Toxic Dermatitis Research Articles

Viral mixed infection complicated by acute hepatitis and allergic toxic dermatitis (clinical case)

Epstein-Barr virus (EBV) belongs to the family of herpesviruses (herpes type 4) and is one of the most common and highly contagious. During the pandemic of a new coronavirus disease, it was found that in patients previously infected with EBV, COVID-19 can cause its reactivation, which is often manifested by the clinic of acute hepatitis. The article presents a clinical case of the development of acute hepatitis in a patient with mixed infection with EBV and SARS-CoV-2 in combination with allergic toxic reaction while taking sulfasalazine prescribed for spondyloarthritis. A feature of this case was the development of severe hepatitis of mixed genesis with a favorable outcome. The importance of adherence to drug monitoring rules for newly prescribed drugs for COVID-19 was emphasized. In severe cases of the disease, the possibility of mixed infection should be taken into account.

Toxicoderma in a child as a complication after a bedbug bite

Background. Toxic dermatitis is an adverse skin reaction caused by various factors. Analysis of clinical cases helps identify problems, and plan future studies, which can change the understanding of the consequences of the disease. The purpose was to improve the diagnosis of allergic dermatoses in children, to analyze clinical and paraclinical features of their course, and biomarkers of sensitization to allergens. Materials and methods. Presentation of a case study was a basis for discussion, as well as literature search in the MEDLINE and Scopus databases. The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the ethics committee of the institution mentioned in the work. Informed consent of child’s parents was obtained for the research. Results. The clinical picture of toxic dermatitis is very diverse, almost any type of lesion can occur, and often the clinical symptoms are very similar to skin diseases that are not caused by various toxic agents. The most common clinical symptom is maculopapular exanthema. Conclusions. The peculiarity of the presented case is toxicoderma in a child after a bedbug bite. It is important to establish the correct diagnosis of toxic dermatitis, identify toxic agent, stop its exposure and treat the adverse reaction, usually with antihistamines and corticosteroids.

Shiitake dermatitis: experience of the Poison Control Centre Network in France from 2014 to 2019

Objective Shiitake mushrooms (Lentinus edodes) are an edible fungus, initially grown in Japan and China that are increasingly marketed in Europe. We previously presented 15 shiitake dermatitis cases reported to Poison Control Centres (PCCs) in France from January 2000 to December 2013. The aim of this study was to describe changes in the number of shiitake dermatitis cases since 2014, and to better describe the clinical characteristics and risk factors of this reaction. Case series This observational study is a retrospective review of cases in the French PCCs database between 1 January 2014 and 31 December 2019. Out of 125 shiitake exposures, we identified 59 cases of dermatitis: sex ratio of 1.80 M/F; ages ranging from 19 to 69 years (median: 39 years). Dermatitis occurred after raw or undercooked shiitake consumption (e.g., from the wok, in soup, or on pizza). The rash appeared 1–168 h (median: 48 h) after shiitake ingestion. Linear, erythematous, urticarial papules and plaques developed across the trunk, arms, and legs within a few hours and persisted for 1–40 d (median 10 d). The amount of shiitake eaten (low vs. medium vs. high) significantly increased the duration of dermatitis (median days 4 vs. 7 vs. 15, respectively; p = .007). In all, 38 patients received corticosteroids, antihistamine drugs, or both without demonstrated benefit. All patients made a complete recovery. Conclusions The mechanism of shiitake dermatitis is thought to involve lentinan, a heat-labile polysaccharide component. Inadequate cooking clearly seems to be a driver of the occurrence of shiitake dermatitis. This study highlighted a dose-dependent response, suggesting a partial toxic mechanism or a th1-type hypersensitivity mechanism. Treatment is focused on symptom management. Health professionals and the general population should be aware of both the risk associated with inadequately cooked shiitake consumption and the favourable prognosis of this still poorly known toxic dermatitis.

Causes, signs and medical care for poisoning with toxic technical fluids

Quite often, poisoning with toxic chemical liquids occurs when they are consumed instead of alcoholic beverages. In case of spills of toxic technical liquids, especially in closed rooms, conditions are created for inhalation and transcutaneous intake of toxic substances into the body. When these liquids come into contact with the skin, toxic dermatitis occurs, up to the detachment of the epidermis.

