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PubMedDate not supplied

A review of NSAID complications: gastrointestinal and more.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely prescribed medications in the world. Their use is associated with significant morbidity, commonly including gastrointestinal, renal, and hepatic effects. Other less common effects include otic, central nervous system (CNS), ophthalmic, allergic, and dermatologic effects. Recognizing and diagnosing potential complications are imperative to obtain favorable outcomes in patients on NSAIDs. Among the NSAIDs currently on the market, there exists a wide variability of incidence of organ-specific side effects. Some of these side effects are class specific, but most are not. Much research also is being performed in the field of COX-2-specific inhibitory agents, which would theoretically reduce the gastrointestinal insult of these drugs. Patient awareness through education is crucial in decreasing morbidity and preventing the adverse effects of these drugs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2001

Occurrence of serious adverse effects in patients receiving community-based therapy for multidrug-resistant tuberculosis.

SETTING: A community-based treatment program for multidrug-resistant tuberculosis (MDR-TB) in an urban shantytown of Lima, Peru. OBJECTIVES: To ascertain the occurrence of serious adverse effects associated with therapy for MDR-TB in northern Lima, Peru, where therapy was individualized according to drug-susceptibility testing of patients' infecting strains and delivered through a community-based program. DESIGN: A retrospective record review of 60 patients who had received individualized therapy for MDR-TB between September 1996 and October 1998. RESULTS: Although adverse effects were common, they occurred less frequently than previously reported in the literature and were rarely life-threatening. Effects occurring most frequently in this population included: mild gastritis (100%), dermatological effects (43.3%), peripheral neuropathy (16.7%), depression (18.3%), and anxiety (11.7%). These effects never resulted in the discontinuation of anti-tuberculosis therapy, and only occasionally resulted in the suspension of an agent (11.7%). CONCLUSION: In young patients with little comorbid disease, multidrug, long-course regimens rarely caused life-threatening adverse effects. Common side effects may be managed successfully on an out-patient basis through a community-based treatment program in conjunction with MDR-TB experts, even in resource-poor settings. The very low rate of default in this cohort offers hope that strategies to manage the adverse effects may reduce the incidence of abandonment of therapy and increase rates of cure.

Adolescent↗
PubMed1990

[Evaluation of cutaneous risks of the Pill].

Despite the fact that about 150 millions women must have taken hormonal contraceptives all over the world since the 1960s, the risk/benefit ratio of this birth control method has yet not been reliably assessed. The side effects of the pill on the skin do not pertain, in general, to those (like thrombo-embolism or, perhaps, breast cancer) which might be life-threatening, but they are probably more frequent and may have a potential to alter the quality of life of women who use it. The aim of this paper is to review the dermatological effects of hormonal contraceptives from the point of view of everyday prescribing, with the emphasis on the quality of life of patients. The reported side effects of the pill are therefore classified according to their real or probable frequency, not to their severity or the theoretical importance of their mechanisms. As it would be unwise to speak of the risks without consideration for the benefits, an attempt is made to compare the dermatological safety profile of oral contraceptives to that of other birth control methods (barrier contraceptive methods, intrauterine devices, etc.) on the one hand; on the other hand, one insists upon the fact that the pill in itself may have health benefits, general (reduction in the incidence of some cancers) or dermatological (e. g. an effect on acne).

Adult↗
PubMed1995

[Multiple cutaneous neoplasms in cyclosporine therapy after kidney transplantation].

We report on a 56-year-old renal allograft recipient receiving cyclosporin A immunosuppression. During this therapy he subsequently developed the following cutaneous neoplasms: squamous cell carcinomas, basal cell carcinomas, Bowen's disease, actinic keratosis, sebaceous hyperplasia, a dysplastic naevus and, finally a nodular malignant melanoma. Adverse effects of the cyclosporin A therapy are discussed, with special reference to dermatologic effects and the implications for patient and doctor.

Bowen's Disease↗
PubMed2000

The safety profile of the fluoroquinolones.

