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Drug-induced Photosensitivity

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121. Oral Manifestations of Systemic Diseases (Diagnosis)

, purpura, paraneoplastic pemphigus, Sweet syndrome) or therapy-induced lesions (eg, drug reactions, graft vs host disease). [ , ] Oral manifestations are more common in acute leukemias than in chronic leukemias. [ ] Gingival hypertrophy and hyperplasia are most commonly associated with acute myelogenous leukemia and acute promyelocytic leukemia. [ ] The gingiva are friable, edematous, and erythematous. [ , ] Thrombocytopenia commonly manifests as petechiae and ecchymoses on the mucosal surfaces (...) phenotype and severity of symptoms vary greatly and include nonimmune hydrops fetalis in utero, scarring and deformities, hemolytic anemia, corneal scarring, and blindness. Cutaneous manifestations include severe photosensitivity with blistering hypertrichosis. [ ] In the oral cavity, erythrodontia, a red-brown discoloration of the teeth, is pathognomonic for congenital erythropoietic porphyria. [ , ] Teeth appear bright red with exposure to UV fluorescence. [ ] It has been proposed that erythrodontia

2014 eMedicine.com

122. Pseudoporphyria (Diagnosis)

other authors have corroborated these findings. Other mechanisms have been proposed to explain the role of ultraviolet or visible light radiation in drug-induced pseudoporphyria. An alternative theory is based on the finding that exogenous photosensitizers are deposited along the endothelium of blood vessels of lesional and nonlesional skin. An immune response targeted against antigens is proposed to develop after phototoxic injury to the dermal microvascular endothelium. Dabski and Beutner proposed (...) . . Stenberg A. Pseudoporphyria and sunbeds. Acta Derm Venereol . 1990. 70(4):354-6. . Wilson CL, Mendelsohn SS. Pseudoporphyria and sunbeds, a coincidence in identical twins?. Br J Dermatol . 1991 Aug. 125(2):191. . Quaiser S, Khan R, Khan AS. Drug induced pseudoporphyria in CKD: A case report. Indian J Nephrol . 2015 Sep-Oct. 25 (5):307-9. . Keane JT, Pearson RW, Malkinson FD. Nalidixic acid-induced photosensitivity in mice: a model for pseudoporphyria. J Invest Dermatol . 1984 Mar. 82(3):210-3. . Dabski

2014 eMedicine.com

123. Pseudoporphyria (Overview)

other authors have corroborated these findings. Other mechanisms have been proposed to explain the role of ultraviolet or visible light radiation in drug-induced pseudoporphyria. An alternative theory is based on the finding that exogenous photosensitizers are deposited along the endothelium of blood vessels of lesional and nonlesional skin. An immune response targeted against antigens is proposed to develop after phototoxic injury to the dermal microvascular endothelium. Dabski and Beutner proposed (...) . . Stenberg A. Pseudoporphyria and sunbeds. Acta Derm Venereol . 1990. 70(4):354-6. . Wilson CL, Mendelsohn SS. Pseudoporphyria and sunbeds, a coincidence in identical twins?. Br J Dermatol . 1991 Aug. 125(2):191. . Quaiser S, Khan R, Khan AS. Drug induced pseudoporphyria in CKD: A case report. Indian J Nephrol . 2015 Sep-Oct. 25 (5):307-9. . Keane JT, Pearson RW, Malkinson FD. Nalidixic acid-induced photosensitivity in mice: a model for pseudoporphyria. J Invest Dermatol . 1984 Mar. 82(3):210-3. . Dabski