Toxicodermias

IntroductionToxic dermatitis is an adverse skin reaction caused by drugs. Toxic dermatitis is increasing in incidence due to the greater range of available drugs, as well as the aging population. Practically any drug can cause skin disorders. AetiopathogenesisThe mechanisms that cause toxic dermatitis are very varied and often unknown. Clinical pictureThe clinical picture is very varied, almost any type of lesion can occur and often the clinical symptoms are very similar to skin diseases that are not caused by drugs. The most common clinical picture is maculopapular exanthema. Diagnosis and treatmentOn occasion, adverse skin reactions to drugs can be of major importance. It is important to establish the correct diagnosis of a toxic dermatitis, identify the drug involved, discontinue its use and treat the adverse reaction, usually with antihistamines and corticosteroids.

Shiitake dermatitis in a 5-year old boy: First pediatric case report

Shiitake mushrooms are increasingly being consumed in the West because of their possible health benefits and changing dietarypreferences. A rare but increasingly occurring undesired effect caused by the thermolabile polysaccharide lentinan in the Shiitakemushroom is the incidence of a particular toxic dermatitis called flagellate dermatitis or Shiitake dermatitis. This dermatitis isextremely pruritous, heals without scarring in one to eight weeks and the effect of treatment is doubtful. The pathogenesis has notbeen completely explained and it is unclear why some people react more than others. We here present what we believe to be thefirst pediatric case of Shiitake dermatitis in a 5-year-old boy.

Clinical and morphological diagnostics of skin manifestations in case of graft-versus-host disease

The graft-versus-host disease is a life-threatening complication of allogeneic bone marrow transplantation, which demands fast and reliable diagnostics. Goal. To study clinical features of the graft-versus-host disease as well as differential and diagnostic value of histological and immunohistochemical signs in skin biopsy samples in case of graft-versus-host disease (GvHD). Materials and methods. The authors made a comparative assessment of clinical data available for patients suffering from acute GvHD (50 patients) and toxic dermatitis (10 patients). Skin biopsy samples taken from patients from both groups underwent postmortem and immunohistochemistry examinations: the drugs were stained with hematoxylin and eosin as well as by using anti-CD3, CD20, CD4, CD8, FOXP3, CD56, CD1a and CD 68 antibodies. Results. Based on the results of clinical data assessments, no significant differences in the groups were revealed. The morphological examination revealed that the number of eosinophils, CD8+, CD1a+, CD3+ and FOXP3+ cells and share of FOXP3+ cells among Т lymphocytes was higher in the group with toxic dermatitis. Conclusion. An integrated assessment of clinical data and morphological examination results accompanied by the analysis of the population composition of the infiltrate is needed to diagnose the acute GvHD.

Skin Rash with Eosinophilia Resulting from Bendamustine Plus Rituximab Treatment: A Hematological and Pathological Analysis of 5 Cases

