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Drug-induced Photosensitivity

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141. 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

142. 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

144. 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

145. 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

146. 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

147. 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

148. 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

149. 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

150. 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

151. 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

152. 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

153. Porokeratosis (Overview)

) porokeratosis Sun exposure and/or artificial ultraviolet radiation exposure in a patient who is genetically predisposed causes disseminated superficial actinic porokeratosis (DSAP). Exacerbations have been reported following prolonged sun exposure, repeated tanning bed exposure, electron beam radiation therapy, and therapeutic phototherapy or photochemotherapy for psoriasis. Drug-induced photosensitivity may play a role. Protection from ultraviolet radiation may lead to spontaneous resolution. Additionally

2014 eMedicine.com

154. Neurosyphilis (Overview)

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

155. Nevi of Ota and Ito (Overview)

or plaques Photodistribution, especially on face 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

2014 eMedicine.com

156. Systemic Lupus Erythematosus (Treatment)

. [ ] Patients with class III or IV disease, as well as those with a combination of class V and class III or IV disease, generally undergo aggressive therapy with glucocorticoid drugs and immunosuppressants. [ ] Immunosuppressive therapy consists of induction and maintenance therapy. Induction therapy involves potent immunosuppressive drugs (eg, mycophenolate mofetil, cyclophosphamide) to achieve remission; these drugs are generally used for 3 months to 1 year, with an average of 6 months’ treatment having (...) endothelial function, which may reduce cardiovascular disease. [ , , ] No diet-based treatment of SLE has been proven effective. Patients with SLE should be reminded that activity may need to be modified as tolerated. Specifically, stress and physical illness may precipitate SLE flares. Additionally, persons with SLE should wear sunscreen and protective clothing or avoid sun exposure to limit photosensitive rash or disease flares. Consultations The multisystemic nature of SLE often requires involvement

2014 eMedicine.com

157. Oral Manifestations of Systemic Diseases (Overview)

, 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

158. Lupus Erythematosus, Subacute Cutaneous (Overview)

of complement (C2d), or it may be drug-induced. SCLE is the most common subtype of CLE associated with Sjögren syndrome. [ ] Some patients with SCLE may also have (ACLE), if they have concomitant SLE, or the lesions of (DLE), and some may develop small-vessel vasculitis. (See the image below.) Early lesions of subacute cutaneous lupus erythematosus may simulate polymorphous light eruption. See , a Critical Images slideshow, to help recognize cutaneous manifestations of rheumatologic diseases. Patients (...) , Bahrami S, Callen JP. Golimumab-exacerbated subacute cutaneous lupus erythematosus. Arch Dermatol . 2012 Oct. 148(10):1186-90. . Lowe G, Henderson CL, Grau RH, Hansen CB, Sontheimer RD. A systematic review of drug-induced subacute cutaneous lupus erythematosus. Br J Dermatol . 2011 Mar. 164(3):465-72. . Durosaro O, Davis MD, Reed KB, Rohlinger AL. Incidence of cutaneous lupus erythematosus, 1965-2005: a population-based study. Arch Dermatol . 2009 Mar. 145 (3):249-53. . Durosaro O, Davis MD, Reed KB

2014 eMedicine.com

159. Fixed Drug Eruptions (Overview)

: Jun 07, 2018 Author: David F Butler, MD; Chief Editor: Dirk M Elston, MD Share Email Print Feedback Close Sections Sections Fixed Drug Eruptions Overview Background Adverse reactions to medications are common and often manifest as a cutaneous eruption. Drug-induced cutaneous disorders frequently display a characteristic clinical morphology such as morbilliform exanthem, urticaria, hypersensitivity syndrome, pseudolymphoma, photosensitivity, pigmentary changes, acute generalized exanthematous

2014 eMedicine.com

160. Dermatomyositis (Overview)

to cytoplasmic antigens (ie, antitransfer RNA synthetases) may be present. Although their presence may help to define subtypes of dermatomyositis and polymyositis, their role in pathogenesis is uncertain. Infectious agents have been suggested as possible triggers of dermatomyositis. These include the following: Viruses (eg, , , , [HTLV-1], ) species Borrelia species Cases of drug-induced dermatomyositis have been reported. Dermatomyositis-like skin changes have been reported with hydroxyurea in patients (...) . Diagnosis Examination for cutaneous dermatomyositis may reveal the following findings: Characteristic, possibly pathognomonic cutaneous features: Heliotrope, Gottron papules Characteristic but not pathognomonic features: Malar erythema, violaceous erythema or poikiloderma in a photosensitive distribution, violaceous erythema on the extensor surfaces, and periungual and cuticular changes Violaceous erythema or poikiloderma involving the anterior chest is referred to as the “V-neck sign” whereas

2014 eMedicine.com

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