RESUMEN
OBJECTIVE: To identify and characterize cases of chemical leukoderma, an underrecognized adverse event, associated with the methylphenidate transdermal system (MTS) reported to the US Food and Drug Administration Adverse Event Reporting System (FAERS). STUDY DESIGN: We searched the Food and Drug Administration Adverse Event Reporting System for reports of chemical leukoderma associated with MTS, received by the Food and Drug Administration from April 6, 2006 to December 23, 2014. RESULTS: We identified 51 cases of chemical leukoderma reported with the use of MTS. The median age was 11 years; 43 cases reported leukoderma at or near the application site only, and 7 reported leukoderma at other parts of the body in addition to the application site; 1 case did not provide enough information to confirm the affected site. The time to onset ranged from 2 months to 4 years after the initiation of MTS. MTS was discontinued in 31 cases. Thirteen patients were prescribed treatment for repigmentation. Three cases reported continued spread of leukoderma after MTS was discontinued. Nineteen cases were diagnosed as vitiligo, including 5 cases reporting histologic features consistent with vitiligo. Leukoderma was persistent in all cases. The median follow-up interval after the discontinuation of MTS in 23 cases was 14 months. CONCLUSIONS: As outlined in recent changes to the prescribing information for MTS, health care professionals need to be aware of the potential risk of chemical leukoderma caused by MTS, especially given that chemical leukoderma is often misdiagnosed as idiopathic vitiligo. MTS should be discontinued at the earliest sign of pigment loss and other treatment options considered.
Asunto(s)
Estimulantes del Sistema Nervioso Central/efectos adversos , Erupciones por Medicamentos/etiología , Hipopigmentación/inducido químicamente , Metilfenidato/efectos adversos , Adolescente , Adulto , Sistemas de Registro de Reacción Adversa a Medicamentos , Niño , Femenino , Humanos , Masculino , Parche Transdérmico , Estados Unidos , United States Food and Drug Administration , Adulto JovenAsunto(s)
Niño , Preescolar , Humanos , Masculino , Informes de Casos , Infecciones por HTLV-I/complicaciones , Dermatitis/etiología , Relación CD4-CD8 , Dermatitis/inmunología , Estudios de Seguimiento , Haplotipos , Antígenos HLA , Infecciones por HTLV-I/inmunología , Inmunoglobulinas/sangre , Estudios Prospectivos , Subgrupos de Linfocitos TRESUMEN
Objectives: To define the clinical and laboratory features associated with infective dermatitis (ID) and confirm its association with human T-lymphotropic virus type 1 (HTLV-I). Design: A case series of patients with ID were compared with patients with atopic dermatitis (AD) which is an important disease in the differential diagnosis of ID. Setting: Patients were recruited from dermatology and pediatric clinics at the University Hospital of the West Indies and the Bustamante Children's Hospital, Kingston, Jamaica. Main Outcome Measures: Clinical and laboratory features of patients with AD were compared with those of patients with ID. Patients: Consecutive patients older than 1« years diagnosed as having ID (n=50) and AD (n=35) were enrolled based on clinical findings. Results: The mean age of patients with ID and AD were 6.9 and 7.8 years, respectively. Histologically, both disease were predominantly chronic dermatitis... Conclusion: Infective dermatitis is a distinct clinical entity associated with HTLV-I, which plays a role in the pathogenesis and immune perturbations observed.(AU)
Asunto(s)
Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Estudio Comparativo , Adolescente , Lactante , Dermatitis/patología , Dermatitis/virología , Infecciones por HTLV-I/inmunología , Infecciones por HTLV-I/patología , Recuento de Células , Linfocitos T CD8-positivos/patología , Linfocitos T CD4-Positivos/patología , Dermatitis/inmunología , Dermatitis Atópica/inmunología , Dermatitis Atópica/microbiología , Dermatitis Atópica/patología , Infecciones por HTLV-I/fisiopatología , Activación de Linfocitos/fisiología , Piel/patología , Staphylococcus aureus/aislamiento & purificación , Streptococcus agalactiae/aislamiento & purificaciónAsunto(s)
Niño , Humanos , Enfermedades de la Piel , Eccema/diagnóstico , Eccema/terapia , Escabiosis/diagnóstico , Escabiosis/terapia , Papillomavirus Bovino 1 , Impétigo/diagnóstico , Impétigo/terapia , Tiña del Cuero Cabelludo/diagnóstico , Tiña del Cuero Cabelludo/terapia , Infestaciones por PiojosRESUMEN
