Lymphangitis and Refractory Lymphedema After Treatment With Topical Cantharidin

Stazzone, Anthony M.; Borgs, Peter; Witte, Charles L.; Witte, Marlys H.

doi:10.1001/archderm.134.1.104

Cited by 16 publications

(11 citation statements)

References 1 publication

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“…29 Lymphangitic streaking has also been reported after topical application of cantharidin for verrucae vulgaris. 30,31 In 1 case series, 2 patients developed edema and tender lymphangitic streaks on the extremities 1 day after the application of topical cantharidin. 30 It was suggested the lymphangitis may be related to an inflammatory reaction extending to the lymphatic vessels.…”

Section: Iatrogenic Causesmentioning

confidence: 99%

Nonbacterial Causes of Lymphangitis with Streaking

Cohen

Nagler

Pomeranz³

2016

The Journal of the American Board of Family Medicine

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Background: Lymphangitic streaking, characterized by linear erythema on the skin, is most commonly observed in the setting of bacterial infection. However, a number of nonbacterial causes can result in lymphangitic streaking. We sought to elucidate the nonbacterial causes of lymphangitic streaking that may mimic bacterial infection to broaden clinicians' differential diagnosis for patients presenting with lymphangitic streaking.Methods: We performed a review of the literature, including all available reports pertaining to nonbacterial causes of lymphangitic streaking.Results: Various nonbacterial causes can result in lymphangitic streaking, including viral and fungal infections, insect or spider bites, and iatrogenic etiologies.

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Section: Iatrogenic Causesmentioning

confidence: 99%

Nonbacterial Causes of Lymphangitis with Streaking

Cohen

Nagler

Pomeranz³

2016

The Journal of the American Board of Family Medicine

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“…Effect of anti-inflammatory drugs on the cantharidin-induced skin blister tion of cantharidin for eradication of plantar verrucae [13]; therefore susceptible patients, in particular those with diabetes or peripheral arterial diseases, should not be studied. …”

Section: Figurementioning

confidence: 99%

Validation of the cantharidin‐induced skin blister as an in vivo model of inflammation

Dinh

Corraza

Mestdagh³

et al. 2011

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Techniques to create aseptic inflammatory reactions provide information regarding acute inflammatory pathways and may be used to assess the anti-inflammatory properties of novel drugs. WHAT THIS STUDY ADDS• In this study, we have shown that the cantharidin-induced blister is a local inflammatory reaction, safe and well tolerated, with a good intra-subject inter-day reproducibility. This induced blister is inhibited by specific (anti-tumour necrosis factor (TNF)) and non specific (corticosteroids) systemic anti-inflammatory agents. This model could be of interest to evaluate anti-inflammatory agents in their early phase development. AIMPharmacological profiling techniques, such as the cantharidin-induced skin blister, may be used to assess the anti-inflammatory properties of novel drugs. However, no data are available on the reproducibility of this technique or on the blocking effect of anti-inflammatory drugs, such as anti-TNF and corticosteroids. METHODSA group of 30 healthy subjects were randomized into three parallel groups treated with placebo, oral methylprednisolone 20 mg day -1 for 7 days or anti-tumour necrosis factor (TNF) (adalimumab, Humira®, Abbott) 40 mg s.c. single dose. A first blister was induced at baseline and collected, immediately before the start of treatment and a second blister was obtained 7 days after the start of treatment. The total number of cells, the cell viability and the differential cell count were evaluated by two independent observers, who were blind to treatment. ANOVA was used to compare change from baseline among the three groups before pairwise comparisons. RESULTSAmong the placebo group, there was no significant difference in the total cell count, neutrophils, eosinophils and monocytes between day 1 and day 7. Methylprednisolone inhibited the eosinophil influx in mean % (95% CI) (-1.0 (-1.7, -0.3); P < 0.02) and absolute (P < 0.02) values, while anti-TNF inhibited the neutrophil influx in mean % (95% CI) (-19.3 (-29.5, -9.1); P < 0.01) and absolute (P < 0.05) values. CONCLUSIONSThe cantharidin-induced skin blister is a safe, well tolerated and reproducible procedure. Pre-treatment with anti-TNF or methylprednisolone inhibited the neutrophilic or eosinophilic trafficking, respectively. It could be useful in profiling anti-inflammatory drugs regarding their effects on the cellular inflammatory response.

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“…Noninfectious dermatitis following a lymphatic course has been described after lymphatic opacification by Evans blue [12] or a radiopaque iodized substance [13], use of topical cantharidin [14, 15] or intralesional bleomycin [16] in the treatment of verruca vulgaris, accidental administration of polysaccharide [17] and local corticosteroid injection [18]. In our observations, a toxic or allergic process induced by an arthropod bite can be hypothesized, with local injection of a toxin contained in the secretion.…”

Section: Discussionmentioning

confidence: 99%

Superficial Lymphangitis after Arthropod Bite: A Distinctive but Underrecognized Entity?

et al. 2008

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Background: Acute bacterial lymphangitis is a common occurrence after skin damage. This diagnosis is often made in case of red linear streaks after arthropod bites, leading to the prescription of oral antibiotics. In this setting, noninfectious superficial lymphangitis after arthropod bites, an eruption rarely mentioned in the medical literature, appears as a diagnostic challenge. Objective: Our purpose was to study the clinical and histopathological features of this underrecognized condition. Methods: We collected the observations of six consecutive patients seen between the years 2003 and 2006, who developed an acute linear erythematous eruption along lymphatic vessels, mimicking common bacterial lymphangitis. Standard histological examinations were completed by immunopathological staining using the monoclonal antibody D2-40, a highly selective marker of lymphatic endothelium. Extensive review of the literature about acute noninfectious superficial lymphangitis was performed. Results: The clinical presentation and histological findings excluded an infectious etiology and suggested superficial lymphangitis after an arthropod bite in all the observations. Conclusions: This article analyzes the clinical and histological features of noninfectious superficial lymphangitis after arthropod bite, a benign underrecognized condition mimicking common bacterial lymphangitis. Physicians should be aware of this benign reaction to avoid the useless prescription of antibiotics.

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Lymphangitis and Refractory Lymphedema After Treatment With Topical Cantharidin

Cited by 16 publications

References 1 publication

Nonbacterial Causes of Lymphangitis with Streaking

Nonbacterial Causes of Lymphangitis with Streaking

Validation of the cantharidin‐induced skin blister as an in vivo model of inflammation

Superficial Lymphangitis after Arthropod Bite: A Distinctive but Underrecognized Entity?

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