1/123. acitretin and AIDS-related Reiter's disease.A patient with AIDS presented with Reiter's syndrome. arthritis and skin lesions responded poorly to nonsteroidal anti-inflammatory drugs and topical corticosteroid therapy. Dramatic improvement was seen 2 weeks after acitretine was added. When Reiter's syndrome recurred 11 months later despite treatment with highly active anti-retroviral drugs and an undetectable plasmatic viral load, acitretin without NSAID or topical treatment was again administered and was rapidly effective.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/123. Secondary hyperparathyroidism exacerbation: a rare side-effect of interferon-alpha?Recombinant human interferon alpha (alpha IFN) is the only treatment with proven benefit for chronic hepatitis c virus (HCV) infection. Nevertheless its use in some susceptible individuals has led to the development or aggravation of different autoimmune conditions. We report the case of a 20 year old woman on peritoneal dialysis with chronic lobular hepatitis secondary to HCV infection who developed de novo psoriasis 9 months after starting treatment with alpha-IFN. In addition to psoriasis, alpha-IFN prescription was also concurrent with an unexpected and refractory secondary hyperparathyroidism exacerbation initially characterized by a marked reduction of serum calcium levels and a consequential increase of PTH. Both complications disappeared after drug withdrawal. The clinical sequence makes an alpha-IFN-induced autoimmune side effect the most plausible hypothesis. The case is discussed and some possible etiopathogenic factors are briefly reviewed.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
3/123. Systemic toxicity following administration of sirolimus (formerly rapamycin) for psoriasis: association of capillary leak syndrome with apoptosis of lesional lymphocytes.BACKGROUND: sirolimus (formerly rapamycin) is an immunosuppressive agent that interferes with T-cell activation. After 2 individuals with psoriasis developed a capillary leak syndrome following treatment with oral sirolimus lesional skin cells and activated peripheral blood cells were analyzed for induction of apoptosis. OBSERVATIONS: A keratome skin specimen from 1 patient with sirolimus-induced capillary leak syndrome had a 2.3-fold increase in percentage of apoptotic cells (to 48%) compared with an unaffected sirolimus-treated patient with psoriasis (21%). Activated peripheral blood T cells from patients with psoriasis tended to exhibit greater spontaneous or dexamethasone-induced apoptosis than did normal T cells, particularly in the presence of sirolimus. CONCLUSIONS: Severe adverse effects of sirolimus include fever, anemia, and capillary leak syndrome. These symptoms may be the result of drug-induced apoptosis of lesional leukocytes, especially activated T lymphocytes, and possibly release of inflammatory mediators. Because patients with severe psoriasis may develop capillary leak from various systemic therapies, clinical monitoring is advisable for patients with inflammatory diseases who are treated with immune modulators.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
4/123. Fatal bacterial endocarditis following aortic valve replacement in a patient being treated with methotrexate.A 41-year-old man being treated with methotrexate for psoriasis underwent aortic valve replacement. He subsequently developed fulminating bacterial endocarditis. Bacterial endocarditis occurs in 1-2% of cases after prosthetic valve replacement and has a high mortality. The long-term use of methotrexate and similar drugs is increasing in conditions such as psoriasis, rheumatoid arthritis and inflammatory bowel disease. Thus, more patients undergoing heart valve surgery will be taking these preparations for coexisting disease. As methotrexate increases the risk of infection, its perioperative use in these patients requires further evaluation.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
5/123. Coexistence of morphea and psoriasis responding to acitretin treatment.A large number of dermatoses associated with either morphea and psoriasis have been reported. However, to the best of our knowledge there is only one report in the literature about coexistence of morphea and psoriasis. Here we report a case of morphea and psoriasis that improved with acitretin treatment. The concomitant occurrence of these two dermatoses may be explained by immunological factors or trauma. We think that the improvement of the morphea lesions may be due to an immunomodulatory effect of the drug or a decrease in collagen production by dermal fibroblasts due to retinoic acid.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
6/123. Hepatitis from 5-methoxypsoralen occurring in a patient with previous flucloxacillin hepatitis.A 55-year-old woman with psoriasis vulgaris was treated with oral 5-methoxypsoralen and UVA photochemotherapy. After 40 treatments over 3 months she became unwell with hepatitis attributable to the psoralen. Six years earlier she developed cholestatic hepatitis to flucloxacillin. A previous history of drug-induced reactions should be sought before prescribing further drugs with similar adverse effects.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
