Pub Date : 2024-03-24DOI: 10.15226/2378-1726/11/1/001154
Kordeva S, Broshtilova V, Tchernev G
Psoriasis and bullous pemphigoid are both chronic inflammatory skin disorders, involving abnormal immune responses. Their coexistence is often observed in the literature in the context of secondary development following an initial inflammatory process. In the majority of cases, the development of psoriasis seems to occur before the onset of bullous pemphigoid. While psoriasis is associated with autoimmune bullous diseases, it’s important to note that not every individual with psoriasis will develop bullous pemphigoid. Therefore the pathogenetic mechanism behind this association remains rather a mystery. Several case reports/studies have been published describing the subsequent development of either psoriasis or bullous pemphigoid following initial monotherapy with beta blockers, sartans, or other drug class medications (which will not be mentioned in our case report as they are not relevant to the presented data). We believe that our case is the first documented example of polymedicamentous development of 2 skin diseases within the intake of 2 antihypertensive drugs heterogeneous in class and action. We present a 78-year-old female with plaque psoriasis followed shortly thereafter by bullous pemphigoid after 10-year period of antihypertensive therapy with bisoprolol and losartan. We believe that the cumulative effect of both medications may have contributed to the coexistence of these skin disorders. Following the discontinuation of the initial antihypertensive therapy with bisoprolol and losartan and substituting it verapamil and moxonidine, along with the initiation of methotrexate and folic acid, the patient showed significant improvement. Key words: psoriasis; bullous pemphigoid; drug-induced; bisoprolol; losartan
{"title":"Psoriasis and Bullous Pemphigoid Developing Simultaneously During Systemic Administration with Bisoprolol and Losartan","authors":"Kordeva S, Broshtilova V, Tchernev G","doi":"10.15226/2378-1726/11/1/001154","DOIUrl":"https://doi.org/10.15226/2378-1726/11/1/001154","url":null,"abstract":"Psoriasis and bullous pemphigoid are both chronic inflammatory skin disorders, involving abnormal immune responses. Their coexistence is often observed in the literature in the context of secondary development following an initial inflammatory process. In the majority of cases, the development of psoriasis seems to occur before the onset of bullous pemphigoid. While psoriasis is associated with autoimmune bullous diseases, it’s important to note that not every individual with psoriasis will develop bullous pemphigoid. Therefore the pathogenetic mechanism behind this association remains rather a mystery. Several case reports/studies have been published describing the subsequent development of either psoriasis or bullous pemphigoid following initial monotherapy with beta blockers, sartans, or other drug class medications (which will not be mentioned in our case report as they are not relevant to the presented data). We believe that our case is the first documented example of polymedicamentous development of 2 skin diseases within the intake of 2 antihypertensive drugs heterogeneous in class and action. We present a 78-year-old female with plaque psoriasis followed shortly thereafter by bullous pemphigoid after 10-year period of antihypertensive therapy with bisoprolol and losartan. We believe that the cumulative effect of both medications may have contributed to the coexistence of these skin disorders. Following the discontinuation of the initial antihypertensive therapy with bisoprolol and losartan and substituting it verapamil and moxonidine, along with the initiation of methotrexate and folic acid, the patient showed significant improvement. Key words: psoriasis; bullous pemphigoid; drug-induced; bisoprolol; losartan","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":" 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140209992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.15226/2378-1726/11/1/001156
Kordeva S, Parambi S, Ivanov L, Khanom S, Tchernev G
An 80-year-old female presented to the dermatology department due to an atrophic lesion in the area of the nasal apex, dating for the past 5-6 years. Moreover, there was a slowly developing tumor-like growth in her left temporal region, initially noticed 1-2 years ago. Over the last month, the formation began to bleed upon light touch. Furthermore, there was another lesion in the sacral area with an irregular hyperpigmented edge, also dating back 1-2 years. The patient denied having any allergies or family history of skin malignancies. Regarding comorbidities, she underwent cholecystectomy in 2016. She has been managing arterial hypertension with lisinopril dehydrate 10 mg once daily for the past 10 years. Additionally, she has been treating vertigo with a daily intake of betahistine dihydrochloride 16 mg for the same duration. She is also taking spironolactone 25 mg once daily at noon and diosmin 600 mg once daily at noon both for the past two months (prior to the consultation). The patient presented with a request for physical evaluation of the lesions and further therapeutic approach to be established.
