Research letter
Exfoliative erythrodermia induced by pantoprazole
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"apellidos" => "Sánchez-Borges" "email" => array:1 [ 0 => "sanchezbmario@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "González-Aveledo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Allergy and Clinical Immunology Department, Clínica El Avila, Caracas, Venezuela" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatology Department, Centro Médico de Caracas, Caracas, Venezuela" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1188 "Ancho" => 1583 "Tamanyo" => 313183 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exfoliative erythrodermia induced by pantoprazole. Observe the extensive skin desquamation on hands and lower limbs.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Although proton pump inhibitors are widely used, allergic reactions to this group of drugs are rarely reported. In this paper we present the case of a patient who developed a delayed reaction to pantoprazole. A 35-year-old female patient complained of generalised erythema with intense itching and desquamation for three weeks before consulting (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The rash was first noticed five days after the initiation of treatment with topical diltiazem, polyethylene glycol 3359 (Milax<span class="elsevierStyleSup">®</span>), Alevian Duo<span class="elsevierStyleSup">®</span> (simethicone/pinaverium bromide) for anal fissuring, and pantoprazole for gastritis. Past medical history disclosed appendectomy, chickenpox, and chronic rhinosinusitis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination showed xeroderma, widely distributed erythema and generalised desquamation, more pronounced on the hands, and lower limbs (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The diagnosis of exfoliative erythrodermia likely related to drug allergy was made and symptoms resolved completely after treatment with oral prednisone, topical corticosteroids (mometasone furoate and 0.1% methylprednisolone aceponate), and oral antihistamines (desloratadine, cetirizine). No other underlying clinical conditions, including autoimmune, allergic or infectious diseases were present, as deducted from patient questioning and physical examination. Routine laboratory investigations, including haematology, blood chemistry, urine and stool examination were within normal limits. Histopathological examination of the skin was not performed.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Six weeks after the first visit patch tests with drugs, with reading after 72 and 96<span class="elsevierStyleHsp" style=""></span>h, were performed. Milax<span class="elsevierStyleSup">®</span>, Alevian Duo<span class="elsevierStyleSup">®</span> and pantoprazole 10% were applied in white petrolatum. Tests were negative for 2% diltiazem ointment, Alevian Duo<span class="elsevierStyleSup">®</span> and Milax<span class="elsevierStyleSup">®</span>. The test was positive for pantoprazole, showing local erythema and oedema at 72 and 96<span class="elsevierStyleHsp" style=""></span>h (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Patch tests with all drugs mentioned above were negative in 12 voluntary individuals who did not have a history of drug allergy. Avoidance of pantoprazole and substitution with lanzoprazole were recommended.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">IgE-mediated allergic reactions to proton pump inhibitors, especially anaphylaxis and urticaria, have been occasionally reported by various investigators.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> In regard to delayed reactions, Mockenhaupt et al. observed nine cases of pantoprazole-induced severe cutaneous reactions of the type Stevens–Johnson syndrome and toxic epidermal necrolysis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Isolated reports of lichenoid eruption, acute interstitial nephritis, neutropenia, and vasculitis attributed to proton pump inhibitors, including pantoprazole, have also been published.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">To the best of our knowledge, this is the first report of a case of exfoliative erythrodermia induced by pantoprazole that was confirmed by drug patch testing. Although a positive patch test does not constitute an absolute diagnostic criterion for establishing drug responsibility in this particular case, it is interesting to mention that the test was negative in non-allergic control subjects, and was also negative for all other drugs tested in the present patient. Therefore, an irritating reaction to the patch test seemed less likely to be occurring. Even though this diagnostic tool has not been adequately standardised, it is useful for a more precise diagnostic evaluation especially in patients who are receiving multiple medications, as was the case in the present report.