sQuiz your knowledge: Polycyclic annular plaques on the trunk following dutasteride treatment
- PDF / 366,021 Bytes
- 2 Pages / 595.3 x 765.3 pts Page_size
- 46 Downloads / 163 Views
A 56-year-old woman with a personal history of hypothyroidism and hormone replacement therapy for early menopause was being followed at the outpatient dermatology unit of our hospital for androgenetic alopecia,
A
refractory to the application of 5% minoxidil solution. The patient was started with dustasteride treatment at a dose of 0.5 mg po three per week. Three weeks after starting treatment, the patient complained of a sudden and progressive appearance of an eruption of erythematous, pruritic plaques with active border and atrophic centre, with mild collarette desquamation (figure 1). Laboratory findings, including complete blood count and biochemistry profile, were normal or negative. Tests for antibodies against syphilis and anti-nuclear antibody, antidsDNA antibody, and anti-SS-A and SS-B antibodies were also negative. Thyroid hormone profile, Quantiferon test, chest X-ray, as well as serology for HIV, hepatitis B, and hepatitis C were found to be normal. What is your diagnosis?
B
Figure 1. A) Polycyclic annular plaques on the trunk. B) Mild spongiosis, parakeratosis and microvesiculation; characteristically, there is a dense lymphohistiocytic infiltrate surrounding superficial vessels, known as the “coat-sleeve anomaly” (H&E; x10).
452
EJD, vol. 30, n◦ 4, July-August 2020
Erythema annulare centrifugum (associated with dustasteride) Histopathological examination showed spongiosis and parakeratosis together with a superficial dermal mixed inflammatory infiltrate. Administration of dutasteride was then suspended. Cutaneous lesions gradually disappeared after three weeks. Drug provocation was not be performed as the patient did not consent. Naranjo score, regarding adverse reaction probability score, was 6 (probable drug reaction). Erythema annulare centrifugum (EAC) is considered a clinical reaction characterized by slowly enlarging annular erythematous lesions. The pathophysiological mechanism is largely believed to be due to a hypersensitivity reaction to infections, medications, and rarely, underlying malignancy [1]. Men and women are affected equally with a peak incidence during the fifth decade of life, even though cases in paediatric age have been described. EAC has been categorized as deep and superficial variants. The main difference from the clinical point of view is the degree of infiltration, being more pronounced in the latter. Histologically, the superficial variant, as in the present case, presents epidermal changes such as spongiosis and parakeratosis. Causative drugs include cimetidine, piroxicam, diuretics, chloroquine, hydroxychloroquine, gold sodium thiomalate, and amitriptyline. Several cases have recently been described in association with biological drugs for different indications, such as sorafenib [1], rituximab [2] and nivolumab [3]. The Naranjo algorithm was used to assess the causal relationship; a probable adverse event caused by a drug is considered based on a score of 5 to 8 [4].
EJD, vol. 30, n◦ 4, July-August 2020
Dutasteride is used off-label for the treatment of female
Data Loading...