{"title":"Multiple Bccs after Lisinopril Intake – Significant Connections to The Drug Related Photo- (Nitroso)-Carcinogenesis in The Context of Oncopharmacogenesis","authors":"Kordeva S, Parambi S, Ivanov L, Khanom S, Tchernev G","doi":"10.15226/2378-1726/11/1/001156","DOIUrl":"https://doi.org/10.15226/2378-1726/11/1/001156","url":null,"abstract":"An 80-year-old female presented to the dermatology department due to an atrophic lesion in the area of the nasal apex, dating for the past 5-6 years. Moreover, there was a slowly developing tumor-like growth in her left temporal region, initially noticed 1-2 years ago. Over the last month, the formation began to bleed upon light touch. Furthermore, there was another lesion in the sacral area with an irregular hyperpigmented edge, also dating back 1-2 years. The patient denied having any allergies or family history of skin malignancies. Regarding comorbidities, she underwent cholecystectomy in 2016. She has been managing arterial hypertension with lisinopril dehydrate 10 mg once daily for the past 10 years. Additionally, she has been treating vertigo with a daily intake of betahistine dihydrochloride 16 mg for the same duration. She is also taking spironolactone 25 mg once daily at noon and diosmin 600 mg once daily at noon both for the past two months (prior to the consultation). The patient presented with a request for physical evaluation of the lesions and further therapeutic approach to be established.","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"39 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140253727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.15226/2378-1726/11/1/001155
Hristova A, Ivanol L, Tchernev G
Non-melanoma skin cancer is the most common cancer in the world (1). Basal cell carcinoma (BCC) is the most common malignant neoplasia of the skin, accounting for approximately 80% of all cutaneous tumors (2). High cumulative ultraviolet (UV) light exposure and the presence of Fitzpatrick skin phototype I or II are pathogenetic risk factors (3). UV radiation induces mutations in the tumor suppressor PTCH1 gene, leading to increased Hedgehog (XX/Hh) signaling pathway activity (4). Dysfunction or abnormal activation of the Hedgehog signaling pathway is associated with disorders of embryonic development and the development of cancers such as Goltz–Gorlin syndrome for example (5). BCC has the characteristics of a locally invasive, slow-growing skin cancer, with a metastatic incidence between 0.0028-0.5%, with areas in the head and neck most commonly affected (6). Metatypical basal cell carcinoma (MTBCC) is a rare variant of BCC that has histopathological characteristics of both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) (7).
非黑色素瘤皮肤癌是世界上最常见的癌症（1）。基底细胞癌（BCC）是最常见的皮肤恶性肿瘤，约占所有皮肤肿瘤的 80%（2）。大量紫外线（UV）累积照射和菲茨帕特里克皮肤光型 I 或 II 是致病风险因素（3）。紫外线辐射会诱导肿瘤抑制因子 PTCH1 基因突变，导致刺猬（XX/Hh）信号通路活性增强（4）。刺猬信号通路的功能障碍或异常激活与胚胎发育障碍和癌症的发生有关，例如戈尔茨-戈林综合征（Goltz-Gorlin syndrome）（5）。BCC 具有局部浸润、生长缓慢的皮肤癌特征，转移发生率在 0.0028-0.5% 之间，头颈部最常受累（6）。偏典型基底细胞癌（MTBCC）是 BCC 的一种罕见变异型，具有基底细胞癌（BCC）和鳞状细胞癌（SCC）的组织病理学特征（7）。
{"title":"Metatypical BCC of The Ear: Partial Amputation of The Auricle as Adequate Dermatosurgical Approach","authors":"Hristova A, Ivanol L, Tchernev G","doi":"10.15226/2378-1726/11/1/001155","DOIUrl":"https://doi.org/10.15226/2378-1726/11/1/001155","url":null,"abstract":"Non-melanoma skin cancer is the most common cancer in the world (1). Basal cell carcinoma (BCC) is the most common malignant neoplasia of the skin, accounting for approximately 80% of all cutaneous tumors (2). High cumulative ultraviolet (UV) light exposure and the presence of Fitzpatrick skin phototype I or II are pathogenetic risk factors (3). UV radiation induces mutations in the tumor suppressor PTCH1 gene, leading to increased Hedgehog (XX/Hh) signaling pathway activity (4). Dysfunction or abnormal activation of the Hedgehog signaling pathway is associated with disorders of embryonic development and the development of cancers such as Goltz–Gorlin syndrome for example (5). BCC has the characteristics of a locally invasive, slow-growing skin cancer, with a metastatic incidence between 0.0028-0.5%, with areas in the head and neck most commonly affected (6). Metatypical basal cell carcinoma (MTBCC) is a rare variant of BCC that has histopathological characteristics of both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) (7).","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"256 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140455458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-10DOI: 10.15226/2378-1726/10/1/001152