It has been suggested that black children of West Indian origin living in London have a higher prevalence of atopic dermatitis (AD) than their counterparts living in the Caribbean. (Williams HC et. al London-born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol 1995; 32: 212-7). To test this hypothesis, we undertook a colloborative study on the prevalence of atopic dermatitis in school children in Lambeth, London and Kingston, Jamaica. Questionnaires were sent to 2126 and 3957 parents of children aged 4 to 11 years attending seven primary schools in London and six schools in Kingston respectively. The questionnaires requested screening information on symptoms of AD and parentally nominated ethnic group of the child. Children whose parents responded affirmatively to the presence of an itchy rash or the presence of generally dry skin (N=562) were examined during two visits to the schools in London. In Kingston, all children whose parents responded and gave consent were examined (N=3027) by the same dermatologist. Cases of AD were defined using the UK Working Party's Diagnostic Criteria. The overall response rate in London and Kingston was 70.3 percent and 86.2 percent respectively. The overall prevalence of AD was 10.8 percent (162/1495) and 4.9 percent (166/3409) in London and Kingston respectively. The prevalence of AD in black children living in London was 18.9 percent (60/317) compared with 4.6 percent (94/2029). These results suggest that black Caribbean children in London are at an increased risk (odds ratio 4.81, 95 percent confidence interval 3.3 to 6.9, p<0.001) of developing atopic dermatitis when compared to their counterparts living in Jamaica. Possible reasons for these large prevalence differences are currently being investigated. (AU)
Asunto(s)
Niño , Humanos , Estudio Comparativo , Preescolar , Dermatitis Atópica/epidemiología , Reino Unido , Jamaica , Negro o Afroamericano , Factores de Riesgo , Prevalencia , Estudios Transversales , Recolección de DatosRESUMEN
This prospective study of seroprevalence of human T-lymphotropic virus Type I (HTLV_I) among patients with sever skin disorders at the University Hospital of the West Indies (UHWI) was undertaken because of the high prevalence of skin lesions in patients with adult T-cell lymphoma/leukaemia (ATL) both before and after diagnosis was made. Of 901 patients admitted to the dermatology ward between May 1989 and October 1996, 195 were found to be HTLV-I seropositive, giving a seroprevalence rate of 21.6 percent. The commonest disorders among the HTLV-I positive group were infected dermatitis (ID), ATL, crusted scabies and eczema other than ID. Skin disorders with the highest HTLV-I positive rates were ID (100 percent), ATL (85.7 percent) and crusted scabies (70 percent). Eczema other than ID, erythroderma and psoriasis also had a significantly higher HTLV-I positivity rate than the general Jamaican population but less than the first three mentioned. Seven patients were co-infected with HTLV-I and HIV-I, and the commonest skin disorder among this group was seborrhoeic dermatitis. There was 100 percent positivity among fifteen mothers of ID patients tested. The results confirm the hypothesis that there is a higher HTLV-I seroprevalence rate among patients with severe skin disorders than the general population in Jamaica. (AU)
Asunto(s)
Humanos , Femenino , Masculino , Infecciones por HTLV-I/complicaciones , Enfermedades de la Piel , Jamaica/epidemiologíaRESUMEN
Eczema in the tropics is a common problem. Although it is a major cause of discomfort among children worldwide, a warm tropical climate often has important repercussions for children with dermatitis. The original description by Sweet empahasized that interest in tropical eczemas extended to the English, as children of West Indian immigrants in England were affected. Likewise, immigrants may carry these disorders with them to the United States. In Jamaica, a tropical country, the largest and most populous of the English-speaking Caribbena islands, eczema is by far the most common skin disorder seen in children attending dermatology clinics. Reports from other Caribbean islands suggest that this is true for the region as a whole. In 1981, Alabi and La Grenade reported that from 1971 to 1975 eczema accounted for 46.7 percent of skin rashes seen in children at the University Hospital of the West Indies. Review of the period 1988 to 1993 showed that 52 percent of the 601 children who attended the skin clinic for the first time had eczema, confirming the earlier finding. In this latter review, atopic eczema was the most common type of eczema (52 percent), followed by seborrheic eczema (20 percent) and infective dermatitis (10 percent). The remaining 18 percent had a variety of unclassified eczemas including pityriasis alba, discoid eczema, acute vesicular eczema of the hands and/or feet, and hyperkeratotic eczema of the feet.(AU)