Introduction: There are several treatment options for follicular lymphoma (FL) ranging from watchful waiting to chemoimmunotherapy using rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Recently, bendamustine plus rituximab (BR) therapy was shown to be more efficacious and less toxic when compared with R-CHOP. Significantly fewer hematological adverse events were observed in patients treated with BR therapy than in those treated with R-CHOP therapy. However, the development of a drug-associated skin rash was more common in BR-treated patients than in R-CHOP-treated patients. We examined 5 patients who developed skin rash following BR therapy. An interesting relationship between the development of skin rash and eosinophilia was noted using hematological and pathological analyses.Patients and Methods: We retrospectively evaluated 33 patients with indolent B cell lymphoma who were treated with BR therapy between January 2011 and June 2013 at the Nagasaki Genbaku Hospital. Of these 33 patients, 5 were diagnosed with BR-induced skin rash and required intervention.Results: Four patients developed skin rash after the first cycle of BR therapy and 1 patient after the third cycle of therapy. One patient had a grade 2 rash and 4 patients had a grade 3 rash. Two patients presented with an insect-bite like reaction and 3 had toxic dermatitis (Table 1). A skin biopsy was conducted in 3 patients, and the pathological diagnoses were erythema multiforme, chronic dermatitis, and superficial perivascular dermatitis with epidermal changes, respectively (Table 1). The 3 diagnoses differed from each other, but the presentation was similar in all 3 cases. Spongiosis, epidermal cell infiltration, and perivascular/accessory organ inflammatory cell infiltration were also observed in all 3 cases. Vesicle formation and eosinophil infiltration were seen in two cases (Table 2). The eosinophil level in the peripheral blood at the time that the skin rash appeared was elevated from 16% to 37%. Human leukocyte antigen (HLA) analysis was carried out for all patients, and it was found that 3 of the 5 patients had an A02:06:01/A24:02 haplotype. A typical clinical course is shown in Figure 1. The patient (Patient No. 3) had a grade 2 rash mainly on the body trunk following the first cycle of BR therapy. The diagnosis was toxic dermatitis. Elevation of the eosinophil level was observed at the same time as the appearance of the skin rash. Both the toxic dermatitis and eosinophilia gradually improved following treatment with steroid-containing ointment and fexofenadine hydrochloride, an anti-allergy drug. The fexofenadine hydrochloride was continuously administered until the last course of BR therapy without the recurrence of any skin rash and eosinophilia. The clinical course of the other 4 cases was similar to that seen in Patient No. 3.Conclusions: The findings from this study suggest that the skin rash that may develop after BR therapy can be accompanied by eosinophilia, and that the rash is treatable with steroid-containing ointment and anti-allergy drugs. The findings also suggest that the usage of anti-allergy drugs may prevent the occurrence of skin rashes and that they may be useful in preventing any delay in starting BR therapy. A specific HLA haplotype may correlate with the development of BR-induced skin rash. However, further studies are required to clarify this.Table 1The Diagnosis of the Type of RashPatient No.Dermatological diagnosisPathological diagnosis1 Insect-bite reactionErythema multiforme2 Insect-bite reactionChronic dermatitis3Toxic dermatitisSuperficial perivascular dermatitis with epidermal changes4Toxic dermatitis (Edematous erythema) 5Toxic dermatitis (Edematous erythema)Table 2Summary of Skin Biopsy ResultsPathologoical findingsPatient No.1Patient No.2Patient No.3Vesicle formation2++-Spongiosis+++Epidermal inflammatory cell infiltration+++Peri-vascular/accessory organ inflammatory cell infiltration2+++Eosinophil infiltration2++- [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Shiitake dermatitis recorded by French Poison Control Centers – new case series with clinical observations

Context. Shiitake (Lentinula edodes) is an edible mushroom which was initially grown in Japan and China and is now sold on the European market. Flagellate erythema may arise following shiitake consumption and was first described in Japan in 1974. Objective. This paper reports a French shiitake dermatitis case series. Methods. The findings of retrospective study of shiitake dermatitis cases, reported to French Poison Control Centres (PCC) from January 2000 to December 2013, are reported. Results. Among 32 exposed patients, 15 presented flagellate urticarial lesions after raw shiitake consumption. The first case of this series was reported in 2006 and the last nine cases were reported as of 2012. After shared meals, no symptoms were reported among guests, who preferred cooked shiitake to the raw mushroom. In this series, rashes appeared 12 h to 5 days (median: 24 h) after raw shiitake ingestion. Linear and itchy urticarial lesions formed on the trunk, arms, and legs within a few hours and persisted for 3–21 days. In four cases, rash and pruritus were either triggered or worsened by sun exposure. Eleven patients received corticosteroids, antihistamines, or both. All patients completely recovered. Conclusion. Due to the rapidly increasing consumption of exotic food in Western countries, it is no surprise that cases of shiitake dermatitis are now appearing in Europe. The mechanism of shiitake dermatitis is thought to be toxic and due to lentinan, a polysaccharide component of the mushroom. There is no specific validated treatment for shiitake dermatitis. Health professionals and the general population should be aware of both the risk associated with raw shiitake consumption and of the good prognosis of this very spectacular and uncomfortable toxic dermatitis.

Schwere toxische Dermatitis nach Injektionslipolyse

The subcutaneous injection of phosphatidylcholine-containing substances is a frequently used method to reduce small localized fat deposits. Even though injection lipolysis is generally safe and free of complications, there have been rare reports on poor results, hematoma, infection or localized skin and tissue necrosis. A 28-year-old woman presented with an extensive toxic dermatitis characterized by well defined, erythematous, partly livid plaques as well as severe edema and strong pain about eighteen days after injection lipolysis on the thighs and knees.

Prinzipien der Behandlung und Schutz für empfindliche Haut

Patients with sensitive skin complain of itching, burning, pricking or stretching sensations of the skin and even pain following application of external agents or exposure to certain environmental factors. In most cases of sensitive skin the cause remains unclear and allergic contact dermatitis, toxic irritant dermatitis or contact urticaria can be diagnosed only in a few patients. After exclusion of known exogenous or endogenous causes patients should be informed on the characteristics of sensitive skin. Potential irritating substances and procedures should be extensively avoided or utilized cautiously.

