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Differences of the inhibition halo of sweating using diferent types of botulinum toxins
P8199
P8608
Differences of the inhibition halo of sweating using diferent types of botulinum toxins Lissa Sabino de Matos, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil; Adilson Costa, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil; Caroline Silva Pereira, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil; Cinthia Mendes, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil; Erica Bruder Botero, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil; Thaisa Saddi Tannous Silvino, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil
Extensive cutaneous necrosis induced by terlipressin Maria Leiva-Salinas, MD, Hospital General Universitario Alicante, Alicante, Spain; Ivan Herrera, MD, Hospital General Universitario de Alicante, Alicante, Spain; Jaime Guijarro, MD, Hospital General Universitario de Alicante, Alicante, Spain; Jose Carlos Pascual, MD, Hospital General Universitario Alicante, Alicante, Spain; Laura Frances, MD, Hospital General Universitario de Alicante, Alicante, Spain
Introduction: Among the existing treatments for focal hyperhidrosis, botulinum toxin type A (BTX-A) is one of the most studied and most effective treatment. This study aimed to assess whether there are differences in the size of the maximum diameter of the extension of the zone of inhibition of sweating in different amounts of units, from 5 different types of TXB-A available in Brazil. Objectives: This study aimed to assess whether there are differences in the size of the maximum diameter of the extension of the zone of inhibition of sweating in different amounts of units, from 5 different types of BTX-A available in Brazil. Methods: It consists an open and monocentric study, approved by the ethics committee. Conducted with 25 female volunteers, who had criteria for inclusion and exclusion. The study consisted in the application of 5 types of BTX-A. It were performed 5 escalating doses application of each BTX-A (1U, 2U, 3U, 4U, and 5U) in the left trunk of each volunteer. Every 30 days, we performed the iodine-starch test to check the size of the inhibition halo. Results: The study was completed after 180 days and the BTX-A commercial evaluated showed an increase of the average sizes of inhibition zones (P \ .05) directly proportional to the amount of units applied. Discussion and conclusions: The 5 types of BTX-A used in this study showed an increase of inhibition zone according to the number of units used, establishing a directly proportional relationship. Our findings again makes us believe that higher is the dose, greater the inhibition is performed. Sponsored 100% by Crist alia Ltda.
Introduction: Terlipressin is a nonselective V1 vasopressin analog with prolonged duration of action used for hepatorenal syndrome, bleeding esophageal varices, catecholamine-resistant shock, and cardiac failure. It is generally well tolerated with a lower incidence of adverse effects, compared with other vassopressin analogs, that are generally mild including paleness, diarrhea, headache, and increased blood pressure. Extensive skin necrosis is a rare and potentially lethal complication caused by tissue ischemia induced by vasoconstriction. Case report: We report a case of a 54-year-old male with alcoholic cirrhosis who was admitted because of ascitis and hepatorenal syndrome. Because of worsening of renal function, terlipressin was started at 1 mg every 6 hours with good response. A few days after the treatment was started, extensive purpuric lesions with hemorrhagic blisters concerning the trunk, buttocks, and inferior limbs appeared. There was no mucosal involvement. The skin biopsy revealed epidermal ulceration along with red blood cell extravasation and partial occlusion of vessels. The patient was diagnosed with terlipressin-induced skin necrosis and then terlipressin was discontinued. The skin lesions stopped progressing but the drug had to be restarted because of renal failure with worsening of the skin lesions. Unfortunately, the patient died because of irreversible liver failure. Discussion: Terlipressin-induced skin necrosis is an extremely rare ischemic event. The mechanism is unclear, but it is thought to result from compromised tissue oxygenation caused by vasoconstriction because of nonselective stimulation of vascular smooth muscle V1 receptors. Necrosis tends to affect the trunk and proximal limbs, but not the fingers and the toes, which are the areas commonly affected in ischemic complications caused by vasoconstrictor medication. This can be explained by the unique distribution of V1 receptors in areas with large skin surface and fat, like the thighs and abdomen. Discontinuation of the treatment generally leads to skin improvement and is key to avoid severe and potentially lethal complications. Conclusions: Terlipressin-induced skin necrosis is a rare and severe complication that must be considered in patients treated with this drug. Its distinct distribution can help to suspect this entity. It is important to recognize this severe side effect in order to discontinue terlipressin. Commercial support: None identified.