BACKGROUND: Premarketing trials showed the fluoroquinolone agents to have a favorable side-effect profile, with treatment-related adverse events comprising gastrointestinal, central nervous system, and dermatologic effects that were generally mild and reversible on cessation of treatment. However, postmarketing surveillance studies have identified severe adverse events, including severe anaphylaxis, QTc-interval prolongation, and potential cardiotoxicity, associated with 3 quinolone agents that either resulted in the removal of the agent from the market (temafloxacin and grepafloxacin) or significantly restricted its use due to substantial mortality and morbidity associated with liver toxicity (trovafloxacin). To date, there have been no such significant adverse events associated with the older fluoroquinolone agents, including ciprofloxacin, ofloxacin, norfloxacin, and levofloxacin. However, there are fewer data from postmarketing surveillance studies on the most recently approved agents, such as moxifloxacin and gatifloxacin, or agents awaiting approval, such as gemifloxacin. OBJECTIVE: This paper examines safety data from the premarketing trials and postmarketing surveillance studies of fluoroquinolones available in the United States. METHODS: A MEDLINE search was performed to identify all English-language studies published since 1980 concerning the safety profiles of the fluoroquinolones. CONCLUSIONS: The fluoroquinolone antibacterial agents offer broad-spectrum therapy in patients with a variety of infections. Given similar spectra of activity, the choice between quinolones may be based on differences in efficacy and safety or tolerability profiles. Most drug reactions involving these agents are minor and reversible on discontinuing treatment, but adverse effects can be associated with significant mortality and morbidity, as was seen in the case of trovafloxacin and temafloxacin.

Anti-Infective Agents↗
PubMed1989

Maximising safety when prescribing non-steroidal anti-inflammatory drugs.

Current knowledge on side-effects of non-steroidal anti-inflammatory drugs (NSAIDs) is reviewed. These occur most commonly in the gastro intestinal tract and include peptic ulceration and haemorrhage as well as effects on the small and large bowel. Renal effects with many manifestations are also increasingly described. Photosensitivity is the most common adverse dermatological effect. The role of various NSAIDs in causing asthma is now well recognised. Many less common side-effects occur, the most significant of which is marrow aplasia. Phenylbutazone and indomethacin are rarely but definitely associated with this, but other NSAIDs including ibuprofen are also suspected, but unproven, causes. A strategy for minimising side-effects is outlined. Where there is not a strong indication for use of an NSAID, local physical measures or a pure analgesic can be substituted. If an NSAID is really necessary, it is best to commence with a drug of lesser potency in the first instance, unless the patient is suffering from a severe inflammatory disorder. Indomethacin and piroxicam should be reserved for when other NSAIDs have not been effective. Patients who have a past or present history of peptic ulceration but still need to continue their NSAID therapy, should combine it with an anti-ulcer drug. In the case of younger patients a H2 receptor antagonist is the drug of first choice, whereas in the older patient a mucosal protective agent such as sucralfate is preferred. In the event of ulcer relapse, combination with a prostaglandin analogue is the next step. The growing awareness of side-effects with NSAIDs suggests that monitoring of patients commencing NSAIDs and on long-term treatment, should be increasingly practiced.

Anemia, Aplastic↗
PubMed2004

Specialty clinics for the dermatologic care of solid-organ transplant recipients.

BACKGROUND: Solid-organ transplant recipients constitute a complex patient population that experiences numerous and aggressive skin cancers. Proactive, comprehensive, ongoing, and effective dermatologic care of these patients is a necessity. OBJECTIVE: The objective of this study was to emphasize the need for organized dermatologic care for transplant recipients and to collect and present various proactive paradigms established in and designed for different practice settings to manage organ transplant recipients at high risk for skin cancer. METHODS: Information about practice setting, patient demographics, and the care model used was obtained through questionnaires sent to a selection of 12 physicians known to care for transplant recipients in various practice settings. RESULTS: All 12 physicians completed the questionnaire. The organized dermatologic care of transplant recipients occurs in three basic clinic settings: multidisciplinary transplant clinics, designated dermatology transplant subspecialty clinics, and integration of transplant recipient care within existing dermatology clinics. CONCLUSIONS: Various practice settings offer both advantages and disadvantages in providing preventive and therapeutic care of organ transplant recipients at risk for skin cancer. Regardless of the clinic design used, an organized and firmly established clinic model to allow proactive and ongoing care for these patients is important for education, prevention, and early intervention.