Kordeva S, Marchev S, Batashki I, Tchernev G
The patient reported four operations in the left nasal area resulting in recurrences over time. The surgical interventions were performed in 2016, 2017, 2022. An appendectomy, cholecystectomy, femur fracture with subsequent implant replacement and pulmonary thromboembolism were also reported in the recent years. From 2008 an arterial hypertension was diagnosed for which the patient was taking the following medications: metoprolol succinate 50 mg once in the morning; from 2010 – ramipril 5 mg once at night and from 2022 apixaban 5 mg once in the morning and once in the evening. No reports for malignancy in any family member, no allergies nor painful sunburns in the nose area declared. The patient requested a further therapeutic approach to be established. The dermatology examination showed in the left ala of the nose, a papule with a pearly edge, superficial telangiectasias and a waxy appearance [Figure 1a]. The lesion was suspected for basal cell carcinoma. Above the left nasolabial fold a plaque with uneven pigmentation was observed – suspected for lentigo maligna [Figure 1b]. In the left axillary region, a tumor-like formation with an irregular shape and inhomogeneously distributed brown to black pigmentation was noticed– suspected for a dysplastic nevus [Figure 1c and 1d].
{"title":"Ramipril Induced BCC and Dysplastic Nevus: Nitrosamine Contamination as Most Potential Trigger for The Development of Melanoma and Nonmelanoma Skin Cancer?","authors":"Kordeva S, Marchev S, Batashki I, Tchernev G","doi":"10.15226/2378-1726/10/1/001152","DOIUrl":"https://doi.org/10.15226/2378-1726/10/1/001152","url":null,"abstract":"The patient reported four operations in the left nasal area resulting in recurrences over time. The surgical interventions were performed in 2016, 2017, 2022. An appendectomy, cholecystectomy, femur fracture with subsequent implant replacement and pulmonary thromboembolism were also reported in the recent years. From 2008 an arterial hypertension was diagnosed for which the patient was taking the following medications: metoprolol succinate 50 mg once in the morning; from 2010 – ramipril 5 mg once at night and from 2022 apixaban 5 mg once in the morning and once in the evening. No reports for malignancy in any family member, no allergies nor painful sunburns in the nose area declared. The patient requested a further therapeutic approach to be established. The dermatology examination showed in the left ala of the nose, a papule with a pearly edge, superficial telangiectasias and a waxy appearance [Figure 1a]. The lesion was suspected for basal cell carcinoma. Above the left nasolabial fold a plaque with uneven pigmentation was observed – suspected for lentigo maligna [Figure 1b]. In the left axillary region, a tumor-like formation with an irregular shape and inhomogeneously distributed brown to black pigmentation was noticed– suspected for a dysplastic nevus [Figure 1c and 1d].","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91135302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-06DOI: 10.15226/2378-1726/10/1/0011150
Kordeva S, Marchev S, Batashki I, Tchernev G
A 62-year-old male presented in the dermatology department with primary complaints of a 1-year-old lesion located in the right upper nose segment. He noticed the formation growing in size and changing its texture. The patient denies having allergies or any malignancy in any family member. He has arterial hypertension for which he takes bisoprolol 10 mg once in the morning, amlodipine 10 mg once in the evening, spironolactone 25 mg once in the morning, atorvastatin 20 mg once in the evening and from 5 years till present telmisartan/hydrochlorothiazide 80/12.5 mg once in the morning.For five years the patient took clonidine hydrochloride 0.15 mg once daily and for a year - prazosin 2mg once daily. Now the clonidine hydrochloride is administered when needed. The patient requested a physical examination and further therapeutic approach to be established. The dermatological examination showed an elevated large lesion with crusts and regular borders located in the right upper nasal region, in close proximity to the right eye [Figure 1]. The lesion was suspected clinically for basal cell carcinoma.
