1/4. Increased topical tacrolimus absorption in generalized leukemic erythroderma.OBJECTIVE: To report a case of elevated blood tacrolimus concentration after application of topical tacrolimus ointment in an erythrodermic patient. CASE SUMMARY: A 44-year-old man developed generalized erythroderma and itching due to infection with human T-cell lymphotropic virus. Despite application of strong glucocorticosteroid ointments, the symptoms and area of erythroderma were not alleviated. Daily topical application of tacrolimus 0.1% ointment was added and therapeutic drug monitoring was started. The dose and applied area of tacrolimus were gradually increased from 2.5 to 12.5 g/d and from 10% to 90% of body surface area, respectively. Because the trough concentration of tacrolimus in whole blood increased from 7.5 ng/mL on treatment day 9 to 15.4 ng/mL on day 13, the dose was reduced to 10 g/d. However, the concentration further elevated to 16.5 ng/mL. Therefore, the applied area was reduced to 20% of body surface area, and the tacrolimus concentration decreased gradually thereafter. Although the transient increase of blood tacrolimus concentration was observed on day 23, treatment with 20% applied area and 5 g/d were maintained. DISCUSSION: Topically applied tacrolimus was substantially absorbed with the expansion of its applied area and dose. Increased tacrolimus concentrations may have a tendency to depend on the increase of the percent of body surface area per dose. Our findings showing the elevation of blood tacrolimus concentration after application of the ointment to a large area of the body suggest that the applied area should be as narrow as possible in a barrier-disrupted condition such as erythroderma. However, the safety of tacrolimus ointment has not been established in patients with generalized erythroderma. CONCLUSIONS: tacrolimus concentrations in whole blood should be carefully monitored to prevent nephrotoxicity. Based on the results of that monitoring, the application area and dose of tacrolimus ointment should be closely adjusted, especially in generalized erythrodermic cases.- - - - - - - - - - ranking = 1keywords = erythroderma (Clic here for more details about this article) |
2/4. Oral bexarotene in a therapy-resistant sezary syndrome patient: observations on Sezary cell compartmentalization.BACKGROUND: A 63-year-old man with therapy-resistant sezary syndrome was enrolled in a multicenter trial of oral bexarotene for advanced-stage cutaneous T-cell lymphoma (CTCL). methods: Monthly evaluations for efficacy and side-effects were conducted and documented. RESULTS: Gradual improvement in erythema, pruritus, and scale was noted during the initial 16-week trial period and treatment was extended to 40 weeks. From week 20 to week 40, the erythroderma continued to improve and the lymph node burden decreased, but the absolute Sezary cell count inversely increased. By week 40, intractable pruritus and erythroderma abruptly recurred, and bexarotene was discontinued. CONCLUSIONS: Bexarotene is well tolerated and can be efficacious in patients with sezary syndrome. Shifting of Sezary cells between different compartments was noted. Further studies on the interaction between the skin, lymph nodes, and peripheral blood compartments during bexarotene treatment in this subset of patients with CTCL are needed.- - - - - - - - - - ranking = 0.25keywords = erythroderma (Clic here for more details about this article) |
3/4. Generalized pustulation as a manifestation of the anticonvulsant hypersensitivity syndrome.BACKGROUND.-The anticonvulsant hypersensitivity syndrome is characterized by the development of fever, rash, lymphadenopathy, and hepatitis, and is associated with leukocytosis and eosinophilia. This article describes the unusual development of a follicular pustular eruption in two patients as a manifestation of this syndrome. OBSERVATIONS.-This pustular eruption most commonly develops on the face and scalp but may subsequently become generalized. While cultures of the pustules are negative, biopsy specimens reveal a dilated follicular infundibulum filled with neutrophils. Recognition of cutaneous pustulation as a potential manifestation of this syndrome is important, as a generalized pustular eruption developing in a febrile patient can easily be confused with an infectious process. CONCLUSIONS.-The anticonvulsant hypersensitivity syndrome may present with a follicular pustular eruption rather than the more commonly associated macular or papular rash or erythroderma. The three most commonly used anticonvulsants, phenytoin, phenobarbital, and carbamazepine, can each produce an identical hypersensitivity reaction. In addition, in vitro testing has demonstrated that approximately 80% of patients tested to all three medications had positive reactions to each. Furthermore, with in vitro testing researchers are able to predict which anticonvulsants are safe to use, thereby allowing for prospective individualization of therapy. However, this technology is not yet available for widespread use.- - - - - - - - - - ranking = 0.125keywords = erythroderma (Clic here for more details about this article) |
4/4. hypereosinophilic syndrome with unusual cutaneous manifestations in two men with hiv infection.We report two men with human immunodeficiency virus infection who had unusual cutaneous manifestations of hypereosinophilic syndrome, exfoliative erythroderma, and linear flagellate plaques. In the first patient the cutaneous disease was the initial manifestation, and in the second the skin was the only organ affected. We also describe a favorable response to systemic corticosteroids and to psoralen with UVA phototherapy in one patient.- - - - - - - - - - ranking = 0.125keywords = erythroderma (Clic here for more details about this article) |