Dermatology↗
PubMedDate not supplied

Adverse health effects of selenium in humans.

Epidemiologic studies and case reports have shown that chronic exposure to selenium compounds is associated with several adverse health effects in humans. An early toxic effect of selenium is on endocrine function, particularly on the synthesis of thyroid hormones following dietary exposure of around 300 micrograms Se/d, and on the metabolism of growth hormone and insulin-like growth factor-1. Other adverse effects of selenium exposure can be the impairment of natural killer cells activity and at higher levels, hepatotoxicity and gastrointestinal disturbances. Dermatologic effects, such as nail and hair loss and dermatitis, occur after exposure to high levels of environmental selenium. Assessing the toxicity and morbidity after long-term exposure to environmental selenium is difficult: neurotoxicity, particularly the degeneration of motor neurons leading to increased risk of amyotrophic lateral sclerosis, might occur after chronic exposure to both organic and inorganic selenium compounds. The results of laboratory investigations and cohort studies suggest that selenium species exhibit a bivalent effect in cancer, either increasing or decreasing risk. Current environmental selenium exposure limits appear to be inadequate for averting adverse health effects.

Biomarkers↗
PubMed2005

Side effects associated with the treatment of multidrug-resistant tuberculosis.

SETTING: Süreyyapaşa Centre for Chest Diseases and Thoracic Surgery, Istanbul, Turkey. OBJECTIVE: To report the frequency of treatment side effects in cases of multidrug-resistant (MDR-TB) tuberculosis. DESIGN: A retrospective review of the medical records of 263 patients who received individualised treatment for MDR-TB between April 1992 and June 2004. RESULTS: One or more side effects developed in 182 cases (69.2%). These effects led the clinicians to withdraw one or more drugs from the treatment regimen in 146 cases (55.5%). Side effects observed most frequently included: ototoxicity (41.8%), psychiatric disorders (21.3%), gastrointestinal disturbance (14.0%), arthralgia (11.4%), epileptic seizures (9.9%), hepatitis (4.5%), and dermatological effects (4.5%). At the time of analysis, treatment was successful in 204 (77.6%) cases. Fifty-nine patients (22.4%) had poor outcomes. CONCLUSION: Timely and aggressive management of drug side effects means that high side effect rates in MDR-TB treatment need not compromise success rates.

Administration, Oral↗
PubMedDate not supplied

A comparison of the efficacy and safety of lymecycline and minocycline in patients with moderately severe acne vulgaris.

A multicentre, randomised, double-blind and double-dummy study was conducted to compare the efficacy and safety of lymecycline (n = 71) with that of minocycline (n = 73) in 144 patients with moderately severe acne vulgaris. Patients with an acne score of 1-5 on the Leeds scale received oral lymecycline, 300 mg/day for 2 weeks, then 150 mg/day for 10 weeks or oral minocycline, 100 mg/day for 2 weeks then 100 mg every other day for 10 weeks. Inflammatory, non-inflammatory and total lesion counts were determined at baseline (week 0) and after 4, 8 and 12 weeks' treatment, and global efficacy and safety assessments were made by the patient and investigator at the end of the study. Both treatments were equally effective at reducing differential lesion counts and improving acne condition and severity, with no significant differences between treatments. Inflammatory lesions were reduced by 50.6% and 52.2% with lymecycline and minocycline, respectively, and non-inflammatory lesions by 40.6% and 32.2%. Acne severity was reduced by 42.4% with lymecycline and by 47.9% with minocycline. A total of 4.3% of lymecycline recipients and 4.1% of minocycline recipients experienced treatment-related adverse events, the majority of which were mild in nature. Lymecycline was as effective as minocycline for the treatment of moderately severe acne vulgaris. Both treatments were well tolerated, although there were slightly fewer adverse gastrointestinal and dermatological effects with lymecycline.