Toxic dermatitis in patients treated with Taxotere® (docetaxel): three case reports

Three out of 25 patients receiving the same batch docetaxel, developed toxic dermatitis within 5 days after administration. Timing of occurrence was equal and symptoms were similar. Two patients continued with docetaxel without any problems. There is no assignable cause found that could explain the toxic dermatitis.

Limits of Simplicity

TO THE EDITOR: Palmar-plantar erythrodysesthesia (PPE) is a time-honored term in clinical oncology that has found its way into textbooks and public dictionaries. It accurately describes a typical adverse effect of continuous-infusion fluorouracil, oral capecitabine, and other cytotoxic anticancer agents. With time, the descriptive term PPE has been replaced with the term hand-foot syndrome (HFS), which is preferred for its simplicity. With the advent of the multikinase inhibitors sunitinib and sorafenib, a new type of dermatologic toxicity has been recognized. It consists of callosities (thickened callous skin) that are usually in patchy distribution on palms and soles, mostly located where skin is subjected to particular pressure or strain (heel, ball, or above joints), often painful, and sometimes ulcerated or blistering. This type of dermatitis has been called hand-foot-skin reaction (HFSR). Unfortunately, HFSR is being confused with HFS. Many oncologists have become negligent in this respect, calling any toxic dermatitis on the palms and soles HFS. This is clearly an undue medical simplification because the dermatitis induced by capecitabine is clearly different from the dermatitis induced by sunitinib or sorafenib both clinically and histologically and, most importantly, requires different dermatologic treatment. Dermatologists should help us distinguish the two conditions, perhaps by using time-honored descriptive terms such as PPE. What then could be a descriptive term for HFSR? Should we call it palmar-plantar patchy callosities (PPPC)? Maybe you have a better idea.

Haut und Auge

Numerous diseases affect both skin and eyes due to similar ontogenetic origin. The eye is the second most common site of melanoma after the skin. The eyelids are predisposed for development of toxic and allergic dermatitis as the skin in this region is four times thinner than the other facial skin. The differential diagnosis must include atopic and seborrhoeic eyelid dermatitis. Atopic and vernal keratoconjunctivitis are associated with atopic eczema. Various immunobullous disorders involve the conjunctiva with varying severity. Side effects of dermatologic treatments with glucocorticoids, antimalarials, psoralens, retinoids, or tetracyclines may involve the eye.

Hemorrhagic bullous henoch schonlein purpura: a diagnostic challenge for paediatricians

Patients A 9-year-old girl and 11-year-old boy were admitted to our hospital with abdominal pain, arthralgia, ecchymoses and petechiae at legs, arms and buttocks. Shortly, large, tense hemorrhagic bullae and vesicles (2 to 30 mm) developed over the purpuric rash, while petechiae spreaded over face and neck. Both patients were prostrate and drowsy with a diffuse oedema of periorbital region, hands and feet. Laboratory tests showed increased CRP 5.2 mg/ dl, WBC 23 × 109/L and PTL 623 × 109/L. Serological investigation for viruses (Epstein Barr Virus, Cytomegalovirus, and Hepatitis-C Virus) and bacteria were negative. ANA, pANCA, cANCA absent. Urinalysis showed proteinuria (1 g/24 h) and hematuria (1074 red blood cells/ field) in the girl. Cardiologic evaluation, lung X-ray, and abdominal ultrasound were unremarkable. Due to an aggressive infection of the cutaneous lesions, imipemen and teicoplanine were introduced. Three pulses of methylprednisolone were given to the girl, and then oral prednisone (2 mg/kg/daily) to control renal disease. Bullae faded within the next two weeks and necrotic lesions healed leaving a mild pigmentation and scars. Conclusion In childhood HSP the occurrence of hemorrhagic bullae may be a diagnostic challenge at onset in absence of other typical symptoms as many paediatric diseases including toxic epidermal necrolisis, erythema multiform, pemphigus, bullous impetigo, dermatitis herpetiformis and staphylococcal scalded skin syndrome may present with bullous cutaneous lesions. from 15th Paediatric Rheumatology European Society (PreS) Congress London, UK. 14–17 September 2008