7/123. Coexistence of epilepsy, myasthenia gravis and psoriasis vulgaris.We report the case of a 36-year-old Chinese man with a history of complex partial seizure of temporal lobe origin since the age of 12 years, superimposed by myasthenia gravis since the age of 27 years and psoriasis vulgaris since the age of 29 years. With an eight-year follow-up, the above three diseases remained without complete remission. Anticonvulsant therapy (phenytoin and trimethadione) caused drug-induced myasthenia gravis, which should gradually disappear after discontinuing the drugs. However, the myasthenic symptoms and serum acetylcholine receptor antibody persisted following the discontinuation of phenytoin in our patient. myasthenia gravis and psoriasis are both autoimmune diseases and correlate with specific human histocompatibility antigens. This suggests a close connection between these two diseases. The coexistence of epilepsy, myasthenia gravis and psoriasis vulgaris has not been previously reported, and to the best of our knowledge, our patient is the first reported case. The relationship among these three diseases requires further investigation.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
8/123. Generalized pustular psoriasis or drug-induced toxic pustuloderma? The use of patch testing.Pustular psoriasis is a rare but serious form of psoriasis. Clinically it may be difficult to differentiate from a pustular drug reaction. We report a case of a generalized pustular eruption triggered by exposure to amoxycillin in a patient with chronic psoriasis. Patch testing to 1% and 5% amoxycillin preparation confirmed a delayed hypersensitivity reaction.- - - - - - - - - - ranking = 2.5keywords = drug (Clic here for more details about this article) |
9/123. Troglitazone improves psoriasis and normalizes models of proliferative skin disease: ligands for peroxisome proliferator-activated receptor-gamma inhibit keratinocyte proliferation.BACKGROUND: psoriasis is often treated with agents that activate nuclear hormone receptors for glucocorticoids, retinoids, and vitamin d. The peroxisome proliferator-activated receptor-gamma (PPARgamma) is a related nuclear hormone receptor that can be activated by its ligands, including the thiazolidinediones. OBJECTIVE: To assess whether treatment with troglitazone, a currently available thiazolidinedione used to treat diabetes mellitus, has an effect on psoriasis in normoglycemic patients and whether ligands for PPARgamma have an effect on models of psoriasis. DESIGN: Open-label administration of troglitazone in patients with psoriasis and evaluation of drug actions in cellular, organ, and transplant models of psoriasis. SETTING: University and community hospital outpatient departments and university laboratories. patients: patients with chronic, stable plaque psoriasis and control subjects. Five patients with psoriasis received troglitazone (none withdrew); 10 different untreated patients and 10 controls provided tissue samples. INTERVENTIONS: Oral troglitazone therapy at various dosages in patients with psoriasis; also, use of troglitazone, ciglitazone, and 15-deoxy-delta-12,14-prostaglandinJ2 in psoriasis models. MAIN OUTCOME MEASURES: Investigator-determined clinical results in patients and cell counts and histological evidence in models. RESULTS: All patients' psoriasis improved substantially during troglitazone therapy. Peroxisome proliferator-activated receptor-gamma was expressed in human keratinocytes; ligands for PPARgamma inhibited the proliferation of normal and psoriatic human keratinocytes in culture. Troglitazone treatment normalized the histological features of psoriatic skin in organ culture and reduced the epidermal hyperplasia of psoriasis in the severe combined immunodeficient mouse and human skin transplant model of psoriasis (P<.05 compared with untreated controls). CONCLUSIONS: Peroxisome proliferator-activated receptor-gamma might be a useful intracellular target for the treatment of psoriasis; further study is needed to assess the clinical value of ligands for PPARgamma, including troglitazone.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
10/123. Rapid improvement of psoriasis vulgaris during drug-induced agranulocytosis.The role of neutrophils in psoriasis has long been discussed. We report a patient with long-standing psoriasis vulgaris who showed rapid improvement during agranulocytosis caused by ticlopidine. The patient did not develop any new psoriatic lesions for several days, although neutrophils increased daily after the administration of ticlopidine was stopped. The day after the peripheral blood neutrophil count recovered, several psoriatic plaques reappeared. The correlation of psoriatic activity with peripheral blood neutrophil counts suggests that a certain number of neutrophils may be required to initiate and maintain psoriasis.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
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