P8480 Drug content and uniformity in commonly split tablets in dermatology Mohammed Al-Haddab, MD, King Saud University, Riyadh, Saudi Arabia; Adnan Kadi, PhD, King Saud University, Riyadh, Saudi Arabia Introduction: Tablet-splitting is a widespread practice among all sectors of health care for different reasons: it increases dose flexibility, makes tablet parts easier to swallow, and allows cost savings for both patients and health care providers. However, the tablet parts obtained are often not equal in size, and a substantial amount of tablet can be lost during splitting. Objectives: To determine the drug content in split half-tablets and quarter-tablets of 2 commonly split medications in dermatology practice (terbenafine and finasteride) using drug assay analysis. Method:A tablet cutter was used to split all the tablets. A preliminary mass spectrometer scan followed by a product ion scan of each compound was carried out to determine the parent ion peaks as well as the fragment ions of compounds. Results: Thirty-one quarters of a tablet of terbinafine (expected to contain 62.5 mg) showed the mean content is 50.45 with SD ¼ 8.75 and RSD ¼ 17.35%. Seventeen halves of a tablet of terbinafine (expected to contain 125 mg) showed the mean content is 91.57 mg with SD ¼ 30.78 and RSD ¼ 33.62%. Thirty quarters of a tablet of finasteride (expected to contain 1.25 mg) showed the mean content is 1.33 with SD ¼ 0.29 and RSD ¼ 21.57%. Fourteen halves of a tablet of finasteride (expected to contain 2.5 mg) showed the mean content is 2.88 with SD ¼ 0.5 and RSD ¼ 17.3%. Discussion and conclusion: Tablet splitting is a common practice in health care systems around the globe. Various factors could influence the outcome of tablet splitting such as size, shape, scoring, and coating of the tablet. In one study, weight loss during tablet splitting was found to be 10% off the ideal weight in 41% and 20% off in 12% of manually split hydrochlorothiazide 25 mg tablets. In our study unequal distribution of the drug on the intact tablet indicated by very high standard deviation and relative standard deviation beyond the accepted value. Some of the dose loss is from fragmentation during splitting. Although terbenafine tablets are round and have scores while finasteride tablets are rectangular and do not have scores, still the uniformity of drug content is more in divided finasteride tablets than terbinafine tablets.The clinical importance of this nonuniformity is not clear and additional studies are needed to measure the impact of the different daily dosing on the clinical outcome of the treated condition. Commercial support: None identified.
MAY 2014
P8073 Imipramine-induced hyperpigmentation Courtney McFaddin, MD, Texas A&M Health Science Center/Scott & White Memorial Hospital, Temple, TX, United States; Martin Fernandez, MD, Texas A&M Health Science Center/Scott & White Memorial Hospital, Temple, TX, United States; Palak Parekh, MD, Texas A&M Health Science Center/Scott & White Memorial Hospital, Temple, TX, United States Imipramine is a tricyclic medication that is uncommonly used to treat depression, anxiety, and other psychiatric illnesses. While relatively rare, it has been associated with hyperpigmentation of the skin, including slate-grey discoloration of sunexposed areas. We present the case of a 63-year-old female who had been taking imipramine for [20 years when she developed a bluish brown discoloration on her face and neck. Histopathology of biopsy specimens showed numerous perivascular and interstitial brown globules in the dermis that were composed of melanin only, as evidenced by positive FontanaeMasson staining and negative Perls staining. A diagnosis of imipramine-induced hyperpigmentation was made based on the histopathology and clinical history. In addition to the case presentation, we provide a review of drugs that commonly cause hyperpigmentation and their associated histopathologic staining characteristics. Commercial support: None identified.
