Tacrolimus

Tacrolimus Reactions 1704, p354 - 2 Jun 2018 Symmetric drug-related intertriginous and flexural exanthema: case report A 41-year-old man developed symmetric drug-related intertriginous and flexural exanthema (SDRIFE) during treatment with tacrolimus as an immunosuppressant therapy [route and duration of treatment to reaction onset not stated]. The man had undergone a kidney and liver transplantation three years ago. Following the transplant, he started receiving tacrolimus 7mg daily. Nine months before presentation, he had developed a chronic, erythematous, itchy, papular eruption, which symmetrically affected his legs and arms including the groins, axillae, flexural folds, neck and gluteal region. He did not show any other signs or symptoms. A skin biopsy revealed epidermal spongiosis and a perivascular superficial and dermo-epidermal infiltrate, which were composed of histiocytes, lymphocytes and some eosinophils without the involvement of basal layer. Drug eruption and allergic contact dermatitis were suspected and patch tests were planned. The patch testing included tacrolimus ointment [Tarfic] at two different concentrations of 0.1% and 0.03% respectively, with occlusion of two days. On day four, his test was positive for cobalt, nickel and the tacrolimus ointment 0.1%. A diagnosis of the SDRIFE was made. The man started receiving corrective treatment with propranolol. His serum tacrolimus level was within normal range. Due to unavailability of everolimus, tacrolimus withdrawal was not possible. Hence, therapy with prednisone and clobetasol was started. Subsequently, most of his lesions cleared. The remaining lesions were treated with betamethasone valerate. Author comment: "Taken together, the clinical, exposure and histopathological features and the patch test results are consistent with a diagnosis of SDRIFE caused by tacrolimus". Scherrer M, et al. Tacrolimus-induced symmetric drug-related intertriginous and flexural exanthema (SDRIFE). Contact Dermatitis 78: 414-416, No. 6, Jun 2018. Available from: URL: http://doi.org/10.1111/cod.12954 - Brazil 803323310 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Tacrolimus

Reactions Weekly , Volume 1704 (1) – Jun 2, 2018
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Publisher
Springer International Publishing
Copyright
Copyright © 2018 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-018-46997-x
Publisher site
See Article on Publisher Site

Abstract

Reactions 1704, p354 - 2 Jun 2018 Symmetric drug-related intertriginous and flexural exanthema: case report A 41-year-old man developed symmetric drug-related intertriginous and flexural exanthema (SDRIFE) during treatment with tacrolimus as an immunosuppressant therapy [route and duration of treatment to reaction onset not stated]. The man had undergone a kidney and liver transplantation three years ago. Following the transplant, he started receiving tacrolimus 7mg daily. Nine months before presentation, he had developed a chronic, erythematous, itchy, papular eruption, which symmetrically affected his legs and arms including the groins, axillae, flexural folds, neck and gluteal region. He did not show any other signs or symptoms. A skin biopsy revealed epidermal spongiosis and a perivascular superficial and dermo-epidermal infiltrate, which were composed of histiocytes, lymphocytes and some eosinophils without the involvement of basal layer. Drug eruption and allergic contact dermatitis were suspected and patch tests were planned. The patch testing included tacrolimus ointment [Tarfic] at two different concentrations of 0.1% and 0.03% respectively, with occlusion of two days. On day four, his test was positive for cobalt, nickel and the tacrolimus ointment 0.1%. A diagnosis of the SDRIFE was made. The man started receiving corrective treatment with propranolol. His serum tacrolimus level was within normal range. Due to unavailability of everolimus, tacrolimus withdrawal was not possible. Hence, therapy with prednisone and clobetasol was started. Subsequently, most of his lesions cleared. The remaining lesions were treated with betamethasone valerate. Author comment: "Taken together, the clinical, exposure and histopathological features and the patch test results are consistent with a diagnosis of SDRIFE caused by tacrolimus". Scherrer M, et al. Tacrolimus-induced symmetric drug-related intertriginous and flexural exanthema (SDRIFE). Contact Dermatitis 78: 414-416, No. 6, Jun 2018. Available from: URL: http://doi.org/10.1111/cod.12954 - Brazil 803323310 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704

Journal

Reactions WeeklySpringer Journals

Published: Jun 2, 2018

References

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