Skin irritants and contact sensitizers induce Langerhans cell migration and maturation at irritant concentration

Skin irritants and contact allergens reduce the number of Langerhans cells (LCs). It has been assumed that this reduction is due their migration to the draining lymph node (LN) for initiating immune sensitization in a host. Skin irritation, however, as opposed to contact allergy is not considered to be an immunological disease. Nevertheless, skin irritants are also known for their adjuvant-like effects on contact allergy, resulting in skin hypersensitivity reactions like toxic dermatitis. The human organotypic skin explant culture (hOSEC) model is used to study the characteristics of chemical-induced migration of CD1a(+) LCs out of the epidermis in relation to irritancy or toxicity. We analysed cells emigrating out of hOSEC for CD1a(+) LCs, CD83(+) mature dendritic cells (DCs) and CCR7(+) LN homing cells. After exposure to a toxic concentration of a non-immunogenic irritant, an increase of CD1a(+)CD83(+) LCs was found in the culture medium. A non-toxic concentration of an sensitizer induced an increase of CD1a(+) cells. About 50% of skin emigrating CD1a(+) LCs were CD83(-) (immature) but all were CCR7(+). Skin irritation by both non-allergenic and allergenic compounds induces LC migration and maturation. In contrast, only allergenic compounds induced LC migration with partial maturation at subtoxic concentration. This effectively demonstrates that irritation is physiologically needed stimuli for inducing LC maturation.

Nécrolyse épidermique toxique. Revue des cas observés dans le service de réanimation du centre national hospitalier et universitaire de Cotonou

Introduction. – Toxic epidermal necrolysis (TEN) is usually a drug-induced disease, involving vital or functional prognosis with 20 to 30% mortality rates. Objectives. – The aim was to collect cases of TEN in an intensive care unit in Cotonou National University and Teaching Hospital, and describe epidemiologic, clinical, therapeutic and evolutive patterns. Study design. – Retrospective and descriptive study over five years. Patients and methods. – The medical report–forms of patients admitted between January 1998 and December 2002, for toxic dermatitis with total skin injury area more than 10% were reviewed. Results. – Fourteen patients with TEN were identified. The average incidence was three cases per year, accounting for 0.25% of the admissions in the unit. Sulphonamides ( n = 4), antituberculous drugs ( n = 2), penicillin ( n = 3) were the main cause of TEN. In five patients, the cause was not found. Self-medication was found in 7 patients. Total skin injury area reached from 26 to 87%. Mucosal and viscera injury occurred in respectively 11 and 9 patients. The treatment was usual as in extended burns. Four patients died (28.5%). The average time before hospitalisation was 11.4 days. Conclusion. – The growing-awareness of people can prevent/reduce the morbidity and improve the prognosis of TEN.

Toxische Phytodermatitis nach Kontakt mit Euphorbia helioscopia L. (Sonnenwend-Wolfsmilch)

A 6-year-old patient presented with linear erythema and bullae on the face. The lesions developed after playing with plants the day before. The plant was identified as Euphorbia helioscopia L. (sun spurge). The sun spurge belongs to the Euphorbiaceae plant family. These plants produce a typical milky juice that causes toxic reactions following contact with skin and mucous membranes. In the literature several cases of toxic dermatitis caused by plants of the Euphorbiaeae family have been described. The most important differential diagnosis of these skin lesions is the bullous phototoxic dermatitis caused by psoralens. Plant-induced toxic dermatitis is of increasing importance in dermatology. The exact determination of the causative plants is a prerequisite for the diagnosis of phytodermatitis.

Disturbance in the Well-being of a Patient with Acne: Suggestions for Anticipation and Detection

Sir, According to surveys, approximately 30–50% of persons between 12 and 20 years of age with acne show psychological responses to their disease, which includes lowered self-esteem, lack of self-confidence, perceived social rejection as well as anxiety and depression (1–6). We describe here a patient with acne who suffered from a toxic dermatitis after topical application of a wart solution on his acne lesions due to an unrecognized reduction of his well-being.

Role of superantigens in dermatology.

Superantigens are very potent agonists of T-lymphocytes. The superantigenic types of reactions on various subsets of T-lymphocytes are compared with those of classical antigens and aspecific mitogens. The role they could play in skin disease is reviewed with special emphasis to acute and chronic diseases, auto-immunity, immediate type reactions, immunodeficiency, carcinogenesis, psoriasis and other inflammatory cutaneous conditions.