Cutaneous manifestations

Bauer M, Rabens SF. 1974. Cutaneous manifestations of trichloroethylene toxicity. Arch Dermatol 110 886-890. 

Goh CL, Ng SK. 1988. A cutaneous manifestation of trichloroethylene toxicity. Contact Dermatitis 18 59-61. 

Atopic dermatitis has been proposed to be the cutaneous manifestation of IgE-mediated hypersensitive reaction to allergenic substances [29]. Conceptually, antagonizing IgE emerges as a logical therapeutic option. Systemic treatment with omalizumab, however, appears to be less efficacious in the skin than in the airway mucosa [23]. It is possible that small molecule Syk inhibitors may offer a more suitable mode to reach and prevent activation of sensitized dermal mast cells and dendritic cells. 

The hydroxamic acid class is probably the most widely explored class of HDACis and indeed, since the discovery of Trichostatin A (9), significant progress has been made culminating with the approval of vorinostat (2) for the treatment cutaneous manifestations of advanced CTCL that has relapsed or progressed on or following two or more systemic therapies. Multiple other compounds from this class are now being explored in man. The following section tries to capture all the key developments of this class of HDACi, nevertheless several excellent reviews can be consulted for further details [17]. 

Vorinostat (Zolinza) [Histone Deacetylase Inhibitor] Uses Rx cutaneous manifestations in cutaneous T-cell lymphoma Action Histone deacetylase inhibitor Dose 400 mg PO daily w/ food if intolerant X 300 mg PO d for X 5 d each wk Caution [D /-] w/ warfarin (t INR) Disp Caps SE NA /D, dehydration, fatigue, anorexia, dysgeusia, DVT, PE, Xplt, anemia, hypoglycemia, QT prolongation Interactions t Risk of thrombocytopenia GI bleed W/HDAC inhibitors (valproic acid) EMS May t QT interval, monitor ECG may t glucose T risk of DVT has been r orted OD Sxs unknown... 

Thalidomide is approved for use in the United States for the treatment of cutaneous manifestations of erythema nodosum leprosum, a potentially life-threatening systemic vasculitis that occurs in some patients with leprosy. Although not approved for other indications, thalidomide has also been shown to be very effective in the management of Behget s disease, HIV-related mucosal ulceration (aphthosis), and select cases of lupus erythematosus. 

Etanercept is approved in the United States for the treatment of psoriatic arthritis and rheumatoid arthritis. Although etanercept has not been specifically approved for the treatment of the cutaneous manifestations of psoriasis, it significantly improves the skin lesions of patients with moderate to severe cutaneous psoriasis who have used it for psoriatic joint disease. 

P8. Provost, T. T., Watson, R., and Simmons-O Brien, E., Significance of anti-Ro (SS-A) antibody in evaluation of patients with cutaneous manifestations of a connective tissue disease. J. Am. Acad. Dermatol. 35, 147—169 (1996). 

Caputo R, Monti M, Ermacora E,et al. 1988. Cutaneous manifestations of tetrachlorodebenzo-p-dioxin in children and adolescents Follow-up 10 years after the Seveso, Italy, accident. J Am Acad Dermatol 19 812-819. 

Prottey, C., Hartop, P.J., and Press, M., Correction of the cutaneous manifestations of essential fatty acid deficiency in man by application of sunflower-seed oil to the skin, J. Invest. Dermatol., 64, 228, 1975. 

Body BA Cutaneous manifestations of systemic mycoses. Dermatol Clin 1996 14 125-135. 

Common causative organisms in adults with canaliculitis include Staphylococcus aureus and Actinomyces species. Primary herpetic infections (herpes simplex, varicella, and vaccinia) have a higher prevalence among patients younger than age 20 years and often present with cutaneous manifestations of the infectious disease. Chronic allergies may also be associated with canalicular obstruction. Occasionally, patients may suffer from canalicular obstruction as a result of topical antimetabolite treatment such as 5-fluorouracil or mitomycin C. 

Animals and yeasts can synthesize nicotinamide from tryptophan via hydroxyanthranilic acid (52) and quinolinic acid (53, Fig. 6A) (31), but the biosynthetic capacity of humans is limited. On a diet that is low in tryptophan, the combined contributions of endogenous synthesis and nutritional supply of precursors, such as nicotinic acid, nicotinamide, and nicotinamide riboside, may be insufficient, which results in cutaneous manifestation of niacin deficiency under the clinical picture of pellagra. Exogenous supply of nicotinamide riboside was shown to promote NAD+-dependent Sir2-function and to extend life-span in yeast without calorie restriction (32). 

Simpson RM, Leno M, Hubbard BS, Kindt TJ (1996) Cutaneous manifestations of human T cell leukemia virus type I infection in an experimental model. J Infect Dis 173 722-726. 

In man, histamine release by atracurium is common. The chnical significance of this is disputed, but it can cause minor transient skin reactions. Systemic effects of histamine release are much rarer than cutaneous manifestations. 

