Adverse Skin Reactions Research Articles

Initial evidence that skin health deteriorates for younger age groups and with increased daily use of face masks for healthcare professionals at a dental hospital in the United Kingdom

ObjectiveTo determine the incidence and site of any adverse effects of wearing face masks via an online questionnaire. MethodsHealthcare workers in a dental hospital who wear Respiratory Protective Equipment (RPE) were invited to participate. An online questionnaire was used to identify adverse effects as a result of wearing face masks and possible remedies. ResultsRed marks (72.1 %) and indentations (66.7 %) were the most frequently reported issues with increased use of the RPE. The bridge of the nose and cheeks were the most frequently reported sites of facial skin problems, such as blanching (54.1 % and 42.2 %, respectively) and pressure damage (42.3 % and 24.3 %, respectively). Overall perceived facial skin health deteriorated strongly and significantly (P < 0.001) following the use of RPE, where the mean skin health score (0 = best possible skin health and 10 = worst possible skin health) increased from 2.68 to 4.76. Broadly, there was increased discomfort with increased hours of use of RPE per day (P = 0.049). 71 % of participants said that they generally felt safe or very safe using RPE. ConclusionThe facial skin health of respondents deteriorated strongly after the use of RPE. Guidelines for using RPE should be made clearer. A greater range of face mask sizes or bespoke masks should be made available to improve the fit and wearability, as well as to reduce the frequency and incidence of surface skin problems. Clinical significanceThis study has identified the factors influencing adverse skin reactions from face mask use, which can be used to inform face mask designers and manufacturers to improve the fit and wearability of face masks.

Treatment in Patients DRESS (Drug Reaction With Eosinophilia And Systemic Symptoms) : Case Report

Drug reactions with eosinophilia and systemic symptom syndrome (DRESS) are rare and potentially life-threatening severe skin adverse reactions (SCAR) The mean age at diagnosis is approximately 50-55 years and less than 10% of patients are under 20 years men : women 0.7-0.8. All drugs used by the patient during DRESS should be stopped immediately. Complications of DRESS are myocarditis, Pneumocystis jiroveciipneumonia, sepsis, liver failure, and gastro-intestinal bleeding. Systemic corticosteroids (prednisolone 1 mg/kg/day) are the gold standard of treatment in the acute phase of patients with severe organ involvement. Therefore, the importance of appropriate therapy to reduce the occurrence of complications from DRESS disease.

Literature analysis of cutaneous adverse reactions induced by tislelizumab

Objective Tislelizumab may induce immune-related adverse events, especially adverse skin events. Early detection and timely intervention of cutaneous adverse events are crucial to improve patients’ quality of life and reduce the disruption of therapeutic regimens. This study aimed to determine the clinical characteristics of cutaneous adverse reactions to tislelizumab and offer a reference for its rational clinical use. Methods Case reports of cutaneous adverse reactions induced by tislelizumab were collected from the relevant databases (up to 31 March 2023). Patient age, sex, primary disease, medication use, occurrence of adverse skin conditions, treatment, and outcomes were recorded and descriptively analysed. Results A total of 13 patients were enrolled, including six males and seven females, aged 55–79 years, with a median age of 75 years and a mean age of 70.92 ± 8.84 years. The original disease was lung carcinoma in none patients, cervical carcinoma in two, and urothelial carcinoma and squamous cell carcinoma in one each. The time from the initiation of medication use to the occurrence of cutaneous adverse reactions ranged from 7 to 177 days. Among the 13 patients, 10 showed improvement after drug withdrawal or symptomatic treatment. Two patients died (one died of disease progression and multiorgan failure, one died of acute coronary syndrome), and one patient’s adverse skin reactions persisted without treatment. Conclusions Tislelizumab-related cutaneous adverse reactions mostly occur after several days to months of treatment. In clinical practice, evaluation and monitoring should be strengthened. More attention should be paid to erythema and rashes, which may be signs of serious adverse skin reactions. Early detection and intervention can ensure the safe use of drugs and provide greater clinical benefits to patients.

