Stevens-Johnson Syndrome From Ophthalmic Sulfonamide

Gottschalk, Helen R.

doi:10.1001/archderm.1976.01630280041010

Cited by 52 publications

(9 citation statements)

References 7 publications

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“…An EM-like picture as an expression of contact allergy has previously been described for many topical medications: bufexamac (19,20), chloramphenicol (21), dinitrochlorobenzene (22), diphenylcyclopropenone (23), econazole (24), ethylenediamine and clioquinol (25), idoxirudine (26), ketoprofen (27), lincomycin (28), mafenide acetate (29), mephenesin (30,31), neomycin (25), povidone iodine (32), proflavine (33,34), promethazine (25), pyrrolnitrin (25,26,35), scopolamine (36), sulfonamide (25,37,38), and vitamin E (39). Phenylbutazone can now be added to this list.…”

Section: Discussionmentioning

confidence: 93%

Erythema‐multiforme‐like contact dermatitis due to phenylbutazone

1995

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A 65-year-old woman presented with a severely itchy prethoracal eruption of erythematous, edematous papules and papulovesicles. These were much more pronounced on the right side, with some presternal confluence, and had already been spreading for 3 days. She also had erythematous papules on both inner thighs. A week before the onset, she had applied the revulsive (counterirritant) cream NF V for 4 days to the right side of the thorax for muscle pain, which she stopped when the eruption started. Revulsive cream contains phenylbutazone as active ingredient and also menthol, cetyl alcohol, propylene glycol, lavender oil, and methyl nicotinate. In spite of a corticosteroid cream and an oral antihistamine, the dermatitis spread. She had also been taking diphenylhydantoin and levodopa for many years and piroxicam for I week.As she recalled a reaction I 0 years previously after using a phenylbutazone-containing ointment (Butazolid-ine®), and because of suspicion of allergy to the revulsive cream and its failure to respond to topical corticosteroids, oral methylprednisolone was given. 2 days later, the eruption had spread and become more painful. The right side of the thorax (the left being less affected) showed a monomorphic eruption of papulopustules, with confluence presternally and in the right axilla. There was a sharp delineation towards the back. A toxicoderma or viral rash was considered as the diagnosis. Systemic corticosteroid was stopped and a menthol lotion prescribed. By 5 days after the 2nd visit, however, large plaques had appeared in the precordal region, right submammary fold and under the right axilla, by confluence of erythematous macules and papules. On the right breast, cocardiform lesions were present. A potent corticosteroid ointment was prescribed, which the patient applied just once. All the lesions regressed in a week.Patch tests with the standard series and with the patient's own medications yielded the following results: D2 D3 Standard series balsam of Peru + fragrance mix ?+ ++ Own medications revulsive cream NF V ++ +++ Butazolidine® ointment ++ +++ phenylbutazone (2% pet.) ++ ++ oxyphenbutazone (5% pet.)This patient had thus developed allergic contact dermatitis from the revulsive cream, having previously been sensitized by Butazolidine® ointment. Discussion

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Section: Discussionmentioning

confidence: 93%

Erythema‐multiforme‐like contact dermatitis due to phenylbutazone

1995

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“…They are best characterized to be triggers for erythema multiforme. Two cases of the Stevens-Johnson syndrome (erythema multiforme major) have even been reported after ophthalmic sulfacetamide [24,25]. Both patients had previously got other sulfonamide preparations.…”

Section: Sulfonamidesmentioning

confidence: 99%

Chapter 4: Requirements Concerning Antiseptics for Periorbital, Orbital and Intraorbital Application. 4.3.: Systemic Tolerance of Antiseptics Used in Ophthalmology

Siegmund

Gießmann²

2002

Developments in Ophthalmology

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Topical administration of ophthalmic drugs might be followed by systemic and/or ocular absorption. Ocular bioavailability depends upon how fast a drug is taken up into the eye throughout cornea, conjunctiva and sclera relative to the rate of its elimination from the place of administration via the lacrimal drainage system and by absorption from conjunctiva and nasal mucosa [1, 2] (see also Chapter 4.4). Usually, drugs are better absorbed into the systemic circulation by mucous membranes than into the eye through the tight corneal epithelium which is for most drugs a major diffusion barrier. The penetration is further limited by tight junctions connecting the apical cells of the corneal epithelium. Lipophilicity of drugs and viscosity of their ocular formulations are major determinants of corneal permeability.Drugs after ocular administration reach the systemic circulation without significant first-pass metabolism [3].The appearance in blood might be nearly as fast as after intravenous administration. Thus, maximal plasma levels of phenylephrine after instillation of eyedrops were measured within 10-20 min [4]. There is evidence that ophthalmic drugs after topical administration may enter the systemic circulation in pharmacodynamically relevant concentrations as could be shown for ␤-adrenoreceptorblocking agents, atropine, steroids, epinephrine or pilocarpine.2.

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“…The systemic effects of ocular sulphonamides include possible lupus (Mackie & Mackie 1979) and Stevens-Johnson syndrome: the latter has occurred in a patient allergic to sulphonamides (Gottschalk & Stone 1976).…”

Section: ~Yste~ic Effectsmentioning

confidence: 99%

Systemic and Local Tolerability of Ophthalmic Drug Formulations

Hugues

Jeunne

1993

Drug Safety

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All eye drops raise problems of local tolerance, but with variable frequencies. They can induce pain on instillation, allergic reactions, delayed healing, punctate keratitis, disturbances of lacrimal secretion, disturbances of accommodation (especially the parasympathomimetics) and local pigmentation after prolonged use. Corticosteroids are associated with 2 major risks: chronic glaucoma and cataract, initially reversible if treatment is stopped. There is still a major risk of corneal herpes with corticosteroids. It is important to be aware of these local problems as they are responsible for poor patient compliance. The systemic effects essentially concern the agonists and antagonists of the autonomic nervous system. beta-Blocker eye drops can cause bronchospasm, heart failure, syncope and psychiatric disorders, especially at high doses and with nonselective beta-blockers. These consequences are usually related to failure to comply with the prescribing precautions. alpha-Adrenergic agonists, which exert dose-dependent effects, can induce hypertensive crises or angina attacks. Apart from patients at risk (children under the age of 30 months and the elderly), parasympathomimetics cause few systemic adverse effects; anticholinesterases, which have curare-like properties, are contraindicated for 6 weeks before general anesthesia. In the very young and the very old, atropinic eye drops carry a risk of cardiovascular collapse and neuropsychiatric disturbances. Problems may also occur with other classes of drugs such as anti-infectives, antispectics, anti-inflammatories and contact lens products. Nevertheless, it is clear that this form of treatment is generally very well tolerated in relation to the volume of eye drops prescribed by ophthalmologists each day.

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Stevens-Johnson Syndrome From Ophthalmic Sulfonamide

Cited by 52 publications

References 7 publications

Erythema‐multiforme‐like contact dermatitis due to phenylbutazone

Erythema‐multiforme‐like contact dermatitis due to phenylbutazone

Chapter 4: Requirements Concerning Antiseptics for Periorbital, Orbital and Intraorbital Application. 4.3.: Systemic Tolerance of Antiseptics Used in Ophthalmology

Systemic and Local Tolerability of Ophthalmic Drug Formulations

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