Drug-Induced Acneiform Eruptions
Acne vulgaris is a polymorphic inflammatory skin disease, clinically characterized by mixture of comedones, superficial and deep inflamed papules, pustules, and nodules. It is a chronic inflammation of the pilosebaceous unit. Acneiform drug eruptions are
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Drug-Induced Acneiform Eruptions Ha K. Do, Navid Ezra, and Stephen E. Wolverton
54.1
Introduction
Acne vulgaris is a polymorphic inflammatory skin disease, clinically characterized by mixture of comedones, superficial and deep inflamed papules, pustules, and nodules. It is a chronic inflammation of the pilosebaceous unit. Acneiform drug eruptions are a monomorphic inflammatory skin disease lacking comedones with lesions typically in the same stage. This type of drug eruption has an abrupt onset and is often associated with various medications (Table 54.1). The pathogenesis of acneiform drug eruptions is poorly understood; documented evidence when available will be presented under the specific drug categories in this chapter.
54.2
Drugs Associated with Acneiform Eruption
54.2.1
Hormones
54.2.1.1
Corticosteroids
Systemic corticosteroids causing acneiform eruption were first reported in 1950s [1]. Exposure to high levels of systemic (oral [2] or intravenous [3]), topical [4, 5], and inhaled [6–8] corticosteroids can induce or exacerbate acne. Perioral (periorificial)
H.K. Do, M.D. • N. Ezra, M.D. • S.E. Wolverton, M.D. () Department of Dermatology, Indiana University School of Medicine, New York, NY, USA e-mail: [email protected]; [email protected]; [email protected]
J.A. Zeichner (ed.), Acneiform Eruptions in Dermatology: A Differential Diagnosis, DOI 10.1007/978-1-4614-8344-1_54, © Springer Science+Business Media New York 2014
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H.K. Do et al. Table 54.1 Drugs involved with acneiform eruption Hormones Oral, inhaled, and topical corticosteroids Anabolic steroids and androgens Danazol Hormonal contraceptives (levonorgestrel) Neuropsychotropic agents Tricyclic antidepressants Amineptine Maprotiline Imipramine Lithium Antiepileptics Hydantoin (phenytoin) Lamotrigine Valproate Antipsychotics Aripiprazole Targeted therapies Epidermal growth factor receptor inhibitors (EGFR inhibitors) Erlotinib Gefitinib Imatinib Epidermal growth factor receptor monoclonal antibodies Cetuximab Panitumumab TNF-α inhibitors Infliximab Lenalidomide G-CSF Vemurafenib Retinoids Etretinate Cardiac medication Propranolol Quinidine Immunosuppressive agents Sirolimus Tacrolimus Cyclosporine Azathioprine Antituberculosis drugs Isoniazid Rifampicin Thiacetazone Other medications Gold (continued)
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Drug-Induced Acneiform Eruptions
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Table 54.1 (continued) Dactinomycin Dapsone Halogens Bromides Dioxin Iodides Vitamins Vitamin B6 and B12 White petrolatum Cow udder ointment Tetraethylthiuram disulfide Dantrolene PUVA
dermatitis is an example of a corticosteroid-induced eruption around the mouth [9] that is often associated with high-potency (class I and II) corticosteroid usage. These lesions might lack the erythema due to the anti-inflammatory effect of the topical corticosteroid [10]. However, when the topical agent is discontinued, an exuberant flare can occur. The acneiform eruptions have a variable onset after a new drug introduction, usually 2–4 weeks, but can take up to several months [11, 12]. Most lesions clinically pre
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