Asunto(s)
Niño , Preescolar , Humanos , Infecciones por HTLV-I/diagnóstico , Enfermedades Cutáneas Infecciosas/diagnóstico , Virus Linfotrópico T Tipo 1 Humano/aislamiento & purificación , Biomarcadores/análisis , Dermatitis/diagnóstico , Dermatitis/fisiopatología , Dermatitis/terapia , Diagnóstico Diferencial , Infecciones por HTLV-I/fisiopatología , Infecciones por HTLV-I/terapia , Enfermedades Cutáneas Infecciosas/fisiopatología , Enfermedades Cutáneas Infecciosas/terapia , Clima TropicalRESUMEN
A possible causal association between infective dematitis and HTLV-I infection was reported familial infective dematitis (ID) occurring in a 26-year-old mother and her 9-year-old son. The mother was first diagnosed with ID in 1969 at the age of 2 years in the Dermatology Unit at the University Hospital of the West indies (U.H.W.I.) in Jamaica. The elder of her 2 sons was diagnosed with ID at the age of 3 years, also at U.H.W.I. Both mother and son are HTLV-I-seropositive. A second, younger son, currently age 2 years, is also HTLV-I-seropositive, but without clinical evidence of ID. Major hitocompatibility complex (MHC), class II, human leucocyte antigen (HLA) genotyping documented a shared class II haplotype, DRB*DQBI* (1101-0301), in the mother and her 2 sons. This same haplotype has been described among Japanese patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and has been associated with a possible pathologically heightened immune repsonse to HTLV-I infection. The presence of this haplotype in these familial ID cases with clinical signs of HAM/TSP may have contributed to their risk for development of HAM/TSP. The unaffected, HTLV-I seropositive younger son requires close clinical follow-up. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Preescolar , Adulto , Informes de Casos , Dermatitis/etiología , Antígenos HLA-DQ , Antígenos HLA-DR/genética , Infecciones por HTLV-I/inmunología , Paraparesia Espástica Tropical/inmunología , Enfermedades Cutáneas Infecciosas/etiología , Genotipo , Haplotipos , Prueba de Histocompatibilidad , Jamaica , Linaje , Valor Predictivo de las Pruebas , Dermatitis/genética , Dermatitis/inmunología , Infecciones por HTLV-I/complicaciones , Infecciones por HTLV-I/genética , Paraparesia Espástica Tropical/inmunologíaRESUMEN
Skin manifestations are a common feature of HTLV-1 associated disorders and of HTLV-1 infection itself. These include the lymphomatous skin infiltrates in adult T-cell lymphoma/leukaemia, most commonly manifesting as persistent, generalised papules, nodules and plaques with later ulceration, acquired ichthyosis and xeroderma in HAM/TSP, infective dermatitis of children, dermatomyositis, crusted (Norwegian) scabies, psoriasiform rashes which may precede one of the more serious disease associations, and possibly also seborrhoeic dermatitis. Disorders typically associated with immunosuppression such as disseminated herpes zoster, and ulcerative non-healing herpes simplex may also be seen occasionally both in ATK as well as in other wise asymptomatic HTLV-1 infection (AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adulto , Virus Linfotrópico T Tipo 1 Humano , Linfoma Cutáneo de Células T , Dermatitis , Dermatomiositis , Escabiosis , Psoriasis , Herpes Zóster , Herpes Simple , Leucemia-Linfoma de Células T del Adulto , Paraparesia Espástica Tropical , Uveítis , Hipercalcemia , Anemia , Complejo Relacionado con el SIDA , Lepra , Sarcoidosis , Dermatitis Exfoliativa , Esclerodermia Sistémica , Enfermedades Cutáneas Vesiculoampollosas , Eccema , Ictiosis , Inmunoglobulina G , Anticuerpos Anti-HTLV-I , Staphylococcus , Streptococcus , Bronquiectasia , Catarata , Polimiositis , Eritema , Edema , Sarcoptes scabiei , Dermatitis Seborreica , Tiña del Cuero Cabelludo , Región del Caribe , Estados Unidos , Haití , Japón , América del Sur , ÁfricaRESUMEN
An association between HTLV-1 infection and infective dermatitis(ID), a relapsing eczematous condition of Jamaican children, was reported in 1990. These patients are at a risk of developing other known HTLV-1 related diseases. We have observed the development of HTLV-1 associated myelopathy/tropical spastic paraparesis im two patients, ages 14 and 35 years, who were diagnosed with ID at ages 2 and 10 years, respectively. Infective dermatitis of children serves as an early marker of HTLV-1 infection and may predict later development of either the malignant outcome, adult T-cell leukaemia/lymphoma or the neurologic manifestation HAM/TSP among adult carriers of HTLV-1 infection(AU)