Acne Vulgaris↗
PubMed2003

Onycholysis associated with paclitaxel.

Chemotherapeutic agents are known to cause a myriad of cutaneous side effects that the dermatologist is often called upon to identify and treat. The taxoid drug paclitaxel is commonly used in oncology. To date, there have been few adverse dermatologic effects reported secondary to paclitaxel use. This is in contrast to the related drug docetaxel. We report a case in which paclitaxel caused onycholysis and nail loss in a patient being treated for lung cancer. To our knowledge, this finding has not previously been reported in the American dermatologic literature, though it has been reported in association with docetaxel use. It is important for clinicians to recognize that onycholysis can be associated with paclitaxel. Prompt recognition may prevent the unnecessary use of antibiotics or antifungal medications. Discontinuation of paclitaxel chemotherapy generally is not required, and regrowth of nails can be expected following completion of therapy.

Adenocarcinoma↗
PubMed1977

Failure of hand disinfection with frequent hand washing: a need for prolonged field studies.

In a prolonged field trial a 4% chlorhexidine digluconate detergent scrub (Hibiscrub(R)), that had earlier proved to be an effective hand disinfectant, was studied in hospital wards. Finger tips were found to harbour more bacteria than the hand dorsum and the samples collected from them yielded more information on the bacteriological and dermatological effects of hand disinfectants in practice.In wards with a relatively low hand-washing frequency (less than 20 times in 8 hours) the bacteriological results resembled those obtained by in-use tests with volunteers. In the neonatal unit where the hand washing frequency was remarkably high, even occasionally over 100 times/8 h shift, an increase in the bacterial colony counts of the majority of the staff was recorded both before and after hand washing already after using the preparation for 1 week. Age, occupation and hand-washing frequency all correlated with the bacteriological results. Twenty-seven out of 37 persons complained of side effects such as wounds of finger tips and redness or heavy drying of the skin. Wounds, particularly on finger tips, resulted in the failure of disinfection. An increase in bacterial counts was sometimes noted without any dermatological or subjective changes. Drying of the skin was complained of less often when no increase in skin bacteria occurred.After the changeover of washing practice to a detergent followed by a rinse with spirit solution containing chlorhexidine and glycerol a decrease was recorded in the bacterial counts. It is concluded that more attention should be paid to long-term testing of hand washing and disinfection methods to ensure optimum final results in practice. It is obvious that the knowledge obtained from short time in-use testing cannot be applied to all conditions of use.

Adult↗
PubMedDate not supplied

Dermatological toxicity of ixabepilone.

Ixabepilone is a new class of non-taxane microtubule-stabilizing agents. These agents bind tubulin, stabilize microtubules and, thus, block mitosis and result in cell death (1-8). In phase I studies, neutropenia was the only grade 4 toxicity while fatigue, anorexia and mucositis occurred as grade 3 toxicities. Neuropathy, myalgia, arthralgia, alopecia and gastro-intestginal toxicities also occurred at grades 1 and 2. No dermatological effects have been documented to date. Here, a case is reported of a 62-year-old woman with stage 4 breast cancer being treated with Ixabepilone (40 mg/m2) who developed a dermatological reaction not previously described as a toxicity from Ixabepilone therapy.

Breast Neoplasms↗
PubMed2006

The use of dermatologic drugs in pregnancy and lactation.

Physicians are generally reluctant to prescribe dermatologic drugs to pregnant or nursing women because treatment is often elective and can be harmful to the patient, her fetus, or nursing infant; concerns for potential litigation also give pause. Yet, some effective dermatologic drugs have been determined to be safe during pregnancy and lactation. Of great practicality is an easily accessed reference guide that condenses information on such drugs into a set of tables that list pregnancy and teratogenicity ratings. Indications and contraindications are ordered in relation to the phases and trimesters of pregnancy. A discussion of the necessity of considering stages of childbearing in choosing drug therapies introduces the tables. A summary list of cautions spells out the steps physicians should take in treating women of childbearing age.

Dermatologic Agents↗
PubMed2006

[Fixed pigmented erythema related to the oral administration of carbamazepine: report of one case].

