Drug-Induced Rosacea-like Dermatitis

Rosacea is a common, chronic cutaneous disorder with a prevalence of 0.5-10%, predominantly affecting women. The disease presents with a heterogeneous clinical picture characterized by transient flushing, persistent facial redness, telangiectasias, and, in more severe clinical forms, the presence of inflammatory papules and pustules in the central third of the face. Although its pathophysiology is complex and still remains unknown, factors that exacerbate the disease are well defined. They include genetic predisposition as well as external factors such as exposure to UV light, high temperature, and diet. Besides these well-known factors, recent studies suggest that drugs and vitamins could also be possible factors inducing rosacea-like dermatitis or aggravating pre-existing rosacea. Although these are less common possible triggering factors, the aim of this article is to present the current knowledge on the association between use of certain drugs or vitamins and rosacea. </p

Basal cell carcinoma - etiopathogenesis, clinical picture and treatment

Bazocelularni karcinom je najčešći maligni tumor, koji se uobičajeno razvija u starijoj životnoj dobi, javljajući se na foto-eksponiranim područjima, najčešće na licu, iznad zamišljene linije koja spaja kutove usana i lobulus uške. Osim genetske predispozicije i svijetlog fototipa, izlaganje sunčevoj svijetlosti je jedan od najznačajnijih etioloških čimbenika u patofiziologiji bazocelularnog karcinoma. Iako se bazocelularni karcinom sporo razvija i rijetko metastazira, može uzrokovati značajnu destrukciju tkiva infiltrirajući okolno tkivo. Poticanje provođenja fotoprotektivnih mjera je temelj prevencije, a rana detekcija sumnjivih kožnih promjena i pravovremeno liječenje su ključne za zadovoljavajući terapijski ishod.Basal cell carcinoma (BCC) is the most common malignant tumor, commonly developing in elderly age, appearing in the sun-exposed areas, most often in the face, above the imaginary line that connects lip angles with ear laps. Apart from the genetic predisposition and light-colored skin, sun exposure is one of the most significant ethiological factors in pathophysiology of basal cell carcinoma (BCC). Altough basal cell carcinoma (BCC) progresses slowly and metastasizes rarely, it can cause significant destruction and disfigurement by invading surrounding tissues. Consequently, encouraging the adoption of photoprotective measures is the cornerstone of prevention, and early detection of suspectable skin lesions and in time treatment are critical for satisfatory therapeutical outcome

Erlotinib-induced Rosacea-like Dermatitis

Skin and skin adnexa toxicities are the most common side effects associated with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and occur in most patients receiving this therapy. The majority of these cutaneous side effects are transient, reversible, and dose dependent. Although these symptoms are in general not severe, they significantly affect quality of life and can have a serious effect on treatment compliance as well as the treatment regimen. The most common early symptoms present as papulopustules on an erythematous base, usually localized in seborrheic areas. This clinical presentation is commonly described as “acneiform”, although these adverse reactions have clinical presentations, such as rosacea-like and seborrheic-like dermatitis. In this context, we report a case of a 77-year-old man with a medical history of planocellular lung cancer with ipsilateral pulmonary metastasis and mediastinum infiltration who received  erlotinib as a third-line therapy, presenting with centrofacial rosaceiform rash as a side effect associated with the use of EGFR-TKIs. The patient had a negative previous history of rosacea. Therefore, symptoms probably occurred as an adverse reaction due to the oncological therapy. Current terminology of early cutaneous adverse reactions caused by EGFR-TKIs refers to “acneiform” or “papulopustular” lesions, excluding less common side effects such as rosacea-like dermatitis  so these symptoms might be overlooked and misdiagnosed. Thus, we would like to emphasize the importance of developing a more accurate classification of terms in order to provide early detection of all possible cutaneous side effects, including less common ones, providing specific and timely treatment, and allowing continuation of drug therapy. </p

Photodistributed Hyperpigmentation Induced by Diltiazem.