Guarding skin under PPE: Mechanistic insights and technological innovations.

In the presence of diseases transmitted through respiratory droplets and direct contact, healthcare workers (HCWs) necessitate the use of personal protective equipment (PPE). For optimal safety, PPE should securely conform to the skin during extended wear. However, conventional PPE often lacks adequate air permeability and hygroscopicity, trapping heat and moisture emitted by the body within the enclosure. Such a hot and humid internal environment can induce skin damage, such as erythema, rash, pruritus, and itching among others, leading to microbial growth on the skin surface, the production of inflammatory mediators at the wound site and an increased risk of infection. This review strives to comprehensively elucidate the fundamental mechanisms triggering adverse skin reactions and their resultant manifestations. Furthermore, we explore recent advancements aimed at inhibiting these mechanisms to effectively mitigate the occurrence of skin lesions.

Enhanced wound healing and hemostasis with exosome-loaded gelatin sponges from human umbilical cord mesenchymal stem cells.

Rapid wound healing remains a pressing clinical challenge, necessitating studies to hasten this process. A promising approach involves the utilization of human umbilical cord mesenchymal stem cells (hUC-MSCs) derived exosomes. The hypothesis of this study was that these exosomes, when loaded onto a gelatin sponge, a common hemostatic material, would enhance hemostasis and accelerate wound healing. To investigate the hemostatic and wound healing efficacy of gelatin sponges loaded with hUC-MSCs-derived exosomes. Ultracentrifugation was used to extract exosomes from hUC-MSCs. Nanoparticle tracking analysis (NTA), transmission electron microscopy (TEM), and western blot techniques were used to validate the exosomes. In vitro experiments were performed using L929 cells to evaluate the cytotoxicity of the exosomes and their impact on cell growth and survival. New Zealand rabbits were used for skin irritation experiments to assess whether they caused adverse skin reactions. Hemolysis test was conducted using a 2% rabbit red blood cell suspension to detect whether they caused hemolysis. Moreover, in vivo experiments were carried out by implanting a gelatin sponge loaded with exosomes subcutaneously in Sprague-Dawley (SD) rats to perform biocompatibility tests. In addition, coagulation index test was conducted to evaluate their impact on blood coagulation. Meanwhile, SD rat liver defect hemostasis model and full-thickness skin defect model were used to study whether the gelatin sponge loaded with exosomes effectively stopped bleeding and promoted wound healing. The NTA, TEM, and western blot experimental results confirmed that exosomes were successfully isolated from hUC-MSCs. The gelatin sponge loaded with exosomes did not exhibit significant cell toxicity, skin irritation, or hemolysis, and they demonstrated good compatibility in SD rats. Additionally, the effectiveness of the gelatin sponge loaded with exosomes in hemostasis and wound healing was validated. The results of the coagulation index experiment indicated that the gelatin sponge loaded with exosomes had significantly better coagulation effect compared to the regular gelatin sponge, and they showed excellent hemostatic performance in a liver defect hemostasis model. Finally, the full-thickness skin defect healing experiment results showed significant improvement in the healing process of wounds treated with the gelatin sponge loaded with exosomes compared to other groups. Collectively, the gelatin sponge loaded with hUC-MSCs-derived exosomes is safe and efficacious for promoting hemostasis and accelerating wound healing, warranting further clinical application.

The Preparation and Sensory Evaluation of Post-waxing Aftercare Lotion

In this study, we prepared a lotion containing &lt;i&gt;Gymnema sylvestre Leaf&lt;/i&gt; Extract (GSLE) and evaluated its stability, safety, and usability. To assess stability, a series of scientific evaluations were conducted, including centrifugation testing and heat-cool cycling. Following the application of the Lycon, 5% GSLE lotion on the skin, a skin patch test was conducted to detect the presence of erythema in the designated patch area, in accordance with the established guidelines provided by the International Contact Dermatitis Research Group (ICDRG). Using a 10-point scale, the level of satisfaction resulting from actual usage was assessed. The stability of both the vehicle and the 5% GSLE lotion was found to be intact in terms of their physical and chemical properties. No adverse skin reactions were observed in any of the groups tested, which included the vehicle, Lycon lotion, and 5% GSLE lotion. Furthermore, when considering efficacy, functionality, and usability, the 5% GSLE lotion demonstrated the highest value. In terms of absorption, moisturization, smoothness, and calming effects, the Lycon lotion exhibited relatively lower performance compared to both the vehicle and the 5% GSLE lotion. Across all evaluation criteria, the 5% GSLE lotion was found to provide an excellent user experience.

