Phenobarbitone Causing Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in a Child Previously Exposed to Long-Term Phenobarbitone as an Infant
An 8 year old Chinese boy had epilepsy and global development delay associated with underlying West syndrome. He first presented with infantile spasms at 5 months of age and was treated with phenobarbitone for seizure control. Phenobarbitone was well-tolerated then and he was asymptomatic. Vigabatrin and sodium valproate were subsequently added 6 months after phenobarbitone monotherapy was started as the seizures increased in frequency. Phenobarbitone was weaned off over another 2 weeks. His seizures became well-controlled and all antiepileptic medications were discontinued from 3 years of age. 5 years later, generalised seizures recurred and sodium valproate was restarted and it was switched to Phenobarbitone 4 months later for better seizure control.
Acne is a distressing condition for physicians and patients alike. Over 90% adolescents acquire acne with 12-14% cases persisting even in adulthood. The condition and its’ sequelae may cause long term psychological disturbance to the patient as well as compromise in physical appearance.
Etiologic factors such as increased sebum production, hormonal dysfunction, bacterial activity within the follicle (commonly Propionibacterium acnes) etc. are responsible for occurrence of acne. Acne healing process progresses through stages of follicular inflammation, granulation tissue formation and finally matrix remodelling. Scarring occurs due to skin damage during healing of active acne.
The skin represents one of the major organs affected by the side effects of chemotherapy. Recognition of the wide range of cutaneous reactions that may occur and its association with a probable drug is sometimes difficult. On the one hand, the differential diagnosis of a skin reaction in a cancer patient with chemotherapy treatment includes a large number of etiologies: toxicity by the drug itself, infections, paraneoplastic syndromes, tumour dissemination, or nutritional deficiencies, among others.
With the use of combined chemotherapy regimens and the associations with other agents (biological drugs, hormonal treatments, etc.) the attribution of a reaction to a particular drug has become more complex. The suspicion is based on the knowledge and familiarization of the clinician with the most frequently described cutaneous patterns and the association with a specific agent, and the diagnosis is confirmed by the improvement of the condition after its suspension.
The protection of Consumers from misleading claims concerning efficacy and other characteristics of cosmetic products are the central core of the worldwide regulatory framework. Cosmetic products are required to be effective when used by Consumers under normal, labelled or foreseeable conditions of use. In Europe, the regulation CE 655/2013 clearly states “Claims for cosmetic products, whether explicit or implicit, shall be supported by adequate and verifiable evidence regardless of the types of evidential support used to substantiate them, including where appropriate expert assessments”.
Atopic dermatitis is one of the most common causes of paediatric, dermatological and allergological consultation; it is characterized by chronic inflammation of the skin, affecting mainly paediatric patients. It is manifested mostly as a mild disease according to the SCORAD score of symptoms (less than 15).
There is a minority of individuals who have severe manifestations which are not only a diagnostic, also a therapeutic challenge claiming many therapeutic resources. Although this condition is not life-threatening, results in a decrease in their life quality as well as their families, sleep disturbances, increased anxiety, family dysfunction and varying in intensity depending on the severity and comorbidities.The prevalence varies globally between 5-15% 6 and certainly there has been an increase in both prevalence and incidence of the disease especially in Westernized countries.
The world is becoming uninhabitable owing to wide globalization. A large number of industries are contributing in water, soil, air, and environment pollution. Increased use of chemicals and accidental chemical spills are also hampering their surroundings. CFC containing tools and technologies are increasing due to higher demand in the market resulting ozone layers are highly affected which make the UV free towards the earth. Several environmental toxins and UV-radiation are the primary reasons for skin dysfunctions as a result skin loses its tone, strength, flux, density, and glamour that further lead to wrinkles and aging. Chronic UV exposure may also lead to skin cancers.
pycnogenol, On the other hand, has been a major source for both flavonols and polyphenols which is very potent against several diseases. Evidences suggest that pycnogenol prevents from multiple skin dysfunctions. Its components are equally potent against skin cancers as well. Moreover, several harmful downstream kinases and proteins are also inhibited by this component. In addition, it has been strongly proven beneficial in reducing ageing by preventing free radical generations, at the same time; it also helps in cell regeneration and replication. Thus, in this study we tried to identify the correlate possible molecular theories on ageing and related skin diseases. Finally, a possible benefit of pycnogenol using on skin disorders would be established.
Vitiligo is an acquired disease characterized by chromic macules due to the absence of melanocytes. The proposed pathogenesis of vitiligo relates to genetics, neurochemical factors, self-destruction of melanocytes and autoimmunity, etc..
The fact that there are roughly patterned clinical distributions of vitiligenous lesions that conforms to different clinical types of vitiligo suggest different etiological or pathophysiological pathways involved in the disease. Iverson noted that infection by herpes viridae family somewhat matched the symptoms of vitiligo, and he postulated that the infection might be a trigger for the disease. Indeed, a study by Grimes et al found that 38% of vitiligo specimen (12 out 29 specimens) harbored cytomegalovirus specific DNA, but negative for DNAs of herpes simplex, varicella-zoster, Epstein-Barr, HIV, and human T-cell lymphotropic virus, though the relatively small size of the cohorts limited the power of the study.