Cutaneous reactions

The filariform larva found in moist soils may be either ingested or penetrate the skin of its host. It is then carried through the circulatory system to the lungs and migrates up the respiratory tree into the digestive tract. The worms feed on intestinal tissue and blood. Some worms may persist in humans as long as nine years. Infestations cause cutaneous reactions, pulmonary lesions, intestinal ulcerations, and anemia. 

Patients with chronic idiopathic urticaria, who develop cutaneous reactions in response to aspirin, display certain similarities in eicosanoid profile with AIA. The mechanism of the reactions is often related to COX-1 inhibition [18]. Therefore, aspirin and all drugs that inhibit COX-1 should be avoided in patients who already have had cutaneous reactions to NSAID. Coxibs are usually well tolerated, although occasional adverse reactions have been reported [19, 20]. For treatment of the reactions, antihistamines are usually sufficient, but in more severe cases adrenaline and corticosteroids may be warranted. 

Zembowicz A, Mastalerz L, Setkowicz M, Radzis-zewski W, Szczeklik A Histological spectrum of cutaneous reactions to aspirin in chronic idiopathic urticaria. J Cutan Pathol 2004 31 323-329. Mastalerz L, Setkowicz M, Sanak M, Szczeklik A Hypersensitivity to aspirin common eicosanoid alterations in urticaria and asthma. J Allergy Clin Immunol 2004 113 771-775. 

All the jellyfish venoms are toxic but also stimulate the cell mediated and humoral immunological systems of man. After injection of large doses of jellyfish venom into human skin, a perivascular mononuclear cell infiltration appears within the dermis. This infiltration is composed predominantly of helper inducer cells which produce suppressor activity. It appears that the NK enhancement of human leukocytes in patients envenomated by Chrysaora quinquecirrha is depressed when the clinical lesion is inflammatory (10). Recovery from this suppression follows the amelioration of the acute cutaneous reaction. In other instances, envenomated patients have abnormal macrophage migration tests (11). 

Levofloxacin Moxifloxacin Gatifloxacin Adults 500-1 000 mg daily Children See footnote Adults 400 mg daily Children See footnote Adults 400 mg daily Children See footnote Gastrointestinal disturbance, neurologic effects, cutaneous reactions No specific monitoring recommended... 

Hydroxyurea inhibits cell synthesis in the S phase of the DNA cycle. It is used selectively in the treatment of psoriasis, especially in those with liver disease who would be at risk of adverse effects with other agents. However, it is less effective than methotrexate. The typical dose is 1 g/day, with a gradual increase to 2 g/day as needed and as tolerated. Adverse effects include bone marrow toxicity with leukopenia or thrombocytopenia, cutaneous reactions, leg ulcers, and megaloblastic anemia. 

Drug-induced cutaneous reactions tend to be immunologic in origin and relate to hypersensitivity, but some reactions are nonallergic. The pathogenesis of fixed-drug reactions is not well understood. 

Rubber Chemistry and Technology 73, No.3, July/Aug.2000, p.427-85 CUTANEOUS REACTIONS TO RUBBER Taylor J S Yung-Hian Leow Cleveland Clinic Foundation... 

A detailed review is presented of the literature on cutaneous reactions to rubber, the aspects covered including latex allergy, irritant contact dermatitis and allergic contact dermatitis. The adverse cutaneous reactions to rubber occurring following industrial and occupational or consumer exposure to rubber chemicals or products or to natural rubber latex proteins are discussed. 261 refs. 

Substances when applied to human skin might exert a sensitizing potential on the skin and need, therefore, to be evaluated and classified for their possible toxicity. Every substance that provokes immunologically mediated cutaneous reactions (i.e., skin sensitization or allergic contact dermatitis) is referred to as skin sensitizer. Several tests are recommended, but no single method is able to identify all potential substances capable of inducing sensitization of human skin. Widely used test methods for the investigation of skin sensitization, the so-called adjuvant and nonadjuvant tests, are described below. 

Stem, R.S. and Bigby M., An expanded profile of cutaneous reactions to nonsteroidal antiinflammatory dmgs reports to a specialty-based system for spontaneous reporting of adverse reactions to drugs, JAMA, 252,1433-1437,1984. 

Are T Cells Involved in Specific Immune Responses to Autoantigens in Atopic Dermatitis Autoimmune phenomena to human self-proteins may also contribute to the pathophysiology of atopic dermatitis. IgE against autoantigens such as Horn SI-4 have been shown to stimulate type 1 hypersensitivity reactions which in turn may contribute to the clinical cutaneous reactions in atopic dermatitis [15]. Autoallergens induce the proliferation of CLA+ autoreactive T cells derived... 

Adverse effects. Fatigue, orthostatic hypotension, extrapyramidal Parkin-son-like symptoms (p. 88), cutaneous reactions, hepatic damage, immune-hemolytic anemia... 