Proposal for Clinical Classification of Cutaneous Manifestations in Covid-19 and in Post Vaccination Against Sars-Cov-2: An Observational Study

Background: This is a clinical evaluation of patients with the incident, acute, or related cutaneous manifestations associated with coronavirus disease 2019 (COVID-19) and/or vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objectives: We aimed to propose a classification of dermatological manifestations related to either COVID-19 or vaccination against SARS-CoV-2. Methods: In an observational descriptive study, a classification of cutaneous manifestations is proposed based on groups of etiological hypotheses, which came from a systematic characterization and record of the observed skin lesions of patients who were evaluated personally and via teleconsultation from July 2020 to July 2022 in two reference dermatology services located in the state of Mato Grosso, Brazil. Results: A total of 108 patients were included. Eighty-six patients (79.6%) had incident, acute, or COVID-19-related skin manifestations, 15 (13.9%) had dermatological lesions exclusively after vaccination against SARS-CoV-2, and seven (6.5%) %) had cutaneous manifestations related to both COVID-19 and the vaccine. A total of 143 different dermatological manifestations were diagnosed, for which different etiological hypotheses were established based on the clinical and evolutionary characteristics of the lesion, the use of concomitant medications, and the temporal link with COVID-19 and/or the vaccine against SARS-CoV-2. The observed skin manifestations were classified as peri-infectious and post-infectious immune-inflammatory reactions related to COVID-19 (62.2%); exacerbation, by COVID-19, of pre-existing skin diseases in the patient (4.2%); skin manifestations resulting from the socio-sanitary context of the pandemic (2.1%); adverse drug reactions from the treatment of COVID-19 (14%); and adverse skin reactions from SARS-CoV-2 vaccines (17.5%). Conclusions: The proposed clinical classification may assist physicians who are faced with dermatological lesions associated with COVID-19 or after active immunization against SARS-CoV-2.

Topically applied fullerenols protect against radiation dermatitis by scavenging reactive oxygen species

Adverse skin reactions caused by ionizing radiation are collectively called radiation dermatitis (RD), and the use of nanomedicine is an attractive approach to this condition. Therefore, we designed and large-scale synthesized fullerenols that showed free radical scavenging ability in vitro. Next, we pretreated X-ray-exposed cells with fullerenols. The results showed that pretreatment with fullerenols significantly scavenged intracellular reactive oxygen species (ROS) produced and enhanced the antioxidant capacity, protecting skin cells from X-ray-induced DNA damage and apoptosis. Moreover, we induced RD in mice by applying 30 Gy of X-ray irradiation, followed by treatment with fullerenols. We found that after treatment, the RD scores dropped, and the histological results systematically demonstrated that topically applied fullerenols could reduce radiation-induced skin epidermal thickening, collagen deposition and skin appendage damage and promote hair regeneration after 35 days. Compared with Trolamine cream, a typical RD drug, fullerenols showed superior radiation protection. Overall, the in vitro and in vivo experiments proved that fullerenols agents against RD.

Protocatechuic Acid and Syringin from Saussurea neoserrata Nakai Attenuate Prostaglandin Production in Human Keratinocytes Exposed to Airborne Particulate Matter.