J AM ACAD DERMATOL
AB151
P8608
Differences of the inhibition halo of sweating using diferent types of botulinum toxins Lissa Sabino de Matos, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil; Adilson Costa, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil; Caroline Silva Pereira, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil; Cinthia Mendes, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil; Erica Bruder Botero, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil; Thaisa Saddi Tannous Silvino, MD, Pontificia Universidade Catolica de Campinas, Campinas, Brazil
Extensive cutaneous necrosis induced by terlipressin Maria Leiva-Salinas, MD, Hospital General Universitario Alicante, Alicante, Spain; Ivan Herrera, MD, Hospital General Universitario de Alicante, Alicante, Spain; Jaime Guijarro, MD, Hospital General Universitario de Alicante, Alicante, Spain; Jose Carlos Pascual, MD, Hospital General Universitario Alicante, Alicante, Spain; Laura Frances, MD, Hospital General Universitario de Alicante, Alicante, Spain
Introduction: Among the existing treatments for focal hyperhidrosis, botulinum toxin type A (BTX-A) is one of the most studied and most effective treatment. This study aimed to assess whether there are differences in the size of the maximum diameter of the extension of the zone of inhibition of sweating in different amounts of units, from 5 different types of TXB-A available in Brazil. Objectives: This study aimed to assess whether there are differences in the size of the maximum diameter of the extension of the zone of inhibition of sweating in different amounts of units, from 5 different types of BTX-A available in Brazil. Methods: It consists an open and monocentric study, approved by the ethics committee. Conducted with 25 female volunteers, who had criteria for inclusion and exclusion. The study consisted in the application of 5 types of BTX-A. It were performed 5 escalating doses application of each BTX-A (1U, 2U, 3U, 4U, and 5U) in the left trunk of each volunteer. Every 30 days, we performed the iodine-starch test to check the size of the inhibition halo. Results: The study was completed after 180 days and the BTX-A commercial evaluated showed an increase of the average sizes of inhibition zones (P \ .05) directly proportional to the amount of units applied. Discussion and conclusions: The 5 types of BTX-A used in this study showed an increase of inhibition zone according to the number of units used, establishing a directly proportional relationship. Our findings again makes us believe that higher is the dose, greater the inhibition is performed. Sponsored 100% by Crist alia Ltda.
Introduction: Terlipressin is a nonselective V1 vasopressin analog with prolonged duration of action used for hepatorenal syndrome, bleeding esophageal varices, catecholamine-resistant shock, and cardiac failure. It is generally well tolerated with a lower incidence of adverse effects, compared with other vassopressin analogs, that are generally mild including paleness, diarrhea, headache, and increased blood pressure. Extensive skin necrosis is a rare and potentially lethal complication caused by tissue ischemia induced by vasoconstriction. Case report: We report a case of a 54-year-old male with alcoholic cirrhosis who was admitted because of ascitis and hepatorenal syndrome. Because of worsening of renal function, terlipressin was started at 1 mg every 6 hours with good response. A few days after the treatment was started, extensive purpuric lesions with hemorrhagic blisters concerning the trunk, buttocks, and inferior limbs appeared. There was no mucosal involvement. The skin biopsy revealed epidermal ulceration along with red blood cell extravasation and partial occlusion of vessels. The patient was diagnosed with terlipressin-induced skin necrosis and then terlipressin was discontinued. The skin lesions stopped progressing but the drug had to be restarted because of renal failure with worsening of the skin lesions. Unfortunately, the patient died because of irreversible liver failure. Discussion: Terlipressin-induced skin necrosis is an extremely rare ischemic event. The mechanism is unclear, but it is thought to result from compromised tissue oxygenation caused by vasoconstriction because of nonselective stimulation of vascular smooth muscle V1 receptors. Necrosis tends to affect the trunk and proximal limbs, but not the fingers and the toes, which are the areas commonly affected in ischemic complications caused by vasoconstrictor medication. This can be explained by the unique distribution of V1 receptors in areas with large skin surface and fat, like the thighs and abdomen. Discontinuation of the treatment generally leads to skin improvement and is key to avoid severe and potentially lethal complications. Conclusions: Terlipressin-induced skin necrosis is a rare and severe complication that must be considered in patients treated with this drug. Its distinct distribution can help to suspect this entity. It is important to recognize this severe side effect in order to discontinue terlipressin. Commercial support: None identified.