2014 eMedicine.com

124. Morphea (Overview)

infection and morphea based on serologic or polymerase chain reaction data. [ , , ] Vaccination: Morphealike lesions have also been reported to occur following vaccinations, including BCG, tetanus, and mumps-measles-rubella vaccinations. Whether the vaccinations themselves or the trauma from the injections was the inciting event is not clear. Drug-induced morphea: This is only rarely reported (ie, from bisoprolol, bleomycin, D-penicillamine, L-5-hydroxytryptophane, balicatib). [ , ] Trauma: Some morphea (...) , Schmitt A, Pfaltz M, Kempf W. Borrelia in granuloma annulare, morphea and lichen sclerosus: a PCR-based study and review of the literature. J Cutan Pathol . 2010 May. 37(5):571-7. . Peroni A, Zini A, Braga V, Colato C, Adami S, Girolomoni G. Drug-induced morphea: report of a case induced by balicatib and review of the literature. J Am Acad Dermatol . 2008 Jul. 59(1):125-9. . Hanami Y, Ohtsuka M, Yamamoto T. Paraneoplastic eosinophilic fasciitis with generalized morphea and vitiligo in a patient

2014 eMedicine.com

125. Cutaneous Manifestations of HIV Disease (Overview)

, an HIV-1 protease inhibitor. Previous Next: Photosensitivity and Drug-Induced Pigmentation A study by Vin-Christian et al found that photosensitivity in HIV-infected patients appears to be a manifestation of advanced disease. [ ] Most of the patients in that study were sensitive to ultraviolet B (UV-B) light; however, the patients who were most severely affected were sensitive to both UV-B and UV-A light. [ ] Photo-induced lichenoid drug reactions may occur in HIV-infected patients, particularly (...) those with dark skin. In addition, HIV-infected patients may experience drug-induced pigmentation of skin exposed to light. Previous Next: Miscellaneous Dermatologic Disorders The following dermatologic conditions may be associated with HIV disease: HIV-related CD8+ cutaneous pseudolymphoma: This is an inflammatory process that results from a massive infiltration of the skin by activated, oligoclonal, HIV-specific, cytotoxic T lymphocytes and is most often seen in those that are markedly

2014 eMedicine.com

126. Cutaneous Manifestations of HIV Disease (Treatment)

, an HIV-1 protease inhibitor. Previous Next: Photosensitivity and Drug-Induced Pigmentation A study by Vin-Christian et al found that photosensitivity in HIV-infected patients appears to be a manifestation of advanced disease. [ ] Most of the patients in that study were sensitive to ultraviolet B (UV-B) light; however, the patients who were most severely affected were sensitive to both UV-B and UV-A light. [ ] Photo-induced lichenoid drug reactions may occur in HIV-infected patients, particularly (...) those with dark skin. In addition, HIV-infected patients may experience drug-induced pigmentation of skin exposed to light. Previous Next: Miscellaneous Dermatologic Disorders The following dermatologic conditions may be associated with HIV disease: HIV-related CD8+ cutaneous pseudolymphoma: This is an inflammatory process that results from a massive infiltration of the skin by activated, oligoclonal, HIV-specific, cytotoxic T lymphocytes and is most often seen in those that are markedly

2014 eMedicine.com

127. Systemic Lupus Erythematosus (Overview)

in women, frequently starting at childbearing age. See the image below. Photosensitive systemic lupus erythematosus (SLE) rashes typically occur on the face or extremities, which are sun-exposed regions. Although the interphalangeal spaces are affected, the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are spared. Photo courtesy of Dr. Erik Stratman, Marshfield Clinic. See , a Critical Images slideshow, to help recognize cutaneous manifestations (...) [ ] : Constitutional (eg, fatigue, fever, arthralgia, weight changes) Musculoskeletal (eg, arthralgia, arthropathy, myalgia, frank arthritis, avascular necrosis) Dermatologic (eg, malar rash, photosensitivity, discoid lupus) Renal (eg, acute or chronic renal failure, acute nephritic disease) Neuropsychiatric (eg, seizure, psychosis) Pulmonary (eg, pleurisy, pleural effusion, pneumonitis, pulmonary hypertension, interstitial lung disease) Gastrointestinal (eg, nausea, dyspepsia, abdominal pain) Cardiac (eg

