails (ANs) is contact allergy. OBJECTIVE: To evaluate the role of allergic contact dermatitis (ACD) as a cause of adverse reactions related to the use of ANs. METHOD: A 4-year retrospective study of patients with suspected ACD from ANs was conducted. Patients tested with the methacrylate artificial nail (MAAN) series were evaluated clinically and patch test results were analysed. RESULTS: ACD to components of ANs may be a frequent cause of hand eczema, as observed in more than one-third of our patients (38.2%). About half of the patients were beauticians specializing in nail sculpturing who developed occupationally related ACD. All patients had involvement of the hands and fingers. Paronychia, nail dystrophy and onycholysis were less frequent. Dorsal hands and fingers, forearms and distant sites (face and neck) were more frequently affected in patients with occupational ACD (OACD). Typical clinical features were those of chronic dermatitis but atypical forms such as lichenoid and psoriasiform ACD were also observed. Mucosal erythema and oedema developed in two patients with ACD due to MAAN, after application of dental crowns with an acrylate-based cement. The most frequent allergens triggering ACD were 2-hydroxyethyl methacrylate (2-HEMA) and 2-hydroxypropyl methacrylate (2-HPMA) (17.5% each), followed by ethyleneglycol dimethacrylate (EGDM; 13.4%). A quarter of the patients tested with ethyl cyanoacrylate (ECA), a component of nail glue, had positive results. CONCLUSIONS: Acrylic monomers used when sculpturing ANs are important contact and occupational sensitizers that can produce cross-reactions with other acrylic compounds and trigger allergic reactions when re-exposure occurs in a different setting.     

108例化妆品皮肤不良反应的临床分析

对108例化妆品皮肤不良反应进行临床分析，并对部分患者做了可疑致病化妆品斑贴试验。结果表明，中轻年女性患者居多；临床表现主要为接触性皮炎（96．3％）；大部分是由一般化妆品引起，其次为祛斑增白类化妆品。14例做了可疑化妆品斑贴试验，有6例阳性。     

Delayed eczematous skin reaction as an adverse drug reaction to immunoglobulin infusions: A case series

BackgroundPompholyx and eczematous reactions are known adverse reactions to intravenous immunoglobulins (IVIg) infusion, but little is known about their clinical characteristics, associated outcomes and management.ObjectiveTo describe IVIg-induced eczematous skin reactions.MethodsWe conducted a retrospective study on cases of delayed skin reactions post-IVIg infusion notified to the French Regional Pharmacovigilance Centre from 1985 to 2020.ResultsA total of 27 patients were identified, of whom 85% were male. IVIg infusions were given in a neurological indication in 82% of cases. Eczematous skin reactions occurred in two-thirds of cases after the first infusion, with a median time to onset of 11 days. Palmoplantar pompholyx was the most common presentation, being seen in 63% of patients. Other eruptions were erythemato-squamous or maculopapular. Eight patients were classified as severely affected and developed extensive lesions (> 50% BSA). One third of the 27 patients required hospitalization. All of the severe eczematous reactions involved males receiving high doses of IVIg for neurological diseases. Biopsies of severe cases revealed a common non-specific eczematous pattern. Relapses were frequent and more severe than the initial reaction. Reintroduction of the same IVIg product consistently resulted in relapse, whereas switching IVIg type produced relapse in only 53% of patients.ConclusionWe present the largest retrospective study of delayed skin reactions after IVIg infusions. This side-effect may be severe and have a polymorphic presentation. Relapse occurs frequently but less consistently after IVIg switch.     

Patch tests in adverse cutaneous drug reaction

Twenty-one patients with history of adverse cutaneous drug reaction were patch tested with 23 commonly used drugs in 5% concentration in petrolatum. Nine patients (42.85%) tested were positive to the incriminated drugs while 3 (14.28%) showed positive reactions to other drugs. Highest positivity (50%) was seen in maculo-popular cases while Stevens-Johnson syndrome and exfoliative dermatitis patients showed negative results.