{"title":"High Risk BCC of the Nose After Telmisartan Hydrochlorothiazide: Potential Role of Nitrosamine Contamination as Key Triggering Factor for Skin Cancer Development","authors":"Kordeva S, Marchev S, Batashki I, Tchernev G","doi":"10.15226/2378-1726/10/1/0011150","DOIUrl":"https://doi.org/10.15226/2378-1726/10/1/0011150","url":null,"abstract":"A 62-year-old male presented in the dermatology department with primary complaints of a 1-year-old lesion located in the right upper nose segment. He noticed the formation growing in size and changing its texture. The patient denies having allergies or any malignancy in any family member. He has arterial hypertension for which he takes bisoprolol 10 mg once in the morning, amlodipine 10 mg once in the evening, spironolactone 25 mg once in the morning, atorvastatin 20 mg once in the evening and from 5 years till present telmisartan/hydrochlorothiazide 80/12.5 mg once in the morning.For five years the patient took clonidine hydrochloride 0.15 mg once daily and for a year - prazosin 2mg once daily. Now the clonidine hydrochloride is administered when needed. The patient requested a physical examination and further therapeutic approach to be established. The dermatological examination showed an elevated large lesion with crusts and regular borders located in the right upper nasal region, in close proximity to the right eye [Figure 1]. The lesion was suspected clinically for basal cell carcinoma.","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82431371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-06DOI: 10.15226/2378-1726/10/1/001151
Kordeva S, Marchev S, Batashki I, Tchernev G
A 75-year-old male presented himself in the department with primary complaints of a slowly progressive formation in the area of the nose dating from about 6 months. A punch biopsy was taken before hospitalization which resulted in keratinizing squamous cell carcinoma G2 with deep infiltration to the level of the sweat glands, staged later as T1N0M0. No reported allergies or any malignancy in any family member. In 2020 the patient reported a surgical excision of a lesion located in the right shoulder area which resulted in the confirmation of the diagnosis metatypical BCC with clear resection lines. Comorbidities: gonarthrosis, combined otoneurological syndrome, bilateral sensorineural hearing loss. In 2013 the patient was diagnosed with arterial hypertension for which he was taking Valsartan 160 mg once daily for nine years (until 2022) and then the therapy was switched to Chlortalidone 12.5 mg once daily.
{"title":"SCC of the Nose and Metatypical BCC of the Shoulder Developing during Treatment with Valsartan/ Chlortalidone: Nitrosamine Contamination as Main Skin Cancer Triggering Factor","authors":"Kordeva S, Marchev S, Batashki I, Tchernev G","doi":"10.15226/2378-1726/10/1/001151","DOIUrl":"https://doi.org/10.15226/2378-1726/10/1/001151","url":null,"abstract":"A 75-year-old male presented himself in the department with primary complaints of a slowly progressive formation in the area of the nose dating from about 6 months. A punch biopsy was taken before hospitalization which resulted in keratinizing squamous cell carcinoma G2 with deep infiltration to the level of the sweat glands, staged later as T1N0M0. No reported allergies or any malignancy in any family member. In 2020 the patient reported a surgical excision of a lesion located in the right shoulder area which resulted in the confirmation of the diagnosis metatypical BCC with clear resection lines. Comorbidities: gonarthrosis, combined otoneurological syndrome, bilateral sensorineural hearing loss. In 2013 the patient was diagnosed with arterial hypertension for which he was taking Valsartan 160 mg once daily for nine years (until 2022) and then the therapy was switched to Chlortalidone 12.5 mg once daily.","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81013890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.15226/2378-1726/9/1/001148
G. Tchernev, Todor Valchkov, N. Dimchova, N. Oliveira, Lorraine Joseph, I. Batashki, J. Cardoso