2014 eMedicine.com

128. Absence Seizures (Treatment)

by carbamazepine. N Engl J Med . 1985 Oct 10. 313(15):916-21. . Liu L, Zheng T, Morris MJ, Wallengren C, Clarke AL, Reid CA, et al. The mechanism of carbamazepine aggravation of absence seizures. J Pharmacol Exp Ther . 2006 Nov. 319(2):790-8. . Vendrame M, Khurana DS, Cruz M, Melvin J, Valencia I, Legido A, et al. Aggravation of seizures and/or EEG features in children treated with oxcarbazepine monotherapy. Epilepsia . 2007 Nov. 48(11):2116-20. . Guerrini R, Belmonte A, Genton P. Antiepileptic drug-induced (...) , with the faster frequencies seen in syndromes with older age of onset. Bursts of generalized polyspikes and waves (multiple spike-and-slow-wave complexes) may also be seen, [ ] especially during sleep and in syndromes with older age of onset. The onset and ending of these seizures are abrupt; no postictal EEG slowing is noted. Hyperventilation often provokes these seizures and should be a routine part of all EEGs in children. Photosensitivity may be present in idiopathic generalized epilepsies and is more

2014 eMedicine.com

129. Dermatologic Manifestations of Gastrointestinal Disease (Treatment)

uroporphyrinogen decarboxylase (UROD), the fifth enzyme in the heme biosynthetic pathway. Cutaneous findings are characterized by skin photosensitivity with increased skin fragility, facial hypertrichosis, blisters, scarring with milia formation, and skin hyperpigmentation on the hands and other sun-exposed areas. Porphyria cutanea tarda results from the decreased activity of the enzyme uroporphyrinogen decarboxylase (UROD), the fifth enzyme in the heme biosynthetic pathway. The disease can be either sporadic

2014 eMedicine.com

130. Drug Eruptions (Treatment)

, Quatresooz P. Novel treatments for drug-induced toxic epidermal necrolysis (Lyell's syndrome). Int Arch Allergy Immunol . 2005 Mar. 136(3):205-16. . Iannini P, Mandell L, Felmingham J, Patou G, Tillotson GS. Adverse cutaneous reactions and drugs: a focus on antimicrobials. J Chemother . 2006 Apr. 18(2):127-39. . Coopman SA, Johnson RA, Platt R, Stern RS. Cutaneous disease and drug reactions in HIV infection. N Engl J Med . 1993 Jun 10. 328(23):1670-4. . Taddio A, Lee CM, Parvez B, Koren G, Shah V (...) ): . Ellgehausen P, Elsner P, Burg G. Drug-induced lichen planus. Clin Dermatol . 1998 May-Jun. 16(3):325-32. . Camilleri M, Pace JL. Drug-induced linear immunoglobulin-A bullous dermatosis. Clin Dermatol . 1998 May-Jun. 16(3):389-91. . Antonov D, Kazandjieva J, Etugov D, Gospodinov D, Tsankov N. Drug-induced lupus erythematosus. Clin Dermatol . 2004 Mar-Apr. 22(2):157-66. . Brenner S, Bialy-Golan A, Ruocco V. Drug-induced pemphigus. Clin Dermatol . 1998 May-Jun. 16(3):393-7. . Brauchli YB, Jick SS, Curtin F

2014 eMedicine.com

132. Biliary Obstruction (Treatment)

, Kasper DL, et al, eds. Harrison's Principles of Internal Medicine . 14th ed. New York: McGraw-Hill; 1998. 249-55. Kasiske BL, Keane WF. Laboratory assessment of renal disease: clearance, urinalysis, and renal biopsy. Brenner BM, ed. Brenner and Rector's The Kidney . 6th ed. WB Saunders; 2000. 1143. Kok KY, Yapp SK. Tuberculosis of the bile duct: a rare cause of obstructive jaundice. J Clin Gastroenterol . 1999 Sep. 29(2):161-4. . Lewis JH. Drug-induced liver disease. Med Clin North Am . 2000 Sep. 84 (...) to have good results in the palliative treatment of advanced biliary tract malignancies, particularly when used in conjunction with a biliary stenting procedure. [ , ] PDT produces localized tissue necrosis by applying a photosensitizing agent, which preferentially accumulates in the tumor tissue, and then exposing the area to laser light, which activates the medication and results in destruction of tumor cells. Endoscopic biliary stenting is considered first-line treatment for unresectable malignant