Asunto(s)
Informes de Casos , Humanos , Femenino , Niño , Infecciones por HTLV-I/complicaciones , Infecciones Estafilocócicas/complicaciones , Infecciones Estreptocócicas/complicaciones , Dermatitis/complicaciones , Paraparesia Espástica Tropical/etiología , Estudios de Seguimiento , Jamaica/epidemiologíaRESUMEN
An association between HTLV-1 infection and infective dermatitis(ID), a relapsing eczematous condition of Jamaican children, was reported in 1990. These patients are at a risk of developing other known HTLV-1 related diseases. We have observed the development of HTLV-1 associated myelopathy/tropical spastic paraparesis im two patients, ages 14 and 35 years, who were diagnosed with ID at ages 2 and 10 years, respectively. Infective dermatitis of children serves as an early marker of HTLV-1 infection and may predict later development of either the malignant outcome, adult T-cell leukaemia/lymphoma or the neurologic manifestation HAM/TSP among adult carriers of HTLV-1 infection
Asunto(s)
Humanos , Femenino , Niño , Infecciones Estafilocócicas/complicaciones , Infecciones Estreptocócicas/complicaciones , Infecciones por HTLV-I/complicaciones , Paraparesia Espástica Tropical/etiología , Dermatitis/complicaciones , Estudios de Seguimiento , Jamaica/epidemiologíaRESUMEN
A review of dermatofibrosarcoma protuberans diagnosed at the University hospital of the West Indies over a 10-year period revealed 23 cases. The mean age of the patients was 36.3 years. There were 13 females and 10 males. The trunk was the most common site. The clinical diagnosis was commonly missed. The results of this study are compared with those from other countries
Asunto(s)
Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Neoplasias Cutáneas/patología , Dermatofibrosarcoma/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Estudios Retrospectivos , Dermatofibrosarcoma/diagnóstico , Dermatofibrosarcoma/terapiaRESUMEN
Since human T-cell lymphotropic virus (HTLV-I) was identified in 1980 as causing human disease, it has been etiologically associated with adult T-cell lymphoma/leukemia (ATL) and tropical spastic paraparesis (TSP). More recently, several new diseases have been reported in association with this virus, including infective dermatitis of Jamaican children, which we reported in 1990. Studies on infective dermatitis have shown that these children have abnormalities of immune function, and some develop other HTLV-I associated disorders, including TSP. This paper reviews the work done on infective dermatitis to date, and explores the association with TSP (AU)
Asunto(s)
Adulto , Niño , Humanos , Persona de Mediana Edad , Paraparesia Espástica Tropical/virología , Dermatitis/virología , Virus Linfotrópico T Tipo 1 Humano/patogenicidad , Virus Linfotrópico T Tipo 1 Humano/aislamiento & purificación , JamaicaRESUMEN
This paper reports on the immunological findings of a case control study of 50 infective dermatitis (ID) patients and 36 atopic eczema (AE) patients undertaken between December 1990 and August 1991. It also reports on a comparison of these results with those of age and sex matched normal controls, and age and sex matched HTLV-I infected asymptomatic children. Investigations of their immune systems showed that both ID and AE patients had normal responses to delayed hypersensitivity skin tests, and normal compliment levels. However there was a marked increase in the activity of both T and B lymphocyte systems, with all immunoglobulin levels being significantly increased in ID patients versus others. The CD4:CD8 ratio was increased, with an increase in the CD4 counts. Monoclonal antibody tests showed increased T cell activation. The results confirm immune dysfunction though the precise mechanism of the immunodysregulation remains to be determined. (AU)
Asunto(s)
Humanos , Niño , Infecciones por HTLV-I/inmunología , Jamaica/epidemiología , Dermatitis , Dermatitis Atópica , Linfocitos T , Linfocitos BRESUMEN