Saussurea neoserrata Nakai offers a reliable and efficient source of antioxidants that can help alleviate adverse skin reactions triggered by air pollutants. Air pollutants, such as particulate matter (PM), have the ability to infiltrate the skin and contribute to the higher occurrence of cardiovascular, cerebrovascular, and respiratory ailments. Individuals with compromised skin barriers are particularly susceptible to the impact of PM since it can be absorbed more readily through the skin. This study investigated the impact of protocatechuic acid and syringin, obtained from the n-BuOH extract of S. neoserrata Nakai, on the release of PGE2 and PGD2 induced by PM10. Additionally, it examined the gene expression of the synthesis of PGE2 and PGD2 in human keratinocytes. The findings of this research highlight the potential of utilizing safe and efficient plant-derived antioxidants in dermatological and cosmetic applications to mitigate the negative skin reactions caused by exposure to air pollution.

Effectiveness of chlorhexidine diacetate and povidone-iodine in antiseptic preparation of the canine external ear canal prior to total ear canal ablation with bulla osteotomy procedure: A preliminary study.

This article is a preliminary study to compare the ability of 0.05% chlorhexidine diacetate (CD) and 1% povidone-iodine (PI) solutions to reduce bacterial contamination on the canine external ear canal during initial patient preparation and comparison of the incidence of immediate tissue reactions. The study is a multi-institutional, randomised, clinical prospective study. Dogs (n = 19) undergoing total ear canal ablation with bulla osteotomy (TECABO). The external ear of each dog was cleaned with the assigned antiseptic solution. Culture of the ear was performed by standard techniques to semi-quantitatively evaluate bacterial growth and to identify bacterial organisms pre- and post-antiseptic use. Both antiseptic groups showed a significant reduction in bacterial growth score (BGS) between pre- and post-antiseptic use (CD p = 0.009, PI p = 0.005). There was no difference in the reduction of BGS between CD and PI solutions (p = 0.53). Minor adverse skin reactions occurred in 25% of cases. There was no significant difference in the occurrence of adverse skin reactions between antiseptics (p = 0.63). CD and PI were similarly able to decrease the number of bacteria on the external ear following initial preparation. No difference in the incidence of adverse tissue reactions was found. Properly diluted aqueous formulations of either antiseptic may be used for safe preparation limited to the external ear canal of dogs. Additional studies evaluating outcomes such as duration of bacterial inhibition and incidence of surgical site infections are needed to fully elucidate differences between CD and PI antiseptics prior to TECABO.

Contact Dermatitis to Diabetes Medical Devices

Skin adverse reactions to diabetes medical devices have been reported frequently over recent years. Adhesives attaching glucose sensors and continuous insulin infusion sets to the skin are proven to cause both allergic contact dermatitis and irritant contact dermatitis in patients with diabetes mellitus. Several allergens contained in adhesives and/or parts of medical devices are documented to cause allergic contact dermatitis, with acrylate chemicals being the most common culprit-especially isobornyl acrylate (IBOA), but also 2,2′-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate or cyanoacrylates. Epoxy resin, colophonium and nickel were also identified as causative allergens. However, repetitive occlusion, maceration of the skin and resulting disruption of the skin barrier seem to have an impact on the development of skin lesions as well. The purpose of this study is to highlight the burden of contact dermatitis triggered by diabetes medical devices and to show possible mechanisms responsible for the development of contact dermatitis in a group of diabetic patients.

