Drugs causing fixed eruptions: a study of 450 cases

BACKGROUND: Drug eruptions are among the most common cutaneous disorders encountered by the dermatologist. Some drug eruptions, although trivial, may cause cosmetic embarrassment and fixed drug eruption (FDE) is one of them. The diagnostic hallmark is its recurrence at previously affected sites. OBJECTIVE: We evaluated 450 FDE patients to determine the causative drugs. RESULTS: The ratio of men to women was 1:1.1. The main presentation of FDE was circular hyperpigmented lesion. Less commonly FDE presented as: nonpigmenting erythema, urticaria, dermatitis, periorbital or generalized hypermelanosis. Occasionally FDE mimicked lichen planus, erythema multiforme, Stevens-Johnson syndrome, paronychia, cheilitis, psoriasis, housewife's dermatitis, melasma, lichen planus actinicus, discoid lupus erythematosus, erythema annulare centrifugum, pemphigus vulgaris, chilblains, pityriasis rosea and vulval or perianal hypermelanosis. Cotrimoxazole was the most common cause of FDE. Other drugs incriminated were tetracycline, metamizole, phenylbutazone, paracetamol, acetylsalicylic acid, mefenamic acid, metronidazole, tinidazole, chlormezanone, amoxycillin, ampicillin, erythromycin, belladonna, griseofulvin, phenobarbitone, diclofenac sodium, indomethacin, ibuprofen, diflunisal, pyrantel pamoate, clindamycin, allopurinol, orphenadrine, and albendazole. CONCLUSIONS: Cotrimoxazole was the most common cause of FDE, whereas FDE with diclofenac sodium, pyrantel pamoate, clindamycin, and albendazole were reported for the first time. FDE may have multiform presentations.     

Women, dyslipoproteinemia, and estrogens

The most common cause of death in both men and women is coronary atherosclerosis, although atherosclerotic death in women occurs 5 to 10 years later than it does in men. Major risk factors predict coronary risk in both. Available evidence suggests that women benefit from cholesterol lowering just as men do. The role of exogenous estrogenic compounds in favorably affecting lipoprotein levels and promoting antiatherogenesis in both men and women is a promising area for future research.     

Evaluation and management of dyslipoproteinemia in children

The major goal of the evaluation and management of DLP in children is to provide safe and effective therapy with lifestyle modification. There is a strong rationale for the initiation of DLP treatment in childhood to limit the earliest stages of atherosclerosis, to establish lifelong lifestyle changes in diet and activity, and to limit the acquisition of additional CVD risk factors such as smoking and obesity. The NCEP has recommended screening for children with a parent with total cholesterol of 240 mg/dL or greater or a parent or grandparent with onset of CVD before age 55 years. Clinical evaluation and management are based on an LDL-C level of 130 mg/dL or greater. This approach to screening has a low sensitivity to identify children with DLP. Initial therapy is with a step 1 diet followed by the step 2 diet if necessary. Medications are reserved for older children with LDL-C of 190 mg/dL or greater after diet therapy or 160 mg/dL or greater with other CVD risk factors.     

Specific features of cardiovascular diseases in patients with mono- and polygenic types of dyslipoproteinemia

Atherosclerosis as a key factor of cardiovascular morbidity and mortality is one of the most pressing problem of modern medicine. Most phenotypic deviations of serum cholesterol levels are genetically predetermined and the influence of environmental factors is much less. The vast majority of hereditary dyslipoproteinemia are polygenic. Monogenic disorders are seen in a small proportion of patients with atherosclerosis. However, they only emphasizes the carriage of alleles of the genes that determine various aspects of lipid genesis, transport, and predisposition to atherosclerosis. Virtually all primary dyslipoproteinemias appear as atherogenic types and they represent a special form of atherosclerosis. This fact affects the specific features of cardiovascular diseases in patients with hereditary hyperlipidemias. In these patients coronary heart disease as the most common manifestation of atherosclerosis occurs just in infancy, it is malignant and progressive and unresponsive to treatment. Furthermore, there is a drastic increase in the likelihood of a menacing and fatal complication, such as sudden death. For therapeutical and preventive purposes, these all factors make it necessary to perform a comprehensive early diagnosis of hereditary dyslipoproteinemias by using clinical, genealogical and routine studies, followed by correction of the disorders detected.     