2014 eMedicine.com

133. Berloque Dermatitis (Treatment)

and In Vitro Alternatives: Phototoxicity Testing. Cosmet Toilet . 2008 May. 123:61-3. Onoue S, Seto Y, Gandy G, Yamada S. Drug-induced phototoxicity; an early in vitro identification of phototoxic potential of new drug entities in drug discovery and development. Curr Drug Saf . 2009 May. 4(2):123-36. . Onoue S, Seto Y, Oishi A, Yamada S. Novel methodology for predicting photogenotoxic risk of pharmaceutical substances based on reactive oxygen species (ROS) and DNA-binding assay. J Pharm Sci . 2009 Oct. 98 (...) :295. Freund E. Uber bisher noch nicht bershriebene Kunstlicke hauverfarbungen. Dermatol Wochenschr . 1916. 63:931-3. Elkeeb D, Elkeeb L, Maibach H. Photosensitivity: a current biological overview. Cutan Ocul Toxicol . 2012 Feb 17. . Marzulli FN, Maibach HI. Perfume phototoxicity. J Soc Cosmetic Chem . 1970. 21:695-715. Kavli G, Raa J, Johnson BE, Volden G, Haugsbø S. Furocoumarins of Heracleum laciniatum: isolation, phototoxicity, absorption and action spectra studies. Contact Dermatitis . 1983

2014 eMedicine.com

134. Paraneoplastic Diseases (Treatment)

of hyperkeratosis and papillomatosis of the epidermis. Acanthosis is seldom present, and hyperpigmentation is related to hyperkeratosis, not melanin deposition; therefore, the condition is misnamed. Not all patients with AN have a paraneoplastic syndrome. Familial AN, drug-induced AN, AN occurring in hyperinsulinemic states (eg, diabetes, obesity), AN associated with polycystic ovary disease, and AN associated with a spectrum of autoimmune disease in women should be considered before AN is determined (...) are far more common than malignant associations, should be excluded first. Thus, the diagnosis of paraneoplastic AI becomes a diagnosis of exclusion. The differential diagnosis of AI includes xerosis or asteatotic eczema. Some drugs, including lansoprazole, niacin, retinoids, and the statin class of lipid-lowering drugs, cause clinically significant, generalized xerosis. As a paraneoplastic syndrome, AI is often impossible to distinguish from drug-induced ichthyosis; thus, the patient's history

2014 eMedicine.com

135. Oral Manifestations of Systemic Diseases (Treatment)

, purpura, paraneoplastic pemphigus, Sweet syndrome) or therapy-induced lesions (eg, drug reactions, graft vs host disease). [ , ] Oral manifestations are more common in acute leukemias than in chronic leukemias. [ ] Gingival hypertrophy and hyperplasia are most commonly associated with acute myelogenous leukemia and acute promyelocytic leukemia. [ ] The gingiva are friable, edematous, and erythematous. [ , ] Thrombocytopenia commonly manifests as petechiae and ecchymoses on the mucosal surfaces (...) phenotype and severity of symptoms vary greatly and include nonimmune hydrops fetalis in utero, scarring and deformities, hemolytic anemia, corneal scarring, and blindness. Cutaneous manifestations include severe photosensitivity with blistering hypertrichosis. [ ] In the oral cavity, erythrodontia, a red-brown discoloration of the teeth, is pathognomonic for congenital erythropoietic porphyria. [ , ] Teeth appear bright red with exposure to UV fluorescence. [ ] It has been proposed that erythrodontia

