Pemetrexed‐induced pityriasis lichenoides‐like dermatitis

Abstract

Thirty-seven in-patients were men (mean age 48); 47 were women (mean age 49), male : female ratio 0.8 : 1 (ns) ( Table 1).In the systemic clinic, men outnumbered women by almost 2 : 1 (s). Although there was an equal gender distribution in those with less severe psoriasis (NB-UVB, topical), it is worth noting that in those with more resistant psoriasis (PUVA), men outnumbered women by 1.6 : 1. This did not reach statistical significance due to small numbers involved.We have not found reference to an association between severe psoriasis and male gender, yet this was our experience. Were our patients unique? Larger studies indicate a similar trend. Several biological studies showed a preponderance of the male gender. [2][3][4] Patients had moderate to severe psoriasis and failed at least one systemic agent. Women were excluded if pregnant or considering conception. In the CHAMPION study (n = 334), male patients outnumbered female patients by 1.9 : 1. 2 In multicentre studies of etanercept male patients outnumbered female patients by 1.7 : 1 (n = 265) 3 and 2.5 : 1 (n = 720). 4 Although women considering conception were excluded it is unlikely to have made a significant difference since mean age was 45 ± 12 years.If men have more severe psoriasis than women how can this be explained? Severe psoriasis is associated with comorbidities, of which cardiovascular disease confers the greatest mortality. In the general population, men are most at risk. 5 The link between inflammatory arthritis and cardiovascular mortality was reported in 1970s. 6 Gelfand showed that the highest relative risk of myocardial infarction is in young patients with severe psoriasis and that young men have increased cardiovascular mortality. 7 The explanation proffered is that the inflammatory cascade, mediated by Th1 and Th17 cells, is similar in atherosclerosis. 8 Smoking and alcohol consumption are higher in men. 9 Smoking increases cardiovascular risk 5 and negatively affects psoriasis. 10 McAleer 11 found that men have more alcohol misuse than women. Seven percent had an elevated alcohol biomarker, carbohydratedeficient transferrin, and 89% were men.Patients with psoriasis often present young and spend years attending for topical, phototherapy and eventually, systemic treatment. In the light of present knowledge we should intervene early -especially in young men -providing education about comorbidities and lifestyle measures that could potentially reduce them.Letters to the Editor epidermis. These features might be related to a block in the S phase of the cell cycle. On the other hand, the calprotectin immunolabelling throughout the epidermis appeared strikingly motheaten indicating severe vacuolar alterations. As seen in other disorders, the Mac 387-positive keratinocytes were either metabolically altered or engaged in a regenerative phase. The combination of these features was interpreted as a sublethal sign. The dermal dendrocyte alterations were reminiscent of the methotrexate-induced changes. 6 In some instances, CAR associated with ant...

Pityriasis lichenoides-like drug reaction: A clinical histopathologic study of 10 cases

“…Drug reactions mimicking PL have not been well described. To date 11 cases of this rare entity have been reported in the literature thus far [36][37][38][39][40][41][42][43]. Among the implicated drugs were chemotherapeutic agents in three cases, TNF inhibitors in v, intravenous gammaglobulin for combined variable immunodeficiency syndrome in one case, and statins in three.…”

Revisiting cutaneous adverse reactions to pemetrexed

“…The distinction with regular PL (41-44) is not easily achieved during standard histopathological examination. By contrast, immunohistochemistry revealed certain unusual aspects (32). On the one hand, the Ki67 index was high, exhibiting labelled nuclei of irregular size located over the whole thickness of the epidermis.…”

“…The case of pemetrexed-induced PL-like dermatitis occurred during the period that patients were administered preventive folate and vitamin B supplementation and a short course of corticotherapy (32). The distinction with regular PL (41-44) is not easily achieved during standard histopathological examination.…”

“…In some instances, however, CAR identification was more clearly supported (24)(25)(26)(27)(28)(29)(30)(31)(32). The specific diseases associated with these events were reported to be alopecia (22), acute generalized exanthematous pustulosis (AGEP) (24), urticarial vasculitis (25), radiation recall dermatitis (RRD) (26)(27)(28), toxic epidermal necrolysis (TEN) (29,30), eyelid edema (31) and PL-like dermatitis (32).…”