Consensus for the use of fibrates in the treatment of dyslipoproteinemia and coronary heart disease. Fibrate Consensus Group

The hypolipidemic action of fibrates has recently been shown to involve the activation of peroxisome proliferator activated receptors establishing a molecular mechanism for this class of drugs. Increasing clinical trial evidence supports the efficacy of fibrates in the treatment of dyslipoproteinemias, particularly in patients with hypertriglyceridemia and low high-density lipoproteins.     

Mastoid pneumocele causing atlantooccipital pneumatization

A 49-year-old woman had a palpable mass in her occipital region. Plain radiographs and CT examination revealed extensive atlantooccipital pneumatization with findings consistent with the diagnosis of mastoid pneumocele. Decompression was achieved with placement of a myringotomy tube, resulting in prompt symptomatic relief. On a follow-up CT examination, the pneumatized areas had become opacified and new bone formation was present.     

Nerve entrapment causing heel pain

Subcalcaneal heel pain is one of the most common foot ailments, yet the exact etiology is still controversial. Much attention and evidence have recently been presented implicating nerve entrapment as a causative factor for pain. Careful evaluation is needed to discern a nerve entrapment from other possible causes of heel pain. The majority of heel pain cases respond to thoughtful, conservative care; however, this care may take several weeks to months. In the few instances that surgery is necessary, the available reports show good to excellent results in most cases.     

Polarization potentials causing pacemaker oversensing

This case of ectopic pancreas found in the pre-pyloric channel of a 2-day-old infant is unique. A review of the literature reveals no other cases of symptomatic ectopic pancreas in an infant of this age. In this patient, signs and symptoms were consistent with pyloric stenosis. Upper gastrointestinal study and esophagogastroduodenoscopy (EGD) revealed the diagnosis. This case is examined and the literature is reviewed.     

Benign breast dysplasia causing hypercalcemia

An adolescent female had hypercalcemia and massive, bilateral breast enlargement. At neck and mediastinal explorations three parathyroid glands were removed and found to be histologically normal. Following bilateral mastectomy the hypercalcemia resolved within two days and did not recur during a six-year period of followup. Microscopic examination of the excised breast tissue revealed marked dysplasia but no cancer. Those findings suggest that benign, dysplastic breast tissue can release humoral mediators of hypercalcemia.     

Meningiomas causing spontaneous intracranial hematomas

Glomeruli in Cryostat sections of foetal and adult renal tissues adsorbed sheep erythrocytes sensitized with IgM antibody and human or mouse complement (EAC). Activated complement was essential for the reaction to occur. The receptor had specificity for the C3b fragment of C3 and is probably of protein or glycoprotein nature. Complement receptors in glomeruli may explain the deposition of complement components or complement-containing complexes in immune-complex glomerulonephritis.     

Drugs of the future

Many therapeutic approaches are under evaluation in patients with cardiac failure. They include angiotensin receptor inhibitors, selective and non-selective endothelin receptor inhibitors, neutral endopeptidase inhibitors or mixed inhibitors of neutral endopeptidase and of the angiotensin converting enzyme and, finally, cytokinin modulators. Some of these drugs have already entered Phase II therapeutic trials and are at relatively advanced developmental stages. Others are at preliminary or experimental stages. If these new drugs prove to be effective and well tolerated, they will represent new tools for physicians to treat cardiac failure and prevent its progression. However, many questions concerning drug associations and poly-therapy will be raised, leading to a revision of the strategy of treatment of cardiac failure.