Journal of Cutaneous Immunology and Allergy最新文献

Oxatomide and hydroxyzine are two anti-H1 antihistamines used for treating urticaria, pruritus dermatitis, pollinosis, and several other diseases. In general, anti-H1 antihistamines rarely elicit cutaneous adverse effects.¹ We report a case of fixed drug eruption (FDE) caused by the cross-reaction between oxatomide and hydroxyzine.

A 50-year-old woman had a history of taking oxatomide for seasonal pollinosis. She took oxatomide in the first season of 2002. Painful erythema and erosions appeared 5 h after taking the drug. These symptoms appeared on the lower lip and at the mucocutaneous junction (Figure 1A), with positive results in the patch test (PT; Figure 1B) for oxatomide and oral challenge test. The same skin lesion appeared 5 h after taking oxatomide; these results led to the diagnosis of oxatomide-induced FDE. This eruption improved after the discontinuation of oxatomide and administration of prednisolone (PSL) at 0.6 mg/kg/day for 1 week.

We previously reported and published the above-mentioned case until this clinical point.² Although she took eszopiclone and bepotastine besilate for insomnia because of pollinosis, no drug eruption appeared. One year later, she took hydroxyzine for the first time for sleeplessness because of pollinosis. On the next morning, she had fever and subsequently experienced lip discomfort. Furthermore, on the next day, erythema, blisters, and erosions appeared around the lower lip (Figure 1C). These eruptions were almost similar to the previously described oxatomide-induced FDE. PT against hydroxyzine revealed positive results, and the patient was diagnosed with hydroxyzine-induced FDE (Figure 1D). The eruptions improved using the same treatment that was used for oxatomide-induced eruptions. Moreover, pollinosis-associated insomnia improved using eszopiclone and did not cause any skin eruptions.

FDE is a clinical form of drug eruption that induces erythema in the same region of the body after each administration of the causative drug. PT at the lesion is an effective means for diagnosis.³ However, few reports have implicated such drugs in the development of FDE, particularly the piperazine derivatives, such as hydroxyzine, cetirizine, and levocetirizine.¹ Bhari et al.⁴ reported the case of a patient with an allergy to a drug containing a piperazine ring, who presented a cross-reaction to two other drugs containing piperazine rings. There are no reports on the cross-reactivity between oxatomide and hydroxyzine; however, both share a piperazine ring structure (red circles in Figure 1E,F). Thus, cross-reactivity could appear. In this case, although eszopiclone has a piperazine ring (Figure 1G), no eruption has been reported to date. Therefore, the antigenic determinant in our case was not a piperazine ring. Oxatomide and hydroxyzine share not only a piperazine ring but also tw

Mycobacterium stephanolepidis is a rapidly growing mycobacterium, closely related to Mycobacterium chelonae. It was first reported in 2017, and whether it is infectious to humans is unknown. Here, we report a rare case of cutaneous M. chelonae infection requiring a differential diagnosis of M. stephanolepidis infection.

An immunohistochemical study of human vitiligo case was performed. The excimer laser irradiation may induce the differentiation of melanoblasts and melanocytes from bulge stem cell.

Coronavirus disease 19 (COVID-19) mRNA vaccines sometimes cause various skin rashes. We report an unusual case of erythema nodosum-like nodules with vesicular and pustular papules, which arose after the first shot of a COVID-19 mRNA vaccine. A skin biopsy showed marked neutrophilic infiltration with necrobiotic changes throughout the dermis and subcutis. Immunohistochemically, CD8⁺ cells were much more common than CD4⁺ cells in the dense neutrophilic infiltrates. Many CD68⁺ macrophages were present around the CD8⁺ cells. No cases of neutrophilic dermatosis with necrobiotic changes have been reported. Thus, our findings should be added to the cutaneous adverse effects of the vaccines.

A 50-year-old Japanese woman with limited cutaneous-type SSc presented with severe gangrene in the fingertips of the hands and hypertension, tested positive for anti-PL-12 antibodies. She was diagnosed with acute heart failure owing to scleroderma renal crisis and pulmonary arterial hypertension. Therapeutic agents for pulmonary arterial hypertension were also effective for the digital gangrene.

Erythema annulare centrifugum (EAC) is a figurate papulo-erythema following a self-limiting course, caused by a variety of underlying factors. Skin manifestations associated with COVID-19 infection considerably vary,¹ and sometimes exhibit clinically ambiguous appearance compared to the original disease image (e.g., erythema multiforme-like, Gianotti-Crosti-like, pernio-like, and livedo-like eruptions),^2-5 but COVID-19-associated EAC or similar eruption has rarely been reported to date.

An otherwise healthy 49-year-old Japanese male who had a 2-week history of malaise was diagnosed with COVID-19 by a positive reverse transcription-polymerase chain reaction for SARS-CoV-2. He had never received the SARS-CoV-2 vaccine. The next day after receiving 200 mg/day of remdesivir intravenously, asymptomatic erythema appeared suddenly on the lumbar and extremities. Physical examination showed non-coalescent edematous erythema with partially defined borders on the lumbar and legs (Figure 1A,B). A routine laboratory test and screening for autoimmune diseases showed no abnormal findings, except for atypical lymphocytes and elevated CRP. The chest CT showed diffuse frosted shadows in both lungs suggestive of COVID-19. Skin biopsy revealed focal spongiosis, vacuolar changes along with the dermo-epidermal junction, and densely packed inflammatory cell infiltrates around blood vessels in the superficial dermis (Figure 1C). The infiltrating cells are composed of predominant lymphocytes and scant eosinophils with a “coat-sleeve”-like appearance (Figure 1D). The clinicopathological findings raised the diagnosis of EAC. After discontinuation of remdesivir, he was treated with topical steroids and oral antihistamine, providing successful remission of the skin lesion by 1 month, as the COVID-19-related symptoms lessened. The skin lesion has never recurred thereafter.

Most cases with EAC are clinically idiopathic, although the current concept regarding the disease pathogenesis suggests a delayed-type hypersensitivity to various antigens, including viral, bacterial, or fungal infections, drugs, foods, malignancy or other systemic diseases.⁶ This is supported by evidence that the skin manifestation of EAC is alleviated by treatment of the underlying disease. EAC associated with viral infection has been reported to be triggered by various viruses, such as EB virus, poxvirus, HIV, varicella-zoster virus, and influenza virus, and is mostly transient like our case or displays a fluctuating skin lesion in parallel with the viral disease activity.

To our knowledge, there have been only four case reports, including ours, for EAC encountered in association with COVID-19 infection; one of whom resolved with oral doxycycline,⁷ and three others improved with topical steroids and/or antihistamine.^{8, 9} Except one child case,⁸