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Biomedical subjects

J Revuz

Publications and source records attributed to J Revuz.

At least 163 records · Page 9Linked to original sources
PubMed1995

Drug-induced severe skin reactions. Incidence, management and prevention.

Severe skin adverse drug reactions can result in death, but the rate of such events is fortunately low. The incidences of Stevens-Johnson syndrome and toxic epidermal necrolysis range from 1.2 to 6 per million per year and 0.4 to 1.2 per million per year, respectively. Stevens-Johnson syndrome is fatal in about 5% and toxic epidermal necrolysis in 30% of cases. Drugs implicated in these diseases are the sulphonamides, anticonvulsants, allopurinol, pyrazolone derivatives, oxicams and chlormezanone. The principles of symptomatic treatment are the same as for burns, and patients with extensive skin detachment should be transferred to an intensive care unit or a burn centre. Hypersensitivity syndrome is characterised by mucocutaneous eruption and fever with frequent lymphadenopathy, hepatitis and eosinophilia. Drugs implicated are mainly anticonvulsants and sulphonamides. The mortality rate of such a reaction has been estimated to be about 8%. Corticosteroid therapy has been widely used in hypersensitivity syndrome, despite the lack of controlled studies. Drug-induced vasculitis and serum sickness may also be life-threatening when the kidney, liver, gastrointestinal tract or nervous system are involved. In angioedema, congestion may involve mucous membranes and therefore impair swallowing and ventilation. Drugs associated with angioedema include penicillins, radiographic contrast agents and ACE inhibitors. Severe forms of angioedema necessitate epinephrine (adrenaline) subcutaneous injection and possibly resuscitative efforts. Corticosteroids and/or antihistamines are used to block or reduce prolonged or late phase reactions. Prompt recognition and withdrawal of the suspected drug is essential in severe drug-induced skin reactions.

Angioedema↗
PubMed1995

Erythema multiforme with mucous membrane involvement and Stevens-Johnson syndrome are clinically different disorders with distinct causes.

BACKGROUND AND DESIGN: It was recently suggested that erythema multiforme (EM) majus and Stevens-Johnson syndrome (SJS) could be separated as two distinct clinical disorders with similar mucosal erosions but different patterns of cutaneous lesions. To test that hypothesis, we made a single-center retrospective study of severe EM with skin and mucosal involvement. Based on a review of clinical photographs, the skin lesions were reclassified as EM when these lesions were made of typical or raised atypical targets that were located on the extremities and/or the face, or as SJS when these lesions were made of flat atypical targets or purpuric maculae that were widespread or distributed on the trunk. Another investigator who was blinded for that clinical classification related each case to its more probable cause (eg, herpes infection or drug-induced reaction), by using scores derived from the medical charts. RESULTS: The majority (80%) of 76 cases could be classified as one of the two disorders: 28 as EM (37%), 33 as SJS (43%), and 15 as "undetermined" (20%). By using causal scores, the 76 cases were classified as herpes-induced (n = 18 [24%]), drug-induced (n = 40 [52%]), and "other" (n = 18 [24%]). There was a strong correlation between the clinical classification and the probable cause (K = 0.87, P < .001). Specifically, EM was mostly related to herpes (17 of 28 cases) or to other causes (eight of 28 cases); however, EM was rarely related to drugs (three of 28 cases), while SJS was nearly always related to drugs (28 of 33 cases) and never to herpes. CONCLUSIONS: The results of this study support the suggestion that EM with mucosal lesions and SJS could be distinguished on the basis of two different clinical patterns. In addition, a strong relationship was observed between each pattern and specific causes. This is one more piece of evidence that suggests that EM with mucosal lesions and SJS are actually two different diseases.

Adolescent↗
PubMed1995

Metabolic predisposition to cutaneous adverse drug reactions. Role in toxic epidermal necrolysis caused by sulfonamides and anticonvulsants.

BACKGROUND AND DESIGN: Cutaneous adverse drug reactions (ADRs) have been hypothesized to have a metabolic basis. Our aim was to identify detoxification defects involved in toxic epidermal necrolysis and other severe cutaneous ADRs. Lymphoid cells of 33 patients with cutaneous ADRs were challenged with reactive metabolites generated from drugs by a microsomal oxidation system. To be precise in the detoxification defect involved in sulfonamide and anticonvulsant reactions, we challenged lymphoid cells from 11 patients (seven patients with sulfonamide ADRs and four patients with anticonvulsants ADRs) to menadione and formaldehyde. Menadione induces toxic effects by oxygen species; formaldehyde is detoxified by aldehyde dehydrogenase, oxidase, and reductase. RESULTS: When the culprit drug was a sulfonamide or an anticonvulsant (used in 13 and 13 patients, respectively), the toxic effects of culprit drug-reactive metabolites toward patients' lymphoid cells were higher than toward controls'. First-degree relatives of four patients with sulfonamide- and phenobarbital-induced toxic epidermal necrolysis were also tested. In each family, a relative was more susceptible to culprit drug-reactive metabolites than were controls. After incubation with menadione, or formaldehyde, no difference in toxicity was found between patients' and controls' lymphoid cells. CONCLUSIONS: Toxic epidermal necrolysis and other severe cutaneous ADRs to sulfonamides and anticonvulsant drugs may be linked to a highly specific defect in the detoxification of culprit drug-reactive metabolites. Our results suggest that this defect is constitutional and inherited and does not involve oxygen free radicals and/or aldehyde detoxification pathways.

Adolescent↗
PubMed1995

Characteristics of toxic epidermal necrolysis in patients undergoing long-term glucocorticoid therapy.