In the OECD test guideline for skin sensitization (OECD TG 406), the following definition is given Skin sensitization (allergic contact dermatitis) is an immunologically mediated cutaneous reaction to a substance. In the human, the responses may be characterized by pruritis, erythema, edema, papules, vesicles, bullae, or a combination of these. In other species, the reactions may differ and only erythema and edema may be seen. ... 

Ten of 12 workers experienced acute irritant contact dermatitis of the hands after 2 days of direct contact. In the most severe case, a woman with no previous skin problems, who wore latex gloves intermittently, had painful swelling of the fingers of both hands with redness and vesicles on the palms. The affected skin later became thickened and showed a brownish discoloration. Another worker noticed small vesicles on the forehead, probably due to scratching with contaminated fingers. All cutaneous reactions cleared within 3 weeks of termination of exposure. Gas chromatograph analysis of the NMP used at the factory did not reveal any contaminating compounds. 

Leira HL, Tilmes A Svendsen K, et al Irritant cutaneous reactions to A/-methyl-2-pyrrolidone (NAIP). Contact Derm 27 148-150, 1992... 

Hypersensitivity Anaphylactoid purpura, anaphylaxis, angioneurotic edema, myocarditis, pericarditis, polyarthralgia, pulmonary infiltrates with eosinophilia, systemic lupus erythematous exacerbation, urticaria hypersensitivity syndrome (cutaneous reaction, eosinophilia, and one or more of the following Hepatitis, pneumonitis, nephritis, myocarditis, pericarditis, fever, lymphadenopathy). Muscuioskeietai - ArVr ra g a, arthritis, bone discoloration, joint stiffness and swelling, myalgia, polyarthralgia. 

Dermatological reactions Patients have rarely developed serious cutaneous reactions, such as Stevens-Johnson syndrome, during treatment with voriconazole. Photosensitivity Voriconazole has been infrequently associated with photosensitivity skin reaction, especially during long-term therapy. It is recommended that patients avoid strong, direct sunlight during voriconazole therapy. 

The potential of Ecoflex (powder) to cause acute dermal irritation or corrosion was assessed by a single topical application of the test substance to the intact skin of rabbits according to OECD guideline 404. After removal of the patch, the application area was washed off and cutaneous reactions were assessed for 72 h. No cutaneous reactions were observed. Hence, Ecoflex (powder) is not irritating to skin. 

Cutaneous reactions such as rash or Stevens-Johnson syndrome are also consist with initiation through protein haptenation, although in this case dendritic cell activation/ migration and T-cell propagation are involved [31]. Other immune mediators such as cytokines, nitric oxide and reactive oxygen species which may be linked to the formation of reactive metabolites may also be implicated, as may specific processes occurring at the level of the keratinocyte. 

Pruritus is a warning sign for development of cutaneous reactions... 

Holland, P. and White, R.G. The cutaneous reactions produced by o-chlorobenzylidene malononitrile and w-chloroacetophenone when applied directly to the skin of human subjects. Br. J. Dermatol.86 150-154, 1972. 

Erythema scores were lowest in the 0.1 mg treatment group and highest in 10 mg treatment group. Erythema ranged from a pale pink eolor to a bright red cutaneous reaction. The relationship between dose and response was found to be statistieally significant (p<0.05). No erythema response was noted in the lowest dose treatment group, 0.01 mg. 

Dermal Effects. Dermal effects of HDI are limited to those cases of topical exposure. HDI has been demonstrated to be a topical irritant in several studies in laboratory animals at topical (non-occluded) doses as low as 0.1%, resulting in erythema, edema, and, in some cases, frank skin necrosis (Haskell Laboratory 1961). Studies that dosed HDI on the skin of rabbits, with the dosing site occluded, resulted in more severe cutaneous reactions (Mobay Corporation 1981a). In addition to its local irritation effect,... 

As mentioned above, gas has been widely used and it is a powerful vesicant agent. In the form of vapor, it damages the respiratory tract. Eyes become temporarily blind and the skin in contact with the substance becomes inflammatory. The sweaty zones of skin are the most damaged as well as sensitive mucous membranes. If no treatment is applied, the cutaneous reaction provokes blisters full of liquid after 4-8 h. Spread in the form of particles, the gas penetrates the respiratory tract and destroys the mucous membranes with a respiration distress syndrome. Lungs suffer from emphysemae and edema due to the presence of fluids, which may cause a death similar to a drowning if the dose is too strong. 

Al-Sheik OA. Unusual local cutaneous reactions to insulin injections a case report. Saudi Med J 1998 19 199-201. 

Lemlich G, Di Grandi S, Szaniawski WK. Cutaneous reaction to vasopressin. Cutis 1996 57(5) 330-2. 

Sensitive skin is largely believed to be a widespread phenomenon. Epidemiological studies have shown that the incidence of self-reported skin sensitivity is 51.4% in women and 38.2% in men. Studies also show that 10% of women and 5.8% of men consider themselves to have very sensitive skin.3 However, consumer-perceived cutaneous reactions are usually scientifically unconfirmed self-assessment is not an accurate parameter. Furthermore, estimates of the prevalence or incidence of sensitive skin are problematic as the term sensitive skin lacks a consistent definition. 

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