Fotoosjetljivost uzrokovana lijekovima uključuje pojavu promjena na koži kao posljedicu interakcije lijeka i UVA i UVB zraka. U toj skupini fotodermatoza primarno se radi o fototoksičnim reakcijama koje se očituju različitim kliničkim slikama. Hiperpigmentacije na koži su jedna od najčešćih kliničkih prezentacija tih reakcija. Pojava tih kožnih promjena je dosad bila povezana s uzimanjem određenih antibiotika, antiepileptika, antihipertenziva te antidepresiva. Međutim, u novije vrijeme neka istraživanja ukazuju na povezanost pojave fotodistribuirane hiperpigmentacije s korištenjem diltiazema. Hiperpigmentacije uzrokovane lijekovima u većini slučajeva ne reagiraju na konvencionalnu terapiju stečenih poremećaja pigmentacije. Najvažniji korak u terapiji jest ukidanje diltiazema, koji bi trebao biti zamijenjen drugim antihipertenzivnim lijekom, kao jedina mjera koja omogućuje postupnu regresiju kožnih promjena. Bolesnik bi također trebao biti upućen u to da će uz primjenu adekvatnih mjera regresija promjena biti potpuna, međutim, tek kroz razdoblje od nekoliko mjeseci. Prevencija te kožne nuspojave uzrokovane diltiazemom je moguća, i to primjenom krema sa zaštitnim faktorom, s obzirom na to da UVA i UVB zrake imaju značajnu ulogu u nastanku tih promjena.Drug-induced photosensitivity refers to the development of cutaneous disease as a result of the interaction of the drug and UVA and UVB light. These are primarily phototoxic reactions presenting in different clinical patterns. Skin hyperpigmentation presents as one of the most frequent phototoxic reactions. It has been associated with the use of certain antibiotics, antiepileptics, antihypertensive drugs as well as antidepressant medications. Recently, there have been reports suggesting association between use of diltiazem and appearance of photodistributed hyperpigmentation. This drug-induced hyperpigmentation is usually refractory to conventional treatment options. The most important step in treatment management is withdrawal of the incriminating agent. Once hyperpigmentation has been established, diltiazem should be discontinued and replaced with another antihypertensive agent, as it is essential for improvement and gradual resolution of the hyperpigmentation. The patient should be reassured that with proper management, the hyperpigmentation is a reversible process, but informed that for total resolution of skin lesions it may take many months. Prevention of this cutaneous adverse drug reaction may be possible with the use of appropriate photoprotection. Consequently, for all patients on diltiazem, it is imperative to recommend a broad-spectrum sunscreen, as UVA and UVB radiation may both play a significant role in diltiazem-induced photodistributed hyperpigmentation

Cutaneous Adverse Drug Reactions Induced by Amlodipine.

Kožne nuspojave povezane s korištenjem amlodipina su rijetko opisane. Najčešća kožna reakcija povezana s tim lijekom je pojava flushinga. Ostale kožne promjene, osim pojave urtikarije i eritematoznog makulopapuloznog osipa, koje su najčešće posljedica alergijske reakcije na ovaj lijek, uključuju i pojavu rosacee i fotodistribuirane teleangiektazije, koje zbog slične kliničke prezentacije ne bi smjelo pogrešno dijagnosticirati kao flushing. Iako su spomenute nuspojave većinom blaže do srednje klinički izražene, one uzrokuju značajnu nelagodu u bolesnika i mogu utjecati na terapijsku suradljivost. Osim spomenutih, primjena amlodipina je povezana i s nekoliko ozbiljnih i nepredvidivih kožnih nuspojava koji uključuju vaskulitis uzrokovan lijekovima te pojavu Steven Johnsonova sindroma. Spomenute kožne nuspojave su karakterizirane visokim morbiditetom te čak mogućim smrtonosnim ishodom. Iako su te reakcije općenito rijetke i neuobičajene za primjenu amlodipina, važno ih je identificirati kao moguće reakcije preosjetljivosti uzrokovane tim lijekom.Cutaneous adverse reactions associated with amlodipine have been rarely reported. Its most prevalent cutaneous side effect is fl ushing. Other recognized amlodipine associated skin eruptions, apart from urticaria and erythematous maculopapular rash which are most common allergic reactions, are rosacea and photodistributed telangiectasia which it is important not to misdiagnose as flushing, due to similarities in clinical presentations. Although these are usually mild to moderate skin side effects, they can cause serious discomfort and affect the patient´s treatment compliance. Apart from these mild drug reactions, amlodipine use is associated with other more severe and nonpredictable skin disorders including drug induced vasculitis and Steven Johnson syndrome. These cutaneous adverse drug reactions are characterized with high morbidity and even possible lethal outcome. Although these reactions are in general rare and uncommon in the use of amlodipine, it is important to acknowledge them as a possible hypersensitivity syndrome induced by this drug