2014 eMedicine.com

136. Pseudoporphyria (Treatment)

JT, Pearson RW, Malkinson FD. Nalidixic acid-induced photosensitivity in mice: a model for pseudoporphyria. J Invest Dermatol . 1984 Mar. 82(3):210-3. . Dabski C, Beutner EH. Studies of laminin and type IV collagen in blisters of porphyria cutanea tarda and drug-induced pseudoporphyria. J Am Acad Dermatol . 1991 Jul. 25(1 Pt 1):28-32. . Markova A, Lester J, Wang J, Robinson-Bostom L. Diagnosis of common dermopathies in dialysis patients: a review and update. Semin Dial . 2012 Jul. 25(4):408-18 (...) are resistant to wavelengths known to induce porphyric eruptions (400-440 nm). [ ] Resolution of the clinical findings may take many months, particularly in drug-induced pseudoporphyria. In addition to discontinuation of causative agents, some substances have been used in the treatment of pseudoporphyria. N -acetylcysteine (a glutathione precursor) has been reported to improve both dialyzed and nondialyzed forms of chronic renal disease associated pseudoporphyria. [ , , , , , ] Proponents of this therapy

2014 eMedicine.com

137. Morphea (Treatment)

, Adami S, Girolomoni G. Drug-induced morphea: report of a case induced by balicatib and review of the literature. J Am Acad Dermatol . 2008 Jul. 59(1):125-9. . Hanami Y, Ohtsuka M, Yamamoto T. Paraneoplastic eosinophilic fasciitis with generalized morphea and vitiligo in a patient working with organic solvents. J Dermatol . 2015 Oct 28. . Alimova E, Farhi D, Plantier F, Carlotti A, Gorin I, Mouthon L. Morphoea (localized scleroderma): baseline body surface involvement and antinuclear antibody may (...) A, Gambichler T, Avermaete A, et al. Combined treatment with calcipotriol ointment and low-dose ultraviolet A1 phototherapy in childhood morphea. Pediatr Dermatol . 2001 May-Jun. 18(3):241-5. . Ozdemir M, Engin B, Toy H, Mevlitoglu I. Treatment of plaque-type localized scleroderma with retinoic acid and ultraviolet A plus the photosensitizer psoralen: a case series. J Eur Acad Dermatol Venereol . 2008 Apr. 22(4):519-21. . Sapadin AN, Fleischmajer R. Treatment of scleroderma. Arch Dermatol . 2002 Jan. 138(1

2014 eMedicine.com

138. Nevi of Ota and Ito (Treatment)

Elongation of rete ridges; basal layer hyperpigmentation; slight increase of melanocyte number along basal layer Phytophotodermatitis Acquired; exposure to certain plants or cosmetics Gray-to-brown macules and patches Photodistribution, according to sites of contact with photosensitizer Dermal melanophages Drug-induced hyperpigmentation Acquired; following drug exposure (eg, minocycline, amiodarone, gold) Variable according to offending drugs Variable according to specific offending drugs Variable

2014 eMedicine.com

139. Neurosyphilis (Treatment)

that became known as the great imitator. Early treatments, in the age of modern management, included prescription mercury, iodides, guaiacum, or arsenicals with bismuth (1909); suspension therapy; and fever therapy induced from malaria. [ ] The malariotherapy (fever therapy), ironically, was heralded as a revolutionary breakthrough, despite itself being a fatal disease. This was widely adopted treatment until the introduction of penicillin (PCN) in the 1950s; even then, the malariotherapy was thought

2014 eMedicine.com

140. Paraneoplastic Diseases (Overview)

of hyperkeratosis and papillomatosis of the epidermis. Acanthosis is seldom present, and hyperpigmentation is related to hyperkeratosis, not melanin deposition; therefore, the condition is misnamed. Not all patients with AN have a paraneoplastic syndrome. Familial AN, drug-induced AN, AN occurring in hyperinsulinemic states (eg, diabetes, obesity), AN associated with polycystic ovary disease, and AN associated with a spectrum of autoimmune disease in women should be considered before AN is determined (...) are far more common than malignant associations, should be excluded first. Thus, the diagnosis of paraneoplastic AI becomes a diagnosis of exclusion. The differential diagnosis of AI includes xerosis or asteatotic eczema. Some drugs, including lansoprazole, niacin, retinoids, and the statin class of lipid-lowering drugs, cause clinically significant, generalized xerosis. As a paraneoplastic syndrome, AI is often impossible to distinguish from drug-induced ichthyosis; thus, the patient's history

2014 eMedicine.com

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