In its essence, panniculitis is the presence of an inflammatory infiltrate in the subcutaneous adipose tissue. Paniculitis as a clinical diagnosis encompasses a group of diseases that creates difficulties for both clinicians - dermatologists and histopathologists, mainly due to the many known forms of the disease, but also due to the various etiological reasons for their occurrence. Therefore, the clinical-pathological correlation plays an important role in the diagnosis. The development of various forms of panniculitis, in particular eosinophilic and generalized lymphocytic, have been described after Covid-19 infection.In the case of our patient, the development of panniculitis was observed after Covid-19 pneumonia. However, as additional etiological factors should be considered 1) the accompanying chronic diseases of the patient - congestive heart failure, hypertension and type 2 diabetes mellitus, which may also be etiological factors for the appearance of a certain form of panniculitis - stasis dermatitis / lipodermatosclerosis, 2) as well as the presence of probable bladder cancer - possible paraneoplastic genesis, 3) and the intake of enoxaparine - drug-induced panniculitis. Given the multifactorial genesis of panniculitis, the past infection with Covid-19, in our case, can be considered as a major trigger of the disease, which developed in the background of several etiological factors. For these reasons, our patient can also be diagnosed with post-Covid-19 panniculitis. Keywords: Lobular Panniculitis; Septal Panniculitis; Covid-19; Stasis Dermatitis; Corticosteroids; Paraneoplastic Reaction; Drug Induced Panniculitis
{"title":"(Post) Covid-19 Panniculitis","authors":"G. Tchernev, Todor Valchkov, N. Dimchova, N. Oliveira, Lorraine Joseph, I. Batashki, J. Cardoso","doi":"10.15226/2378-1726/9/1/001148","DOIUrl":"https://doi.org/10.15226/2378-1726/9/1/001148","url":null,"abstract":"In its essence, panniculitis is the presence of an inflammatory infiltrate in the subcutaneous adipose tissue. Paniculitis as a clinical diagnosis encompasses a group of diseases that creates difficulties for both clinicians - dermatologists and histopathologists, mainly due to the many known forms of the disease, but also due to the various etiological reasons for their occurrence. Therefore, the clinical-pathological correlation plays an important role in the diagnosis. The development of various forms of panniculitis, in particular eosinophilic and generalized lymphocytic, have been described after Covid-19 infection.In the case of our patient, the development of panniculitis was observed after Covid-19 pneumonia. However, as additional etiological factors should be considered 1) the accompanying chronic diseases of the patient - congestive heart failure, hypertension and type 2 diabetes mellitus, which may also be etiological factors for the appearance of a certain form of panniculitis - stasis dermatitis / lipodermatosclerosis, 2) as well as the presence of probable bladder cancer - possible paraneoplastic genesis, 3) and the intake of enoxaparine - drug-induced panniculitis. Given the multifactorial genesis of panniculitis, the past infection with Covid-19, in our case, can be considered as a major trigger of the disease, which developed in the background of several etiological factors. For these reasons, our patient can also be diagnosed with post-Covid-19 panniculitis. Keywords: Lobular Panniculitis; Septal Panniculitis; Covid-19; Stasis Dermatitis; Corticosteroids; Paraneoplastic Reaction; Drug Induced Panniculitis","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80890443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-24DOI: 10.15226/2378-1726/8/4/001147
G. Tchernev, N. Oliveira, Lorraine Joseph Kandathil, James W Patterson
Introduction: Contamination of drugs for high blood pressure (sartans/ angiotensin receptor blockers) with nitrosamines occurs during the manufacturing process and has proven to be a serious international health problem. The reason for this problem is that the 4 nitrosamines discovered so far have been associated with the simultaneous or gradual development of cutaneous tumors as well as tumors of other organ systems. The presence of angiotensin receptors in melanocytic and keratinocytic tumors and their metastases adds difficulty when attempting to determine the relative importance of each of these two components (i.e. nitrosamines and angiotensin receptors) in the context of carcinogenesis. Case report: We report a 40-year-old patient with arterial hypertension with a duration of skin complaints of about 7 months, clinically