Poster 3. - Nutritivna alergija - uzroci i klinička slika

Cilj: Istaknuti učestalost, uzrok i kliničku sliku nutritivnih alergija. Uvod: Preosjetljivost na hranu bilježi sve veći porast u razvijenim zemljama svijeta, predstavljajući važan javnozdravstveni problem. Pretpostavlja se da je prevalencija kod djece do tri godine između 5% i 8%, te 1% i 2% u odraslih osoba. Reakcije na hranu mogu biti trenutne (posredovane IgE-om) te kasne, nakon nekoliko sati ili dana, po izlaganju alergenu (posredovane T limfocitima). Rane reakcije se očituju kožnim simptomima - pruritusom, urtikarijom, egzantemom, gastrointestinalnim simptomima - mučnina, povraćanje, kolike i dijareja i respiratornim simptomima - nosna kongestija, rinoreja i hripanje. Kasne reakcije se očituju kroničnim gastrointestinalnim simptomima kao što su protrahirana dijareja, povraćanje i nenapredovanje djeteta. Najčešće namirnice odgovorne za nutritivnu alergiju su: mlijeko, jaje, riba, školjke, soja, kikiriki, jezgričavo voće, gluten žitarica (pšenica, raž, ječam). Alergija na hranu najučestalija je tijekom prve godine života s prevalencijom od 2-7% djece i to pretežito na alergene kravljega mlijeka, a očituje se simptomima kao što su gastrzofagealni refluks, kolike, dijareja, opstipacija i krv u stolici. Preosjetljivost na jaje također je jedna od češćih preosjetljivosti u dječjoj dobi koja se može očitovati kao svrbež u ustima/grlu, rinitis te konjunktivitis. Kikiriki je namirnica poznata po snažnim reakcijama koje uzrokuje, čak i kada je prisutna u tragovima, u vidu astme, urtikarije, dijareje, povraćanja i anafilaktične reakcije. Najveći dio nutritivnih alergija nestaje nakon 3. do 6. godine života, iako preosjetljivost na ribu i kikiriki najčešće ostaje doživotno te se preporuča provođenje eliminacijske dijete. Alergija na hranu uzrok je egzacerbacija atopijskog dermatitisa u oko 20% do 40% djece, kao i povećanog rizika od oboljevanja od astme, stoga je izbjegavanje određenih namirnica važan korak u prevenciji ovih alergijskih bolesti. Zaključak: Osviještenost o uzrocima i učestalosti nutritivnih alergija je važna u cilju prepoznavanja simptoma kao i smanjenja rizika od njihove pojave kod osoba s atopijskom predispozicijom

Psoriasis, Cardiovascular Risk, and Antihypertensive Drugs

Psorijaza je kronična upalna bolest koja pogađa 1-2% odrasle opće populacije. Bolest nije ograničena samo na kožu, već je povezana s nizom komorbiditeta, koji značajno utječu na kvalitetu života i predstavljaju povišeni rizik od različitih medicinskih poremećaja. Posljednjih godina, brojne publikacije su pokazale povišenu učestalost srčanožilnih bolesti i metaboličkog sindroma u bolesnika s psorijazom. Iako etiopatogenetska povezanost između ovih stanja još uvijek nije razjašnjena, čini se da dijele zajedničke patofiziološke puteve u vidu sličnih upalnih komponenti. S obzirom na povišenu prevalenciju kardiovaskularnih komorbiditeta u bolesnika, psorijazi bi trebalo pristupiti kao multisistemskoj bolesti. Stoga je potreban multidisciplinarni pristup u cilju najučinkovitijeg liječenja bolesnika sa psorijazom. Kardiološki lijekovi često su povezani s nastankom ili pogoršanjem psorijaze, među kojima su beta-blokatori najčešći uzročni lijekovi. Potrebno je prepoznati ovu povezanost, s obzirom na to da je to kožna nuspojava koja značajno utječe na kvalitetu života, predstavlja veliko psihološko opterećenje i stigmatizaciju za bolesnika te ima značajan utjecaj na daljnju terapijsku suradljivost.Psoriasis is a chronic inflammatory disease affecting 1-2% of the adult general population. Disease is not limited only to the skin but is associated with a number of comorbidities, which significantly affect quality of life and present a higher risk of various medical disorders. Over recent years, numerous publications have shown increased frequency of cardiovascular disease and metabolic syndrome in patients with psoriasis. Although the etiopathogenetic relationship between these conditions is still not entirely clear, it seems that they share common pathophysiological elements in terms of similar inflammatory components. Considering the increased prevalence of cardiovascular comorbidities in patients, psoriasis should be approached as a multisystem disease. Therefore, a multidisciplinary approach is needed in order to most effectively manage patients with psoriasis. In addition, cardiac drugs have been frequently reported to induce or exacerbate psoriasis, among which beta-blockers are found to be the most common triggering drug. It is thus important to acknowledge this relationship, as this is cutaneous drug adverse reaction which significantly affects quality of life and is a great psychological burden and stigma for the patient, as well as having a great impact on further treatment compliance