P8480 Drug content and uniformity in commonly split tablets in dermatology Mohammed Al-Haddab, MD, King Saud University, Riyadh, Saudi Arabia; Adnan Kadi, PhD, King Saud University, Riyadh, Saudi Arabia Introduction: Tablet-splitting is a widespread practice among all sectors of health care for different reasons: it increases dose flexibility, makes tablet parts easier to swallow, and allows cost savings for both patients and health care providers. However, the tablet parts obtained are often not equal in size, and a substantial amount of tablet can be lost during splitting. Objectives: To determine the drug content in split half-tablets and quarter-tablets of 2 commonly split medications in dermatology practice (terbenafine and finasteride) using drug assay analysis. Method:A tablet cutter was used to split all the tablets. A preliminary mass spectrometer scan followed by a product ion scan of each compound was carried out to determine the parent ion peaks as well as the fragment ions of compounds. Results: Thirty-one quarters of a tablet of terbinafine (expected to contain 62.5 mg) showed the mean content is 50.45 with SD ¼ 8.75 and RSD ¼ 17.35%. Seventeen halves of a tablet of terbinafine (expected to contain 125 mg) showed the mean content is 91.57 mg with SD ¼ 30.78 and RSD ¼ 33.62%. Thirty quarters of a tablet of finasteride (expected to contain 1.25 mg) showed the mean content is 1.33 with SD ¼ 0.29 and RSD ¼ 21.57%. Fourteen halves of a tablet of finasteride (expected to contain 2.5 mg) showed the mean content is 2.88 with SD ¼ 0.5 and RSD ¼ 17.3%. Discussion and conclusion: Tablet splitting is a common practice in health care systems around the globe. Various factors could influence the outcome of tablet splitting such as size, shape, scoring, and coating of the tablet. In one study, weight loss during tablet splitting was found to be 10% off the ideal weight in 41% and 20% off in 12% of manually split hydrochlorothiazide 25 mg tablets. In our study unequal distribution of the drug on the intact tablet indicated by very high standard deviation and relative standard deviation beyond the accepted value. Some of the dose loss is from fragmentation during splitting. Although terbenafine tablets are round and have scores while finasteride tablets are rectangular and do not have scores, still the uniformity of drug content is more in divided finasteride tablets than terbinafine tablets.The clinical importance of this nonuniformity is not clear and additional studies are needed to measure the impact of the different daily dosing on the clinical outcome of the treated condition. Commercial support: None identified.
MAY 2014
P8073 Imipramine-induced hyperpigmentation Courtney McFaddin, MD, Texas A&M Health Science Center/Scott & White Memorial Hospital, Temple, TX, United States; Martin Fernandez, MD, Texas A&M Health Science Center/Scott & White Memorial Hospital, Temple, TX, United States; Palak Parekh, MD, Texas A&M Health Science Center/Scott & White Memorial Hospital, Temple, TX, United States Imipramine is a tricyclic medication that is uncommonly used to treat depression, anxiety, and other psychiatric illnesses. While relatively rare, it has been associated with hyperpigmentation of the skin, including slate-grey discoloration of sunexposed areas. We present the case of a 63-year-old female who had been taking imipramine for [20 years when she developed a bluish brown discoloration on her face and neck. Histopathology of biopsy specimens showed numerous perivascular and interstitial brown globules in the dermis that were composed of melanin only, as evidenced by positive FontanaeMasson staining and negative Perls staining. A diagnosis of imipramine-induced hyperpigmentation was made based on the histopathology and clinical history. In addition to the case presentation, we provide a review of drugs that commonly cause hyperpigmentation and their associated histopathologic staining characteristics. Commercial support: None identified.
J AM ACAD DERMATOL
AB151