manifested by 1) the appearance of a solitary tumor near the medial corner of the left eye, verified histologically as Basal Cell Carcinoma (BCC), and 2) multiple, eruptive dysplastic nevi in the area of the posterior sweat gutter. The patient’s systemic medications included: bisoprolol 5mg (1-0-1 / 2) and indapamide 1.5mg (1-0- 0), taken for one year, and 2 years of treatment with amlodipine / valsartan - 5 mg / 160 mg (1-0-1/2) for an initial period of 1 year, followed by a reduced dose of (1/2-0-0) for an additional year. Conclusion: We report the simultaneous development of basal cell carcinoma and dysplastic nevi after the use of a preparation containing generic valsartan. We discuss 1) the role of nitrosamines as possible major factors in the development of dysplastic nevi and BCC; 2) the possible effect of sartans themselves on angiotensin receptors in the skin and: 3) a new, innovative scheme for treatment of drug-induced BCC by cryoimmunotherapy. Keywords Nitrosamines; Valsartan; Angiotensin Receptor Blockers; Arterial Hypertension; Melanoma; BCC; Cryoimmunotherapy
{"title":"Valsartan (or/and Nitrosamine) Induced BCC and Dysplastic Nevi: Current Insights","authors":"G. Tchernev, N. Oliveira, Lorraine Joseph Kandathil, James W Patterson","doi":"10.15226/2378-1726/8/4/001147","DOIUrl":"https://doi.org/10.15226/2378-1726/8/4/001147","url":null,"abstract":"Introduction: Contamination of drugs for high blood pressure (sartans/ angiotensin receptor blockers) with nitrosamines occurs during the manufacturing process and has proven to be a serious international health problem. The reason for this problem is that the 4 nitrosamines discovered so far have been associated with the simultaneous or gradual development of cutaneous tumors as well as tumors of other organ systems. The presence of angiotensin receptors in melanocytic and keratinocytic tumors and their metastases adds difficulty when attempting to determine the relative importance of each of these two components (i.e. nitrosamines and angiotensin receptors) in the context of carcinogenesis. Case report: We report a 40-year-old patient with arterial hypertension with a duration of skin complaints of about 7 months, clinically manifested by 1) the appearance of a solitary tumor near the medial corner of the left eye, verified histologically as Basal Cell Carcinoma (BCC), and 2) multiple, eruptive dysplastic nevi in the area of the posterior sweat gutter. The patient’s systemic medications included: bisoprolol 5mg (1-0-1 / 2) and indapamide 1.5mg (1-0- 0), taken for one year, and 2 years of treatment with amlodipine / valsartan - 5 mg / 160 mg (1-0-1/2) for an initial period of 1 year, followed by a reduced dose of (1/2-0-0) for an additional year. Conclusion: We report the simultaneous development of basal cell carcinoma and dysplastic nevi after the use of a preparation containing generic valsartan. We discuss 1) the role of nitrosamines as possible major factors in the development of dysplastic nevi and BCC; 2) the possible effect of sartans themselves on angiotensin receptors in the skin and: 3) a new, innovative scheme for treatment of drug-induced BCC by cryoimmunotherapy. Keywords Nitrosamines; Valsartan; Angiotensin Receptor Blockers; Arterial Hypertension; Melanoma; BCC; Cryoimmunotherapy","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83308386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.15226/2378-1726/8/4/001145
H. Chen
Frontal Fibrosing Alopecia (FFA) is a condition described in 1994 affect mainly postmenopausal women. It is the most common form of cicatricial alopecia considered as a follicular variant of lichen planopilaris [1]. It is believed that the main pathogenesis in this condition is related to dihydrotestosterone, a derivative converted from the testosterone through 5-Alpha- Reductase (5AR). Because inflammatory, autoimmune, and other organisms are thought to be associated with FFA, there is no one specific cause that can be acted on by 5AR inhibitors [2].Currently, the therapeutic approaches are limited and the patient outcomes are poor [1]. To date, most of the reports are case reports and observational studies [3]. No randomized controlled studies are evaluating the pharmacodynamic profiles of 5AR inhibitors for FFA. The long-term safety of 5AR inhibitors in women should also be considered.