Cutaneous vasculitis can also be the sole cutaneous manifestation of etanercept treatment (19). Purpuric lesions with histological features of leukocytoclastic... 

Aztreonam was the suspected cause of toxic epidermal necrolysis in two patients undergoing bone marrow transplantations (11). Graft-versus-host disease seemed a less likely diagnosis of the cutaneous manifestations. 

Sodium borate decomposes into borate and peroxide and is less toxic than potassium bromate. From 3 to 6g and from 15 to 30 g boric acid is potentially fatal to children and adults, respectively. Cutaneous manifestations include desquamating, erythematous rash commonly over palms, soles, buttocks, and scrotum. The lesion may progress to exfoliation. Central nervous system (CNS) effects range from irritability, restlessness, and headache to coma and convulsions in severe cases. Gastrointestinal symptoms include anorexia, nausea, vomiting, and diarrhea. Acute renal tubular necrosis may lead to renal failure in moderate to severe cases. 

Note For excellent reviews of many of the cutaneous manifestations caused by penicillamine see (1983) Levy RS +, J Am Acad Dermatol 8, 548 and (1981) Sternlieb l +, J Rheumatol 8 (Suppl 7), 149... 

These disorders are associated with acute or cutaneous manifestations (or both). In the acute state, the presentation may include abdominal pain, constipation, hypertension, tachycardia, and neuropsychiatric manifestations. Cutaneous problems consist of photosensitivity (itching, burning, redness, swelling, and scarring), hyperpigmentation, and sometimes hypertrichosis... 

Manifestations in the skin are nearly as common as those involving the musculoskeletal system. " The most well known of these is the butterfly rash, which occurs over the bridge of the nose and the malar eminences. The classic butterfly rash is seen in approximately one-half of patients and often is observed after sun exposure. In fact, photosensitivity is common to many SLE patients who present with cutaneous manifestations. Skin lesions characteristic of discoid lupus occur in 10% to 20% of patients with SLE and may occur without other clinical or serologic evidence of lupus. Some individuals are said to develop subacute cutaneous lupus erythematosus, the nature of whose lesions falls between discoid (one type of chronic... 

Dosage and duration of therapy depend on patient response, tolerance of side effects, and development of retinal toxicity, which is a potentially irreversible adverse reaction associated with long-term therapy, especially with chloroquine. Current recommended doses of antimalarials in SLE are hydroxychloroquine 200-400 mg/day and chloroquine 250-500 mg/day. After 1 or 2 years of treatment, gradual tapering of dosage can be attempted. Some patients may require only one or two tablets per week to suppress cutaneous manifestations. ... 

Willenbrock K, Ichinohasama R, Kadin ME, et al. T-cell variant of classical Hodgkin s lymphoma with nodal and cutaneous manifestations demonstrated by single-cell polymerase chain reaction. Lab Invest. 2002 82 1103-1109. 

Kuo TT. Cutaneous manifestations of Kikuchi s histiocytic necrotizing lymphadenitis. Am J Surg Pathol. 1990 14 872-879. 

Itin PH, Frei R, Lautenschlager S, Buechner SA, Surber C, Gratwohl A, Widmer AF. Cutaneous manifestations of Paecilomyces lilacinus infection induced by a contaminated skin lotion in patients who are severely immunosuppressed. J Am Acad Dermatol 39 401 409, 1998. 

Abel, E.A., Cutaneous manifestations of immunosuppression in organ transplant recipients, J. Am. Acad. Dermatol., 21(2 part 1), 167-179, 1989. 

Thalidomide is an immunomodulator that is indicated for acute treatment of cutaneous manifestations of moderate to severe erythema nodosum leprosum (ENL) and maintenance therapy for prevention and suppression of cutaneous manifestations of ENL recurrence. 

Wong SS, Tan KC and Goh CL (1998) Cutaneous manifestations of chronic arsenicism review of seventeen cases. J Am Acad Dermatol 38 179-185. 

The pattern of NVP-induced liver injury varies, not only in terms of severity (Buyse et al. 2006 Centers for Disease Control and Prevention. 2001 Maniar et al. 2006) but also in time to onset (Clarke et al. 2000 de Maat et al. 2003). For instance, some reactions occur early while others occur late after prolonged exposure and, indeed, are not always accompanied by hypersensitivity manifestations, such as fever and eosinophilia. It is possible that the late-occurring reactions may be nonimmune in nature, while those occurring early (e.g., within the first 3 months) may have an immtme pathogenesis. This is consistent with our recent observation of NVP-reactive T cells in a patient with early-onset hepatitis in the absence of any cutaneous manifestations (Drummond et al. 2006). The patient s T cells proliferated in vitro on exposure to NVP but not its stable metabolites. 

CLINICAL MANIFESTATIONS Bubonic Plague Septicemic Plague Pneumonic Plague Plague Meningitis Pharyngeal Plague Cutaneous Manifestations... 

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