175-OR: Pregnancy Intervention with a Closed-Loop System (PICLS) Study

We performed a parallel, two-site, randomized controlled trial of a commercially available hybrid closed-loop (HCL) system compared to sensor augmented pump therapy (SAPT) in pregnant women with type 1 diabetes (T1D). Participants started SAPT (Medtronic 670G) by 11 weeks gestation, were randomized at 14-18 weeks, and continued therapy until 6 weeks postpartum. The HCL group used assistive techniques, “fake carbohydrate” boluses, to optimize therapy. We performed linear mixed model regression to compare outcomes between groups, adjusted for clinic. There were 24 women randomized and 23 completers. At baseline there were no significant differences between groups (mean baseline A1C 6.8% at 8w5d [SAPT]/9w0d [HCL] enrollment). There were no episodes of severe hypoglycemia or diabetic ketoacidosis after randomization. Adverse skin reactions occurred in 6 participants (5 SAPT vs 1 HCL, p=0.1550) with a median (IQR) number of 1 (1-2) SAPT vs 4 (4-4) HCL (p=0.8774). A1C significantly decreased from baseline to 2nd trimester, and was different between groups in the 3rd trimester (Table 1). There were no differences in time below, within, or above range between groups during the study (Table 1) or in gestational health outcomes (Table 2). In a pilot cohort of pregnant women with T1D, assisted HCL therapy did not increase risk to mothers or fetuses compared to SAPT despite lack of a pregnancy-specific algorithm in the HCL system. Disclosure E.Buschur: Consultant; Beta Bionics, Inc., Research Support; Dexcom, Inc., JDRF, Leona M. and Harry B. Helmsley Charitable Trust. E.R.Nease: None. S.Polsky: Other Relationship; diaTribe, Research Support; Dexcom, Inc., Medtronic, Hemsley Charitable Trust, JDRF, NIH - National Institutes of Health. J.K.Snell-bergeon: None. L.Pyle: None. R.Garcetti: None. K.M.Dungan: Board Member; Elsevier, Consultant; Eli Lilly and Company, Dexcom, Inc., Other Relationship; UpToDate, Research Support; Dexcom, Inc., Abbott, ViaCyte, Inc., Sanofi, Speaker's Bureau; Academy for Continued Healthcare Learning, Cardiometabolic Health Congress, Medscape, Integritas. S.F.Thung: None. A.Bartholomew: None. T.Summerfield: None. T.Bloks: None. Funding JDRF (2-SRA-2018-666-M-R); Colorado Clinical and Translational Sciences Institute; Children’s Diabetes Foundation; National Center for Research Resources (UL1RR02578)

It is not always chlorhexidine: Identification of benzoxonium chloride and lauramine oxide as culprit allergens in a popular antiseptic in Switzerland.

A popular antiseptic spray in Switzerland (Merfen spray), containing chlorhexidine digluconate, benzoxonium chloride and lauramine oxide, is frequently used to treat skin wounds. However, it is also increasingly reported as a major cause of adverse skin reactions, including allergic contact dermatitis (ACD). To investigate the contact allergens responsible for ACD from this antiseptic. Patch tests were performed on seven patients with a clinical history compatible with contact dermatitis from this antiseptic mixture. All patients presented with acute eczematous reactions following contact with either Merfen spray alone, or with multiple products including this spray. Patients showed positive reactions to this product in both patch tests and repeated open application tests (ROATs). Four patients showed dose-dependent reactions to both benzoxonium chloride and lauramine oxide. One patient showed a dose-dependent reaction to the former and a non-dose-dependent reaction to the latter. Finally, two subjects showed responses only to lauramine oxide. One patient reacted to chlorhexidine digluconate 0.5% aq. in addition to both other allergens. Two commercially unavailable allergens, that is, benzoxonium chloride and/or lauramine oxide were identified as major causes of ACD from Merfen antiseptic spray, whereas chlorhexidine digluconate was a contributing culprit in only one patient.

Evaluating the effect of screening dual HLA-A*31:01 and HLA-B*15:02 alleles by multiplex real-time PCR technique on reducing the risk of Carbamazepine-induced hypersensitivity reactions

HLA-A*31:01 and HLA-B*15:02 are strongly associated with Carbamazepine (CBZ)-induced severe cutaneous adverse reactions (SCARs). As a result, it is recommended to screen these two alleles before CBZ therapy to reduce the risk of drug allergy. In this study, the authors applied the simultaneous screening test for HLA-A*31:01 and HLA-B*15:02 alleles by multiplex real-time PCR Taqman LNA probe with high sensitivity and specificity in 35 patients that were diagnosed with neurological diseases. Among thirteen patients (37.14% of total) who were positive for single or dual HLA-B*15:02and HLA-A*31:01 alleles were prescribed alternatives to CBZ and monitored for adverse events, only one patient had a mild skin adverse reaction after 24 days using Trileptal (Oxcarbazepine) at a dose of 600 mg/day, 12 patients had no symptoms or allergic reactions. The remaining negative patients showed good tolerance to CBZ therapy without any allergy symptoms. Compared to the data of 30 control samples carrying these one or two alleles and 21 patients exhibiting CBZ-induced severe hypersensitivity reactions (OR=28, 95%CI: 3.15-248.78), these results confirm the importance of screening for HLA-A*31:01 and HLA-B*15:02 alleles before using CBZ in neurological diseases treatment to reduce SCAR rates by replacing CBZ with another drug in patients positive for one of these two alleles.

