Head and Neck Hyperpigmentation Probably Associated With Polymyxin B Therapy

Zavascki, Alexandre Prehn; Manfro, Roberto Ceratti; Maciel, Rafael Almeida; Falci, Diego Rodrigues

doi:10.1177/1060028015595643

Cited by 20 publications

(22 citation statements)

References 5 publications

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“…Some case reports of SH associated with polymyxin B have been published since 2007 but further research is warranted to study its etiology, duration, and treatment. The reaction has been observed in both newborns and adults receiving intravenous polymyxin B alone or in combination therapy as shown earlier (Gothwal et al, 2016;Knueppel and Rahimian, 2007;Zavascki et al, 2015).…”

supporting

confidence: 57%

Acquired skin hyperpigmentation following intravenous polymyxin B treatment: a cohort study

Mattos

Lloret

Cintra

et al. 2016

Pigment Cell Melanoma Res

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supporting

confidence: 57%

Acquired skin hyperpigmentation following intravenous polymyxin B treatment: a cohort study

Mattos

Lloret

Cintra

et al. 2016

Pigment Cell Melanoma Res

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“…The main areas for prioritization of future research include prospective comparative trials assessing AKI rates with dose‐optimized polymyxins, investigation into the mechanisms of potential discordant toxicity rates between the agents, and finally whether dose‐optimized polymyxins differ in their rates of nonnephrotoxic adverse reactions, most notably neurotoxicity. In addition, studies comparing neurotoxicities and skin hyperpigmentation (e.g., skin darkness of face, ears, neck, and upper chest and head during therapy) for polymyxin B versus colistin require future studies.…”

Section: Clinical Questions and Recommendationsmentioning

confidence: 99%

International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP)

et al. 2019

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The polymyxin antibiotics colistin (polymyxin E) and polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resurged, assuming an important role as salvage therapy for otherwise untreatable gram‐negative infections. Since their reintroduction into the clinic, significant confusion remains due to the existence of several different conventions used to describe doses of the polymyxins, differences in their formulations, outdated product information, and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose colistin and polymyxin B. We report consensus therapeutic guidelines for agent selection and dosing of the polymyxin antibiotics for optimal use in adult patients, as endorsed by the American College of Clinical Pharmacy (ACCP), Infectious Diseases Society of America (IDSA), International Society of Anti‐Infective Pharmacology (ISAP), Society for Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) endorses this document as a consensus statement. The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We established a diverse international expert panel to make therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, polymyxin agent selection, dosing, dosage adjustment and monitoring of colistin and polymyxin B, use of polymyxin‐based combination therapy, intrathecal therapy, inhalation therapy, toxicity, and prevention of renal failure. The treatment guidelines provide the first ever consensus recommendations for colistin and polymyxin B therapy that are intended to guide optimal clinical use.

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“…2 Polymyxin B intravenous treatment has been associated with SH, predominantly of the head and neck. [3][4][5] According to Mattos et al,5 the incidence of SH is 15%; it is not related to sun exposure as the exposed skin of the shoulders and trunk is spared. The first changes typically appear on the third day of treatment as gradual and diffuse darkening of the head and neck skin in shades of brown.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Skin hyperpigmentation following intravenous polymyxin B treatment associated with melanocyte activation and inflammatory process

et al. 2017

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What is known and objective Polymyxins were widely used until the 1960s; however, they fell into disfavour owing to their toxicity. The subsequent growth of infections caused by multidrug-resistant Gram-negative bacteria has led to renewed use of this class of antimicrobials in clinical practice. Acquired skin hyperpigmentation (SH) following intravenous polymyxin B treatment has been previously reported, but little is known about its pathogenesis, clinical course and treatment. To improve understanding of these issues, we conducted a prospective study of adult patients receiving intravenous polymyxin B treatment. Methods Patients receiving intravenous polymyxin B treatment were followed throughout the course of treatment. Clinical, dermatoscopic, histologic and immunohistochemical skin properties of patients who presented with SH were studied. Results and discussion Skin hyperpigmentation was noted in 8% of patients (n=20/249); however, clinical, dermatoscopic, histologic and immunohistochemical examinations were performed only in three patients for whom the consent of relatives was obtained. Histologic and immunohistochemical findings showed an abundant melanocyte-pigmented dendritic network. Langerhans cells' hyperplasia and dermal IL-6 overexpression were also found, presumably for an inflammatory process due to polymyxin B use. As polymyxin B causes the release of histamine, which is known for its melanogenic effect, it is possible that skin darkening is associated with this inflammatory mediator. What is new These clinical and dermatoscopic findings contribute to a better understanding of how the pigmentary reaction manifests following intravenous polymyxin B treatment. Conclusion We concluded that hyperpigmentation due to intravenous polymyxin B treatment is associated with an inflammatory process and subsequent melanocyte activation. Although the pigmentary disorder neither influences the outcome of the therapy nor warrants discontinuation of treatment, it nevertheless considerably affects the patient's quality of life.

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Head and Neck Hyperpigmentation Probably Associated With Polymyxin B Therapy

Cited by 20 publications

References 5 publications

Acquired skin hyperpigmentation following intravenous polymyxin B treatment: a cohort study

Acquired skin hyperpigmentation following intravenous polymyxin B treatment: a cohort study

Skin hyperpigmentation following intravenous polymyxin B treatment associated with melanocyte activation and inflammatory process

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