</p><p id="par0030" class="elsevierStylePara elsevierViewall">With regard to the management, since in patients with immediate reactions to proton pump inhibitors cross-reactions between omeprazole and pantoprazole but not with lanzoprazole are observed, we recommended the use of lanzoprazole, which has been tolerated by this patient during the short three-month follow up period after its initiation.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1778 "Ancho" => 1333 "Tamanyo" => 233813 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythrodermic and exfoliative dermatitis in a 35-year-old female patient with delayed allergy to pantoprazole.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1188 "Ancho" => 1583 "Tamanyo" => 313183 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exfoliative erythrodermia induced by pantoprazole. Observe the extensive skin desquamation on hands and lower limbs.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1000 "Ancho" => 1333 "Tamanyo" => 395061 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Results of patch testing with 10% pantoprazole in white petrolatum in a patient with exfoliative eryhthroderma. 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| 2022 March | 35 | 26 | 61 |
| 2022 February | 31 | 20 | 51 |
| 2022 January | 29 | 23 | 52 |
| 2021 December | 13 | 37 | 50 |
| 2021 November | 6 | 19 | 25 |
| 2021 October | 15 | 34 | 49 |
| 2021 September | 10 | 36 | 46 |
| 2021 August | 3 | 32 | 35 |
| 2021 July | 10 | 17 | 27 |
| 2021 June | 7 | 13 | 20 |
| 2021 May | 14 | 27 | 41 |
| 2021 April | 10 | 38 | 48 |
| 2021 March | 9 | 14 | 23 |
| 2021 February | 11 | 18 | 29 |
| 2021 January | 7 | 12 | 19 |
| 2020 December | 0 | 4 | 4 |
| 2020 November | 0 | 5 | 5 |
| 2020 October | 0 | 2 | 2 |
| 2020 September | 0 | 5 | 5 |
| 2020 August | 0 | 6 | 6 |
| 2020 July | 0 | 4 | 4 |
| 2020 June | 0 | 1 | 1 |
| 2020 May | 0 | 4 | 4 |
| 2020 April | 0 | 1 | 1 |
| 2020 March | 0 | 4 | 4 |
| 2020 February | 0 | 4 | 4 |
| 2020 January | 0 | 3 | 3 |
| 2019 December | 0 | 3 | 3 |
| 2019 November | 0 | 3 | 3 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 0 | 2 | 2 |
| 2019 August | 0 | 1 | 1 |
| 2019 July | 0 | 4 | 4 |
| 2019 June | 0 | 9 | 9 |
| 2019 May | 0 | 91 | 91 |
| 2019 April | 0 | 33 | 33 |
| 2019 March | 0 | 6 | 6 |
| 2019 February | 0 | 3 | 3 |
| 2019 January | 0 | 3 | 3 |
| 2018 December | 0 | 4 | 4 |
| 2018 August | 0 | 1 | 1 |
| 2018 May | 0 | 1 | 1 |
| 2018 March | 2 | 1 | 3 |
| 2018 February | 13 | 3 | 16 |
| 2018 January | 20 | 0 | 20 |
| 2017 December | 11 | 4 | 15 |
| 2017 November | 16 | 6 | 22 |
| 2017 October | 22 | 5 | 27 |
| 2017 September | 16 | 13 | 29 |
| 2017 August | 13 | 5 | 18 |
| 2017 July | 10 | 4 | 14 |
| 2017 June | 14 | 14 | 28 |
| 2017 May | 39 | 16 | 55 |
| 2017 April | 36 | 9 | 45 |
| 2017 March | 26 | 49 | 75 |
| 2017 February | 37 | 4 | 41 |
| 2017 January | 22 | 3 | 25 |
| 2016 December | 36 | 5 | 41 |
| 2016 November | 55 | 5 | 60 |
| 2016 October | 95 | 17 | 112 |
| 2016 September | 167 | 4 | 171 |
| 2016 August | 107 | 9 | 116 |
| 2016 July | 12 | 3 | 15 |
| 2016 June | 33 | 20 | 53 |
| 2016 May | 28 | 14 | 42 |
| 2016 April | 31 | 19 | 50 |
| 2016 March | 37 | 18 | 55 |
| 2016 February | 42 | 22 | 64 |
| 2016 January | 30 | 23 | 53 |
| 2015 December | 25 | 13 | 38 |
| 2015 November | 33 | 16 | 49 |
| 2015 October | 47 | 33 | 80 |
| 2015 September | 31 | 7 | 38 |
| 2015 August | 49 | 7 | 56 |
| 2015 July | 73 | 4 | 77 |
| 2015 June | 30 | 4 | 34 |
| 2015 May | 25 | 4 | 29 |
| 2015 April | 29 | 10 | 39 |
| 2015 March | 40 | 5 | 45 |
| 2015 February | 29 | 4 | 33 |
| 2015 January | 22 | 4 | 26 |
| 2014 December | 18 | 9 | 27 |
| 2014 November | 10 | 7 | 17 |
| 2014 October | 17 | 7 | 24 |
| 2014 September | 35 | 3 | 38 |
| 2014 August | 17 | 3 | 20 |
| 2014 July | 21 | 1 | 22 |
| 2014 June | 14 | 5 | 19 |
| 2014 May | 16 | 5 | 21 |
| 2014 April | 9 | 4 | 13 |
| 2014 March | 59 | 14 | 73 |
| 2014 February | 73 | 14 | 87 |
| 2014 January | 60 | 15 | 75 |
| 2013 December | 66 | 5 | 71 |
| 2013 November | 52 | 13 | 65 |
| 2013 October | 79 | 11 | 90 |
| 2013 September | 51 | 14 | 65 |
| 2013 August | 63 | 15 | 78 |
| 2013 July | 69 | 9 | 78 |
| 2013 June | 29 | 2 | 31 |
| 2013 May | 49 | 7 | 56 |
| 2013 April | 37 | 8 | 45 |
| 2013 March | 24 | 8 | 32 |
| 2013 February | 14 | 8 | 22 |
| 2013 January | 6 | 4 | 10 |
| 2012 December | 6 | 3 | 9 |
| 2012 November | 3 | 5 | 8 |
| 2012 October | 1 | 3 | 4 |
| 2012 September | 3 | 2 | 5 |
| 2012 April | 404 | 0 | 404 |
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