Biológiai és célzott terápiák bőrpathologiai vonatkozásai a mindennapi gyakorlatban

Biological and targeted therapies are the most up-todate treatment modalities in numerous inflammatory and neoplastic cutaneous diseases however they can induce adverse events. Among them skin adverse reactions are very frequent and can draw the attention to other organ’s involvement. Skin symptoms are variable and not specific for the causative agent. Lichenoid and maculopapulous reactions, psoriasiform dermatitis, autoimmune skin disease, vitiligo and granulomatous reaction can all be developed. In order to establish the proper histological diagnosis pathologist should be aware of the treatment and the possible skin symptoms caused by it. Authors describe such cutaneous adverse reactions through case presentations.

The efficacy of detecting arrhythmia is higher with 7-day continuous electrocardiographic patch monitoring than with 24-h Holter monitoring.

Detecting high-risk arrhythmia is important in diagnosing patients with palpitations. We compared the diagnostic accuracies of 7-day patch-type electrocardiographic (ECG) monitoring and 24-h Holter monitoring for detecting significant arrhythmias in patients with palpitations. This was a single-center prospective trial with 58 participants who presented with palpitations, chest pain or syncope. Outcomes were defined as the detection of any one of six arrhythmias, including supraventricular tachycardia (SVT), atrial fibrillation or atrial flutter lasting more than 30 s, pauses of more than 3 s, high-degree atrioventricular block, ventricular tachycardia (VT) >3 beats, or polymorphic VT/ventricular fibrillation. The McNemar test for paired proportions was used to compare arrhythmia detection rates. The overall arrhythmia detection rate was higher with 7-day ECG patch monitoring than with 24-h Holter monitoring (34.5% vs. 19.0%, p = .008). Compared with the use of 24-h Holter monitors, the use of 7-day ECG patch monitors was associated with higher detection of SVT (29.3% vs. 13.8%, p = .042). No serious adverse skin reactions were reported among the ECG patch-monitored participants. The results suggest that a 7-day patch-type continuous ECG monitor is more effective for the detection of supraventricular tachycardia than is a 24-h Holter monitor. However, the clinical significance of device detected arrhythmia should be consolidated.

Investigation of Adverse Reactions in Tattooed Skin through Histological and Chemical Analysis

Background: Just as the number of tattooed people has increased in recent years, so has the number of adverse reactions in tattooed skin. Tattoo colourants contain numerous, partly unidentified substances, which have the potential to provoke adverse skin reactions like allergies or granulomatous reactions. Identification of the triggering substances is often difficult or even impossible. Methods: Ten patients with typical adverse reactions in tattooed skin were enrolled in the study. Skin punch biopsies were taken and the paraffin-embedded specimens were analysed by standard haematoxylin and eosin and anti-CD3 stainings. Tattoo colourants provided by patients and punch biopsies of patients were analysed with different chromatography and mass spectrometry methods and X-ray fluorescence. Blood samples of 2 patients were screened for angiotensin-converting enzyme (ACE) and soluble interleukin-2 receptor (sIL-2R). Results: Histology showed variable skin reactions such as eosinophilic infiltrate, granulomatous reactions, or pseudolymphoma. CD3+ T lymphocytes dominated the dermal cellular infiltrate. Most patients had adverse skin reactions in red tattoos (n = 7), followed by white tattoos (n = 2). The red tattooed skin areas predominantly contained Pigment Red (P.R.) 170, but also P.R. 266, Pigment Orange (P.O.) 13, P.O. 16, and Pigment Blue (P.B.) 15. The white colourant of 1 patient contained rutile titanium dioxide but also other metals like nickel and chromium and methyl dehydroabietate – known as the main ingredient of colophonium. None of the 2 patients showed increased levels of ACE and sIL-2R related to sarcoidosis. Seven of the study participants showed partial or complete remission after treatment with topical steroids, intralesional steroids, or topical tacrolimus. Conclusions: The combination of the methods presented might be a rational approach to identify the substances that trigger adverse reactions in tattoos. Such an approach might help make tattoo colourants safer in the future if such trigger substances could be omitted.