BACKGROUND AND DESIGN: The usefulness of steroid therapy in toxic epidermal necrolysis (TEN) remains controversial. Up to 5% of the TEN cases occur in patients who undergo long-term steroid therapy. We, thus, looked for the potential effect of long-term glucocorticosteroid therapy before the onset of TEN on altering the progression of the disease. The records of 179 patients were reviewed. The characteristics of the 13 patients who were undergoing long-term glucocorticosteroid therapy were compared with those of 166 other patients with TEN. The following parameters were studied: age, mortality, delay between the introduction of the suspect drug and the onset of TEN, length of hospital stay, body surface area involved, time elapsed between the first symptom of TEN and hospital admission, number of medications taken by the patients before the onset of TEN, lymphocyte count, granulocyte count, platelet count, glycemia, serum aspartate aminotransferase level, and total disease duration. RESULTS: Patients who were undergoing long-term glucocorticosteroid therapy differed from other patients with TEN in the administration of more drugs, longer delay between the introduction of the suspect drug and the onset of TEN, and a longer time elapsed between the first symptom of TEN and hospital admission. We observed no differences for the other parameters that were studied. CONCLUSION: Our study shows that long-term steroid therapy may delay the onset of TEN, but it does not halt its progression.

Adolescent↗
PubMed1995

[Hypersensitivity syndrome caused by dapsone. Transient circulating clone T].

INTRODUCTION: Hypersensitivity is a rare side-effect of dapsone. The most complete clinical presentation associates papulous exanthema, lymph node enlargement, liver cell failure and an increase in mononuclear and eosinophil counts. CASE REPORT: A 45-year-old woman developed hypersensitivity to dapsone when this drug was used to treat corticoid-dependent asthma. A transient circulating clone T was demonstrated by Southern blot during the acute phase. The clinical manifestations and laboratory findings returned to normal under systemic corticosteroid treatment. When corticoids were tapered off, hypersensitivity reactions began to progress again. DISCUSSION: Transient circulating clone T, as observed here, emphasizes the importance of close surveillance and long-term follow-up in drug-induced hypersensitivity syndromes.

Anti-Asthmatic Agents↗
PubMed1995

[Eruptive nevus in the course of Lyell syndrome].

INTRODUCTION: Eruptive nevus have been described after severe bullous cutaneous adverse drug reactions. We report herein a berloque-like nevus extension after toxic epidermal necrolysis. CASE REPORT: A 23 year-old woman was hospitalized for toxic epidermal necrolysis. A blister was in contact with a nevus. Four months after healing, extension of the nevus was seen on the blister area. DISCUSSION: During toxic epidermal necrolysis and healing: 1) cytokines and growth factors are produced favouring nevocytes proliferation; 2) macromolecules are exposed on the wound bed; 3) adhesion molecules are expressed on nevocytes, restricting cell migration on exposed macromolecules. Interaction between matrix macromolecules and adhesion molecules could explain the limitation of nevus extension.

Adult↗
PubMed1995

[Cosmetic dermopigmentation. The pigment stays ... as do regrets].

INTRODUCTION: Cosmetic dermopigmentation designates tattooing of the superficial derma with pigments in order to obtain an aesthetic effect. We observed two cases illustrating the inconveniences of this technique. CASE REPORTS: Two women underwent dermopigmentation on the face in a beauty institution to create pseudo-freckles. Definite macular hyperpigmentation occurred with dyschromia in both subjects. COMMENTS: There is a major risk in subjects who undertake dermopigmentation of freckles and/or naevus, a practice which should be discouraged by dermatologists.

Adult↗
PubMed1995

[Exclusive nodular plexiform neurofibroma. An unusual case of neurofibromatosis type 1].

INTRODUCTION: Type 1 neurofibromatous tumours (NF) are benign skin tumours which include cutaneous, subcutaneous and plexiform neurofibromas. Plexiform neurofibromas are either diffuse or nodular, the latter form being much more frequent. CASE REPORT: We observed a particular form of neurofibroma in an 18-year-old patient who developed large deep subcutaneous which histology examination revealed to be exclusively nodular plexiform neurofibromas. The patient also had 6 café au lait spots leading to the diagnosis of sporadic NF 1. He did not have acoustic neuronoma, schwannoma or posterior cataract, eliminating NF 2. COMMENTS: In NF 1, subcutaneous neurofibromas develop in 5 p. 100 of the patients. These lesions are termed nodular plexiform neurofibromas when they form long formations along nerve branches. The exclusive nature of the nodular plexiform neurofibromas in our case was exceptional. It could be hypothesized that the particular phenotype in our patient might correspond to a particular anomaly of the NF 1 gene.

Adolescent↗
PubMed1994

Internal involvement in localized scleroderma.

We studied 76 consecutive patients with localized scleroderma (morphea with or without linear scleroderma) and analyzed the frequency, prognosis, and predictors of internal involvement in a subset of 53 patients systematically investigated for the presence of such involvement. Internal involvement was found by systematic examination in 16 patients. Only 2 of them, including 1 patient who developed systemic scleroderma, had symptomatic and severe visceral disease. The other 14 patients had asymptomatic and minor abnormalities consisting of abnormal lower sphincter pressure, and/or peristaltic failure in the esophagus and slightly impaired carbon monoxide diffusion in the lung. Frequent seroimmunologic abnormalities had no predictive value. Three parameters were found to be associated with internal involvement: male gender (p < 0.05), increasing number of plaque-like lesions (p = 0.02) and hypergamma-globulinemia at 1st examination (p < 0.005). Mild esophageal and pulmonary involvement are not rare in morphea but are usually silent. In our series, after a median follow-up of 48 months, such involvement did not impair the prognosis. The mildness of these visceral abnormalities suggests that they do not justify routine detection in asymptomatic patients. Morphea and systemic scleroderma behave as 2 different diseases.

Female↗