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Drug-induced Photosensitivity

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161. Dermatologic Manifestations of Gastrointestinal Disease (Follow-up)

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

162. Drug Eruptions (Follow-up)

, 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

163. Cutaneous Manifestations of HIV Disease (Follow-up)

, 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

165. Biliary Obstruction (Follow-up)

, 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

166. Berloque Dermatitis (Follow-up)

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

167. Absence Seizures (Follow-up)

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

168. Systemic Lupus Erythematosus (Follow-up)

. [ ] 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

170. Drug Eruptions (Diagnosis)

Author: Jonathan E Blume, MD; Chief Editor: Dirk M Elston, MD Share Email Print Feedback Close Sections Sections Drug Eruptions Overview Practice Essentials Drug eruptions can mimic a wide range of dermatoses. The morphologies are myriad and include morbilliform (see the image below), urticarial, papulosquamous, pustular, and bullous. Medications can also cause pruritus and dysesthesia without an obvious eruption. A drug-induced reaction should be considered in any patient who is taking medications (...) detail. Next: Background Drug eruptions can mimic a wide range of dermatoses. The morphologies are myriad and include morbilliform (most common, see image below), urticarial, papulosquamous, pustular, and bullous. Medications can also cause pruritus and dysesthesia without an obvious eruption. Both calcium channel blockers and interferon are strongly associated with eczematous eruptions. Morbilliform drug eruption. A drug-induced reaction should be considered in any patient who is taking medications

2014 eMedicine.com

171. Dermatomyositis (Diagnosis)

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

172. Dermatomyositis (Diagnosis)

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

173. Dermatologic Manifestations of Gastrointestinal Disease (Diagnosis)

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

174. Cutaneous Manifestations of HIV Disease (Diagnosis)

, 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

175. Berloque Dermatitis (Diagnosis)

, Kim S. Comparative study of skin phototoxicity with three drugs by an in vivo mouse model. J Toxicol Sci . Jan 2010. 35:97-100. . Zhai H, Wilhelm K, Maibach HI. Photoirritation (phototoxicity/phototoxic dermatitis). Dermatotoxicology . 7th ed. Washington, DC: Taylor & Francis; 2008. 209-14, 537-46. Holtz R. REACH 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 (...) , such as aftershave lotion, also may develop berloque dermatitis. Age Berloque dermatitis usually occurs in women, although it can occur in persons of any age who apply fragrances containing oil of bergamot. Previous References Rosenthal O. Berloque dermatitis: Berliner Dermatologische Gesellschaft. Dermatologische Zeitschrift . 1925. 42:295. Freund E. Uber bisher noch nicht bershriebene Kunstlicke hauverfarbungen. Dermatol Wochenschr . 1916. 63:931-3. Elkeeb D, Elkeeb L, Maibach H. Photosensitivity: a current

2014 eMedicine.com

176. Absence Seizures (Diagnosis)

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

177. Fixed Drug Eruptions (Diagnosis)

: 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

178. Porokeratosis (Diagnosis)

) 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

179. Porphyria, Cutaneous (Follow-up)

Imipramine Indomethacin Insulin Labetalol Lithium Methylphenidate Naproxen Narcotics Neostigmine Nitrous oxide Penicillamine Penicillin Phenothiazines Procaine Propranolol Succinylcholine Tetracycline Thyroxine Tubocurarine Many medications induce or worsen acute and cutaneous porphyria. Many of these medications are metabolized, at least to some extent, by the liver. Liver metabolism may induce the cytochrome P-450 enzymes that require heme, thus inducing heme production. Other medications sensitize (...) and cirrhosis. Erythropoietic protoporphyria (EPP) is associated with cholelithiasis in a significant number of cases. Severe liver disease may develop as a result of periportal fibrosis and cirrhosis, leading to death in 20% of cases. Rapidly progressive liver failure associated with accelerating photosensitivity and cholestasis can occur and is accompanied by abdominal pain, splenomegaly, and hemolysis. Previous Next: Prognosis CEP is associated with a significantly decreased lifespan, whereas the other

2014 eMedicine Pediatrics

180. Systemic Lupus Erythematosus (Diagnosis)

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 Emergency Medicine

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