{"title":"5-Alpha-Reductase Inhibitor Treatment for Frontal Fibrosing Alopecia:A Myth or Truth?","authors":"H. Chen","doi":"10.15226/2378-1726/8/4/001145","DOIUrl":"https://doi.org/10.15226/2378-1726/8/4/001145","url":null,"abstract":"Frontal Fibrosing Alopecia (FFA) is a condition described in 1994 affect mainly postmenopausal women. It is the most common form of cicatricial alopecia considered as a follicular variant of lichen planopilaris [1]. It is believed that the main pathogenesis in this condition is related to dihydrotestosterone, a derivative converted from the testosterone through 5-Alpha- Reductase (5AR). Because inflammatory, autoimmune, and other organisms are thought to be associated with FFA, there is no one specific cause that can be acted on by 5AR inhibitors [2].Currently, the therapeutic approaches are limited and the patient outcomes are poor [1]. To date, most of the reports are case reports and observational studies [3]. No randomized controlled studies are evaluating the pharmacodynamic profiles of 5AR inhibitors for FFA. The long-term safety of 5AR inhibitors in women should also be considered.","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85877098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-27DOI: 10.15226/2378-1726/8/4/001144
A. F., Sissinto SaviDTY, Kouanou Aa, H. F., H. O, D. B, S. F., A. F.
Introduction: Deep subcutaneous mycosis results from the involvement of subcutaneous tissue by microscopic fungi. Few studies have been conducted on these diseases in Benin. Patients and methods: This was a retrospective descriptive study that included all cases of subcutaneous mycosis recorded in the Dermatology-Venerology Department of the CNHU-HKM from 2009 to 2020. Results: 3 cases of deep subcutaneous mycosis were recorded in 12 years, including two cases of basidiobolomycosis and one case of fungal mycetoma. The cases of basidiobolomycosis were observed in two girls aged 7 and 8 years whose lesions were located on the right buttock, in the form of indurated placards, adherent to the superficial plane, measuring respectively 10cm by 5cm and 14cm by 7cm. Mycological examination of the biopsy specimens isolated Basidiobolus ranarum. The only case of fungal mycetoma was observed in a 39-year-old man, in the form of a nodular placard measuring 14cm by 12cm, polyfistulised, inflammatory and squamous-crusty with an irregular border that had been evolving for 15 years. Mycological examination of the pus revealed the presence of black grains and the identification of Madurella mycetomatis. Treatment with Ketoconazole was initiated in all three patients but the evolution could not be appreciated. Conclusion : Subcutaneous mycosis is rare in Cotonou, but probably underestimated. Keywords: Subcutaneous Mycosis; Mycetoma; Basidiobolomycosis; Benin
{"title":"Subcutaneous Mycosis in Hospitals: Study of 3 Cases at The National University Hospital Centre Hubert Koutoukou Maga in Cotonou (Benin)","authors":"A. F., Sissinto SaviDTY, Kouanou Aa, H. F., H. O, D. B, S. F., A. F.","doi":"10.15226/2378-1726/8/4/001144","DOIUrl":"https://doi.org/10.15226/2378-1726/8/4/001144","url":null,"abstract":"Introduction: Deep subcutaneous mycosis results from the involvement of subcutaneous tissue by microscopic fungi. Few studies have been conducted on these diseases in Benin. Patients and methods: This was a retrospective descriptive study that included all cases of subcutaneous mycosis recorded in the Dermatology-Venerology Department of the CNHU-HKM from 2009 to 2020. Results: 3 cases of deep subcutaneous mycosis were recorded in 12 years, including two cases of basidiobolomycosis and one case of fungal mycetoma. The cases of basidiobolomycosis were observed in two girls aged 7 and 8 years whose lesions were located on the right buttock, in the form of indurated placards, adherent to the superficial plane, measuring respectively 10cm by 5cm and 14cm by 7cm. Mycological examination of the biopsy specimens isolated Basidiobolus ranarum. The only case of fungal mycetoma was observed in a 39-year-old man, in the form of a nodular placard measuring 14cm by 12cm, polyfistulised, inflammatory and squamous-crusty with an irregular border that had been evolving for 15 years. Mycological examination of the pus revealed the presence of black grains and the identification of Madurella mycetomatis. Treatment with Ketoconazole was initiated in all three patients but the evolution could not be appreciated. Conclusion : Subcutaneous mycosis is rare in Cotonou, but probably underestimated. Keywords: Subcutaneous Mycosis; Mycetoma; Basidiobolomycosis; Benin","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"81 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83980829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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