T cell–mediated acute localized exanthematous pustulosis caused by finasteride

Tresch, S.; Cozzio, Antonio; Kamarashev, Jivko; Harr, Thomas; Schmid‐Grendelmeier, Peter; French, Lars E.; Feldmeyer, Laurence

doi:10.1016/j.jaci.2011.07.033

Cited by 31 publications

(26 citation statements)

References 25 publications

(24 reference statements)

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“…For example, an overlap of AGEP and drug reaction with eosinophilia and systemic symptoms (DRESS) [35,36], or TEN [36,37,38,39,40,41,42,43,44], as well as an AGEP case with targetoid lesions [45,46] have been reported. A dozen of localized reactions have been reported, and referred to as acute localized exanthematous pustulosis (ALEP) [47,48,49,50]. In about 50% of patients, additional skin symptoms such as erythematous oedema of the hand and face, purpura, vesicles and blisters have been reported.…”

Section: Clinical Features and Variantsmentioning

confidence: 99%

Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy

Feldmeyer

Heidemeyer

Yawalkar

2016

IJMS

Self Cite

167

204

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Acute generalized exanthematous pustulosis (AGEP) is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base and spontaneous resolution usually within two weeks. Systemic involvement occurs in about 20% of cases. The course is mostly benign, and only in rare cases complications lead to life-threatening situations. Recent studies highlight the importance of genetic variations in interleukin-36 receptor antagonist gene (IL-36RN) in the pathogenesis of this disease. The physiopathology of AGEP remains unclear, but an involvement of innate and acquired immune cells together with resident cells (keratinocytes), which recruit and activate neutrophils via production of cytokines/chemokines such as IL-17, IL-36, granulocyte-macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor alpha (TNFα) and chemokine (C-X-C motif) ligand 8 (CXCL8)/IL-8, has been postulated. Treatment is based on the removal of the causative drug, supportive care, infection prevention and use of potent topical or systemic steroids.

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Section: Clinical Features and Variantsmentioning

confidence: 99%

Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy

Feldmeyer

Heidemeyer

Yawalkar

2016

IJMS

Self Cite

167

204

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“…7,8,10 IL-8 is likely responsible for recruiting neutrophils in the intraepithelial pustules. Recently, a relative increase in TH17 cell numbers and elevated levels of cytokine IL-22 in the peripheral blood of patients with AGEP was shown.…”

Section: Discussionmentioning

confidence: 99%

Acute localized exanthematous pustulosis caused by cefoperazone and sodium sulbactam

Qu¹,

Jin²,

Han³

et al. 2016

An. Bras. Dermatol.

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Acute localized exanthematous pustulosis is a localized variant of acute generalized exanthematous pustulosis, which is characterized by the eruption of multiple scattered pustules following drug administration. A 72-year-old woman presented with multiple erythematous pustules on her face, which had appeared two days after using cefoperazone and sodium sulbactam. Histopathological findings showed subcorneal pustules and mixed inflammatory cell infiltration in the dermis. The pustules resolved within about two weeks after the patient discontinued the antibiotics. This report discusses the case of a woman with a cutaneous drug reaction consistent with acute localized exanthematous pustulosis that occurred after cefoperazone and sodium sulbactam were administered.

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“…Tresch et al [23] described a T-cell-mediated acute localized exanthematous pustulosis (ALEP) caused by finasteride that also bears histological resemblance with BKT scalp reactions and may share some of the same immunological background of inflammation. This unusual type of acute generalized exanthematous pustulosis (AGEP) presents histological features of psoriasiform acanthosis, spongiosis and infiltration of the epidermis and dermis by neutrophils and eosinophils.…”

Section: Discussionmentioning

confidence: 99%

“…The authors suggest that this individual drug reaction may be related to different genetic factors, to the MHC molecules and to an increase in the number of TH17 cells and the levels of their produced cytokine IL-22. TH17 cells might augment the IL-8 production by keratinocytes through the effects of IL-17 and IL-22, as described in AGEP [23]. Drug administration is the most frequent though not the sole cause of ALEP, and a plant contact was reported as the causative agent in the work of Mohamed et al [24].…”

Section: Discussionmentioning

confidence: 99%

Eczema-Like Psoriasiform Skin Reaction due to Brazilian Keratin Treatment

Gavazzoni-Dias

Rochael

Vilar

et al. 2015

Skin Appendage Disord

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The use of formaldehyde and formaldehyde releasers in hair-straightening formulations started in Rio de Janeiro in 2003. The technique is known as BKT, Brazilian keratin treatment. The aim of this study was to analyze the types of skin reactions presented by patients due to BKT. We describe 7 patients with severe erythema and scurf on the scalp which developed shortly after BKT. The lesions were eczema-like psoriasiform, located mainly on the scalp. Some patients also developed eczema-like lesions and pustules on the face, neck, upper arms, and upper trunk. Dermatoscopic findings included erythema, perifollicular and interfollicular scurf. The peripilar desquamation resembled the outer skin of an onion bulb. Scalp biopsies revealed psoriasiform and spongiotic psoriasiform patterns, one of them similar to anti-TNFα biologic drug psoriasiform alopecia. The possible consequences of the absorption of formaldehyde by hairdressers or clients are still to be verified by the scientific community; however, the skin and scalp reactions observed in our cases suggest a drug reaction phenomenon and not only eczemas of irritant or allergic origin.

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T cell–mediated acute localized exanthematous pustulosis caused by finasteride

Cited by 31 publications

References 25 publications

Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy

Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy

Acute localized exanthematous pustulosis caused by cefoperazone and sodium sulbactam

Eczema-Like Psoriasiform Skin Reaction due to Brazilian Keratin Treatment

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