Рациональная фармакотерапия артериальной гипертензии в реальной клинической практике: диуретики сквозь призму лекарственной безопасности

The use of diuretics in arterial hypertension is pathogenetically justified, which is due to the significant role of an increase in the volume of circulating blood and the retention of sodium ions in the internal environment of the body, in increasing blood pressure. In clinical guidelines, the choice of a diuretic for the treatment of hypertension is limited to 3 drugs: hydrochlorothiazide, chlorthalidone and indapamide. Thiazide and thiazide-like diuretics are often combined into a single group of "thiazides", however, they have significant differences in the mechanism of their action, clinical effects, drug safety profile, partly in the parameters of the effectiveness of blood pressure control, as well as the evidence base in randomized clinical trials. In the first part of the review, along with evidence of the effectiveness of the use of diuretics in arterial hypertension, various aspects of the drug safety of drugs in this group are considered, both possible metabolic disorders and more rare, but possible disorders of the organ of vision, skin adverse reactions and the risk of acute respiratory distress. -syndrome. The second part of the review considers the efficacy and safety of the thiazide-like diuretic indapamide.

Association between methotrexate-induced Stevens-Johnson syndrome/toxic epidermal necrolysis and furosemide: a real-world disproportionality analysis

ABSTRACT Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and life-threatening skin adverse reactions that are usually induced by drugs. This study aimed to assess the association between methotrexate and SJS/TEN when combined with furosemide. Research design and methods Data on suspicious, interactions (PS, SS, I) from the FDA Adverse Event Reporting System database for 2016–2021 were analyzed using the reporting odds ratio (ROR), information component (IC), proportional reporting ratio (PRR) and the Medications and Health Care Products Regulatory Agency (MHRA). Results We identified 28 case reports of TEN associated with the combination of furosemide and methotrexate and 10 reports of SJS associated with furosemide and methotrexate. The association of methotrexate with SJS/TEN was more significant in the entire data set when combined with furosemide than when methotrexate was not combined with furosemide. The association of methotrexate with SJS/TEN remained significant when furosemide was combined with methotrexate in a tumor-based disease context. After sensitivity analysis of the entire dataset as well as all antineoplastic drug datasets, consistent results were observed for TEN. Conclusions Our study confirmed a significant association between methotrexate and SJS/TEN when combined with furosemide, with an increased risk of SJS/TEN.

Adverse skin reactions to antiepileptic drugs - a review

Introduction and objective: Treatment with antiepileptic drugs (AEDs) is frequently used all around the world. Just like in the course of all the drugs administration, side effects may appear, including characteristic side effects presenting on the skin. The aim of the study was to analyse adverse skin reactions to antiepileptic drugs, focusing on their epidemiology, symptoms and treatment.&#x0D; Methods: Databases including PubMed and Google Scholar were browsed using keywords.&#x0D; Description of the state of knowledge: The majority of adverse skin reactions (ASRs) constitute mild rashes and urticaria, however in about 10% cases severe reactions may occur, which can be life-threatening. They include Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), Stevens-Johnson syndrome (SJS), Toxic Epidermal Necrolysis (TEN), Serum Sickness and Serum Sickness - like Reactions and Drug Induced Vasculitis. In the course of TEN mortality rates are highest, however all reactions can be dangerous and treatment should be applied immediately. In mild and moderate cases drug withdrawal is usually sufficient, however more severe cases need to be treated with immunosuppressive agents.&#x0D; Summary: The awareness about possible adverse effects and their treatment is crucial as some can be life-threatening and immediate therapy increases the chance of recovery.