iloprost and Skin-Diseases

There are three distinct syndromes of heparin-induced thrombocytopenia: an acute reversible from seen immediately after intravenous bolus injection, a delayed-onset antibody-mediated form seen several days after the initiation of therapy, and an intermediate type characterized by mild thrombocytopenia developing just a few days after starting therapy. Delayed-onset heparin-induced thrombocytopenia, clinically the most important form, results from the formation of heparin-dependent antibodies that are directed against the platelet membrane. In the presence of heparin, these antibodies may induce in vitro or in vivo platelet aggregation. Consequently, the course may be complicated by arterial thromboses. Treatment of this syndrome includes the prompt cessation of heparin. Since continued or future anticoagulation is usually necessary, alternative means of anticoagulation have been explored. Oral anticoagulation is often started but requires several days to take effect. Other options include low-molecular-weight heparins, antiplatelet agents, prostacyclin analogues, and low-molecular-weight dextran. In vitro laboratory tests may be helpful in guiding alternative therapy in some, but not all cases. Unfortunately, none of these agents have proved to be uniformly effective and additional agents and clinical investigation are needed before a definitive option becomes available.

Topics: Aspirin; Cardiopulmonary Bypass; Chondroitin Sulfates; Dermatan Sulfate; Epoprostenol; Fibrinolytic Agents; Glycosaminoglycans; Heparin; Heparinoids; Heparitin Sulfate; Humans; Iloprost; Necrosis; Platelet Aggregation Inhibitors; Skin; Skin Diseases; Thrombocytopenia; Thrombosis

Rheologically active pharmacotherapy is of high importance in many dermato-logical diseases. The intravenous administration of iloprost belongs to the most effective systemic therapeutic agents that serve this pharmacodynamic approach and additionally substantial knowledge on the safety and efficacy exists. We review the dermatologically relevant data in order to offer an easy, thematically focused overview to practicing dermatologists.

Topics: Dermatology; Humans; Iloprost; Platelet Aggregation Inhibitors; Skin Diseases

The European League Against Rheumatism/EULAR Scleroderma Trials and Research group (EULAR/EUSTAR) has published recommendations for the management of systemic sclerosis (SSc). Members of the Scleroderma Clinical Trials Consortium and the Canadian Scleroderma Research Group were surveyed regarding their level of agreement with the recommendations.. A survey containing the 14 EULAR/EUSTAR recommendations asked participants to indicate their level of agreement with each on a 10-point scale, from 0 (not at all) to 9 (completely agree). The survey was sent to 117 people, and 66 replies were received (56% response rate).. Exceptions to generally high agreement included the use of iloprost and bosentan for digital vasculopathy, methotrexate for skin involvement, and bosentan and epoprostenol for pulmonary arterial hypertension (PAH; all < 69% agreement, defined as ≥ 7 rating). Vasculopathy and PAH treatment had differences in agreement between North America and Europe (p < 0.006). Respondents who were EULAR/EUSTAR recommendation authors shared a similar level of agreement compared to those who were not, except for the use of proton pump inhibitors for the prevention of SSc-related gastroesophageal reflux disease, esophageal ulcers, and strictures.. EULAR/EUSTAR recommendations were relatively well accepted among SSc experts. Overall reduced agreement may be due to the modest efficacy of some agents (such as methotrexate for the skin). Some regional disagreement is likely because of access differences.

Topics: Bosentan; Canada; Epoprostenol; Europe; Health Surveys; Humans; Hypertension, Pulmonary; Iloprost; Methotrexate; North America; Practice Guidelines as Topic; Scleroderma, Systemic; Skin Diseases; Societies, Medical; Sulfonamides; Treatment Outcome; Vascular Diseases

A retrospective study of drug abuse patients who developed arterial and venous complications in the upper extremity during 2002-2006 was performed. Twenty-two patients were admitted to hospital on 24 occasions over this period for treatment by our hand clinic. The drug most frequently causing complications was midazolam. The predominant clinical findings were increasing pain and loss of sensitivity in the hand, followed by oedema, cyanosis and marbling of the skin. Treatments included brachial block anaesthesia, low molecular weight heparin, embolectomy and fasciotomies. Despite these measures, amputations, mainly of the fingertips, were necessary in 15 patients. Complications in the upper extremity after self-injection by drug addicts are increasing; information and preventive procedures to minimize these complications are important and demanding tasks for health care bodies.

Topics: Adult; Amputation, Surgical; Angiography; Anti-Bacterial Agents; Anticoagulants; Compartment Syndromes; Cyanosis; Dermatologic Surgical Procedures; Edema; Embolectomy; Fasciotomy; Female; Fibrinolytic Agents; Heparin; Hospitalization; Humans; Iloprost; Male; Necrosis; Nerve Block; Retrospective Studies; Sensation Disorders; Skin; Skin Diseases; Substance Abuse, Intravenous; Surgical Flaps; Tissue Plasminogen Activator; Upper Extremity; Vasodilation; Vasodilator Agents

Earlier workers have suggested a possible fibrinolytic effect using prostaglandin or prostaglandin analogues. Despite using maximum tolerated doses of the prostaglandin analogue Iloprost, we have been unable to demonstrate any significant effect on fibrinolysis in patients with stage IV peripheral vascular disease (Fontaine classification).

Topics: Fibrinolysis; Humans; Iloprost; Ischemia; Necrosis; Peripheral Vascular Diseases; Skin Diseases

Topics: Animals; Dose-Response Relationship, Drug; Edema; Epoprostenol; Iloprost; Rabbits; Skin; Skin Diseases; Vasodilator Agents