The clinico-pathologic features of 111 patients with non-Hodgkin's Lymphoma (NHL) exhibiting morphologic and immunophenotypic features of peripheral T-cell lymphoma (PTL) were analysed with respect to HTLV-I serostatus. 73 (65.8 percent) were HTLV-I seropositive (HTLV-I+) and 38 (34.2 percent) were HTLV-I seronegative (HTLV-I-). HTLV+ cases had a lower mean age (42.2 yrs) than HTLV- cases (50 yrs) and a male to female ratio of 1:1 while HTLV- cases showed a male preponderance (M:F 2:1). No significant differences in morphology were noted using the Japan Study Group classification. Both groups shared clinical features consistent with Adult T-cell leukemia/lymphoma but hypercalcemia was more likely to occur in the HTLV+ group [Hypercalcemia:- HTLV+ 50.7 percent, HTLV- 15.8 percent; Leukemia:- HTLV+ 39.7 percent, HTLV- 34.2 percent; Skin infiltration:- HTLV+ 38.3 percent, HTLV- 42.1 percent]. It would appear that some cases of HTLV- PTL could be included in the group classified as ATL given the occurrence of sentinel clinical features associated with ATL. Perhaps these will prove to be HTLV-I proviral DNA positive. Further studies to define this group are indicated. (AU)
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Humanos , Masculino , Femenino , Deltaretrovirus , Leucemia-Linfoma de Células T del Adulto , Hipercalcemia , Jamaica/epidemiologíaRESUMEN
A review of dermatofibrosarcoma protuberans diagnosed at the University hospital of the West Indies over a 10-year period revealed 23 cases. The mean age of the patients was 36.3 years. There were 13 females and 10 males. The trunk was the most common site. The clinical diagnosis was commonly missed. The results of this study are compared with those from other countries (AU)
Asunto(s)
Adulto , Persona de Mediana Edad , Anciano , Humanos , Masculino , Femenino , Dermatofibrosarcoma/patología , Neoplasias Cutáneas/patología , Dermatofibrosarcoma/diagnóstico , Dermatofibrosarcoma/terapia , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Estudios RetrospectivosRESUMEN
BACKGROUND:- Human T-cell lymphotropic virus type I (HTLV-I) infection is endemic in Jamaica, with an estimated crude seroprevalence of 5percent. Adult T-cell lymphoma/Leukemia (ATL), a disease caused by HTLV-I, has an incidence of 1-2/100,000 in the Jamiacan population. Familial ATL has not previously been reported from Jamaica. METHODS:- Hospital records and histologic specimens of the two cases were reviewed. HTLV-I infection was confirmed by antibody testing and by polymerase chain reaction on paraffin-embedded tissue,where serum was unavailable. Family members identified by the patient's parents. After giving informed consent, family members were asked to complete an interviewer-administered questionnaire and to agree to phlebotomy. RESULTS:- ATL developed 10 years apart in two siblings from a Jamaican family at age 16 and 24 years. A study of 19 members of their extended family, including both parents, 2 grandparents, and 3 siblings, revealed an overall HTLV-I seroprevalence of 17 percent. This compared with 75 percent among parents and sibling living in the same household as the patients (AU)
Asunto(s)
Informes de Casos , Humanos , Virus Linfotrópico T Tipo 1 Humano , Jamaica , Factores de Riesgo , Hipercalcemia , Linfoma no HodgkinRESUMEN
A randomized controlled trial of Solcoseryl, DuoDerm and conventional conservative therapy with Eusol has been performed in 32 patients with homozygous sickle-cell (SS) disease. After 12 weeks' baseline observation, patients were randomized to one of three therapies and monitored for a further 12 weeks. Of 44 ulcerated legs, 20 received control treatment, 12 Solcoseryl and 12 DuoDerm. DuoDerm was generally unacceptable, and two-thirds of the patients defaulted from this treatment. Solcoseryl increased ulcer healing compared to the controls but the difference was not significant. Solcoseryl was well tolerated and may have a role in the treatment of chronic leg ulcers of sickle-cell disease. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Anemia de Células Falciformes/complicaciones , Úlcera de la Pierna/tratamiento farmacológico , Actiemil/uso terapéutico , Coloides/uso terapéutico , Apósitos Oclusivos , Cooperación del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , JamaicaRESUMEN
A randomized controlled trial of Solcoseryl, DuoDerm and conventional conservative therapy with Eusol has been performed in 32 patients with homozygous sickle-cell (SS) disease. After 12 weeks' baseline observation, patients were randomized to one of three therapies and monitored for a further 12 weeks. Of 44 ulcerated legs, 20 received control treatment, 12 Solcoseryl and 12 DuoDerm. DuoDerm was generally unacceptable, and two-thirds of the patients defaulted from this treatment. Solcoseryl increased ulcer healing compared to the controls but the difference was not significant. Solcoseryl was well tolerated and may have a role in the treatment of chronic leg ulcers of sickle-cell disease.