Carbamazepine (CBZ) is an oral anticonvulsant drug, structurally similar to tricyclic antidepressants. It is preferred over other drugs because it has fewer adverse effects on behavior and alertness. However, hematologic toxicity is possible during therapy with CBZ. Patients should undergo routine monitoring of hematologic function. CBZ can make the skin more sensitive to the sun or ultraviolet light, therefore, dermatological effects of this drug also can happen such as, skin rash, urticaria, and erythema multiforme. The present study reports the case of a female patient that presented hyperchromic-concentric-pruriginous- spots on the skin of her hands after six months of treatment with CBZ. She came to the physicians of the Clinical Pharmacokinetic Service (Laboratory of Toxicology of IAHULA, Mérida-Venezuela) requesting a drug monitoring. The results showed a level of 8.51 microg x. mL(-1), which was found within the therapeutic range (4-12 microg x mL(-1)). Subsequently, the dermatologist diagnosed fixed pigmented erythema related to the ingestion of a specific medication which began disappearing after 15 days of CBZ free-treatment and with the aid of a dermatologic formulation.

Administration, Oral↗
PubMed1997

Agricultural pesticide use in developing countries: health effects and research needs.

Large worker populations in the Third World are exposed to increasing amounts of pesticides, including pesticides severely restricted and banned in industrialized countries. Studies on knowledge, attitudes, and practices indicate that unsafe use of pesticides is the rule in Third World countries. Surveys of acute poisonings show high rates in these countries, despite underregistration. The scarce studies on chronic health outcomes demonstrate neurotoxic, reproductive, and dermatologic effects. Exposure assessment consists mainly of cholinesterase testing, and few studies have quantified dermal and respiratory exposure. The few intervention studies demonstrate the need for evaluation of the impact of preventive measures and policies. There is no evidence that widespread "safe-use" programs have greatly affected exposure and morbidity. It was concluded that research should focus on simple methods for surveillance of exposure and on surveillance of acute illness and its causes in order to develop and evaluate rapid local interventions. Studies on chronic effects should be carried out in selected countries, aiming at long-term and broader interventions. Policies that promote the use of pesticides should be critically evaluated. North-South and South-South research collaborations must be encouraged to address this global health problem.

Africa↗
PubMed1999

[Effects of combined dermatological and behavioural medicine therapy in hospitalized patients with psoriasis and atopic dermatitis].

The present study examined the effectiveness of combined dermatological and behavioural medicine therapy on the skin status and disease-specific stress of eighty-six patients with psoriasis and fifty-eight patients with atopic dermatitis who were hospitalized in the PsoriSol Clinic, Hersbruck, Germany. In addition to receiving instruction about their stain disease, the patients were offered, practice in relaxation techniques, social contacts and scratching control as well as individual psychological counselling. The clinical change was assessed by PASI and SCORAD, respectively. The Marburg questionnaire for coping with skin diseases (MHF) and a questionnaire for health-related control attributes (GKU-S) served as psychometric measures. Patients showed significant improvement in skin status and psychosocial parameters in pre-post comparison. Social fears, avoidance and helplessness were reduced by significant improvement of the emotional status in both groups. Patients with psoriasis also showed an increase in internal control attributes. Dermatological treatment combined with behavioural medicine therapy can be considered an effective method in patients with atopic dermatitis and psoriasis.

Adaptation, Psychological↗
PubMedDate not supplied

[Prospective study on admissions for iatrogenic adverse effects in the emergency service of hospital university center in Poitiers].

Hospital admissions resulting from an adverse drug reaction have been studied in the emergency unit of the university hospital in Poitiers during a 27-day period. This prospective study consisted in documenting all observations considered as an ADR by the medical practitioner in charge of the patient. There were 1235 hospital admissions to the emergency unit during the study period. Thirty-one (2.5 per cent) of admissions were considered to be drug-related. Women were more often affected than men. Patients with ADR were classified taking into account the type of pathology and the drug responsible for the effect. Dermatological and gastrointestinal reactions were predominant. Antibiotic and analgesic drugs were the most common drug groups implicated in causing an ADR.

Adult↗