allopurinol and Skin-Ulcer

Topics: Allopurinol; Diagnosis, Differential; Female; Fingers; Gout; Gout Suppressants; Humans; Middle Aged; Skin Ulcer

Drug-induced hypersensitivity syndrome (DIHS/DRESS) is a severe adverse systemic reaction. Reactivation of human herpesvirus (HHV) family members other than HHV-6 has been reported in patients with DIHS. Reactivation of HHV family members is generally characterized by increased serum antibody titers against the virus. By contrast, clinical symptoms caused by viral reactivation are relatively rare.. We report a case of DIHS with intractable genital ulcers from reactivation of herpes simplex virus (HSV) in accordance with reactivation of HHV-6 and cytomegalovirus (CMV).. Twenty-two days after the onset of the rash, the patient developed intractable genital ulcers that were resistant to treatment. Histological examination of the ulcers revealed necrotic degeneration in the epidermal cells, with giant cells containing inclusion bodies and marked lymphocytic infiltration in the upper dermis. Immunohistochemical staining with antibodies reactive to HSV or CMV showed that these giant cells were positive for HSV but negative for CMV.. Genital herpes is a common skin disease. However, our case was considered to be a DIHS-associated symptom, not an accidental complication, as the symptoms were severe and resistant to treatment.

Topics: Aged, 80 and over; Allopurinol; Drug Hypersensitivity; Gout Suppressants; Herpes Genitalis; Humans; Hyperuricemia; Male; Skin Ulcer; Virus Activation

Reactive perforating dermatosis (RPD) is a primary perforating dermatosis. Histologically, it presents with transepidermal discharge of basophile material and vertical arrangement of collagen fibers. RPD is treated using external keratolytic agents, topical and systemic glucocorticosteroids, retinoids and antihistamines. Good results have also been reported using photo(chemo)therapy. In the case study presented here, the patient responded very well to treatment with allopurinol.

Topics: Aged; Allopurinol; Arm; Dermatologic Agents; Enzyme Inhibitors; Female; Humans; Skin Ulcer; Treatment Outcome

A 60-year-old man with diabetes mellitus and chronic renal insufficiency needing hemodialysis was admitted with a 3 months history of multiple hyperkeratotic papules on the trunk and extremities partly ulcerated with a keratotic central plug.. Laboratory tests revealed elevated levels of blood urea nitrogen, creatinine, and HbA (1c). Histopathology showed vertical strands of collagen perforating from the ulcerated lesions. COURSE, DIAGNOSIS AND TREATMENT: The biopsy specimen was consistent with acquired reactive perforating collagenosis. The progression was stopped and secondary wound healing was initiated after two weeks of therapy with allopurinol and PUVA.. Acquired reactive perforating collagenosis should be considered when ulcera with oystershell-like keratotic plugs are found especially in patients with predisposing diseases like diabetes and renal insufficiency. A good interdisciplinary cooperation between internist and dermatologist is crucial for the early recognition by histopathology and the immediate treatment.

Topics: Allopurinol; Antimetabolites; Blood Urea Nitrogen; Collagen Diseases; Creatinine; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Humans; Kidney Failure, Chronic; Male; Middle Aged; PUVA Therapy; Skin; Skin Diseases; Skin Ulcer; Treatment Outcome

A 43-year-old man developed fever, skin rash, eosinophillia, and severe renal and liver dysfunction following treatment with allopurinol. The patient died after 3 months of hospitalization. Autopsy revealed systemic cytomegalovirus infection and bacteremia.

Topics: Adult; Allopurinol; Anti-Bacterial Agents; Antiviral Agents; Bacteremia; Cytomegalovirus Infections; Drug Hypersensitivity; Drug Therapy, Combination; Ganciclovir; Gout Suppressants; Humans; Kidney Failure, Chronic; Male; Skin; Skin Ulcer

Perforating disorders represent a heterogenous group of dermatoses characterized by transepithelial elimination of dermal structures. Primary perforating disorders should be distinguished from secondary perforating disorders in which perforation with transepithelial elimination is a rare component of a variety of dermatoses. The primary perforating disorders are hyperkeratosis follicularis et parafollicularis in cutem penetrans (Kyrle's disease), elastosis perforans serpiginosa and perforating folliculitis. Acquired reactive perforating dermatosis (also known as acquired reactive perforating collagenosis) together with the hereditary variant of the reactive perforating collagenosis represent further examples of the primary perforating disorders. We report on 84 year old and 96 year old female patients with an acquired perforating dermatosis. Both of the patients additionally showed diabetes and hyperuricemia. Oral administration of allopurinol (100 mg daily) led to a healing of the disseminated skin lesions in 1-2 weeks. After a follow-up period of 6 months, both patients were in complete remission. On one hand, these results prove again the existence and the severity of this disease, and on the other hand suggest an immunomodulating or differentiation-promoting action in addition to the uricostatic effect of allopurinol.

Topics: Aged; Aged, 80 and over; Allopurinol; Antimetabolites; Antioxidants; Collagen Diseases; Female; Gout; Gout Suppressants; Humans; Keratosis; Skin; Skin Ulcer; Treatment Outcome

Topics: Allopurinol; Humans; Leishmaniasis, Mucocutaneous; Skin Ulcer