Griseofulvin-induced photo-onycholysis

Caractéristiques des patients et fréquences des perforations de l’ulcère duodénal dans les deux périodes Période 1 (1986–1990) (n = 103)

p

Période 2 (2000–2004) (n = 121)

p

R (n = 29)

Non R (n = 74)

R (n = 26)

Non R (n = 95)

Âge moyen (ans)

37,4

38,7

NS

38,2

43

NS

Genre (H/F)

27/2

71/3

NS

24/2

94/1

NS

Tabac (%)

31

39

NS

73

71

NS

Prise d’IPP (%)

–

–

11,5

4

NS

H. pylori (+) (%)

–

–

15

10

NS

5,8

1,3

5,2

1,7

0,0049

Nombre moyen de perforation/mois

0,0049

Lettres à la rédaction

Tableau I

H : homme ; F : femme ; IPP : inhibiteur de la pompe à protons ; H. pylori : Helicobacter pylori.

Correspondance : Fethia Bdioui, centre hospitalo-universitaire (CHU), service d’hépatogastroentérologie, Fattouma-Bourguiba, avenue du 1er-Juin, 5000 Monastir, Tunisie. [email protected]

le jeûne prolongé serait un facteur de risque important et indépendant pour la perforation de l’UD au cours du mois de Ramadan. Déclaration d’intérêts : les auteurs déclarent ne pas avoir de conflits d’intérêts en relation avec cet article.

Reçu le 3 mars 2012 Accepté le 30 mai 2012 Disponible sur internet le 27 juin 2012 ß 2012 Elsevier Masson SAS. Tous droits réservés http://dx.doi.org/10.1016/j.lpm.2012.05.008

Références [1]

[2]

[3]

[4]

[5]

[6]

[7]

Iraki L, Abkari A, Vallot T, Amrani N, Haj Khlifa R, Jellouli K et al. Effet du jeuˆne du Ramadan sur le PH intragastrique enregistre´ sur 24 heures chez le sujet sain. Gastroenterol Clin Biol 1997;21:813-9. Bener A, Derbala MF, Al-Kaabi S, Taryam LO, Al-Ameri MM, Al-Muraikhi NM et al. Frequency of peptic ulcer disease during and after Ramadan in a United Arab Emirates hospital. East Mediterr Health J 2006;12(1-2): 105-11. Husseiny AM, El-Sayed MA, Eshra A, Al-Meshaan M. The effect of Ramadan fasting on surgical emergency attendants. Kuweit Med J 2008;40(2):124-6. Kucuk HF, Censur Z, Kurt N, Ozkan Z, Kement M, Kaptanoglu L, Oncel M. The effect of Ramadan fasting on duodenal ulcer perforation: a retrospective analysis. Indian J Surg 2005;67(4):195-8. Torab FC, Amer M, Abu-Zidan FM, Branicki FJ. Perforated peptic ulcer: different ethnic, climatic and fasting risk factors for morbidity in Al-Ain Medical District, United Arab Emirates. Asian J Surg 2009;32(2):95-101. Aziz Hani M, Ben Achour J, Bouaskar I, Bedoui R, Hidoussi A, Guesmi F et al. Pre´valence de l’Helicobacter pylori dans l’ulce`re du bulbe perfore´. Re´ sultats pre´ liminaires d’une e´ tude prospective. Tunis Chir 2006;15(1):27-9. Ben Ammar A, Cheikh I, Ouerghi H, Chaabouni H, Kchaou M, Ben mami N. Prévalence de l’infection à Helicobacter pylori dans la maladie ulcéreuse duodénale. Résultats d’une étude prospective à propos de 78 ulcéreux duodénaux AINS négatifs. Tunis Med 2002;8(10):599-604.

Griseofulvin-induced photo-onycholysis Photo-onycholyse induite par la griséofulvine Drug-induced photo-onycholysis is a rare condition. It consists on the separation of distal nail plate from nail bed under the effect of ultraviolet radiations. We report the first case of photoonycholysis in a woman undergoing griseofulvin for onychomycosis. Case report

1

2

Fethia Bdioui , Wissem Melki , Khaled Dhibi , Abdelaziz Hamdi2, Hamouda Saffar1 1 Centre hospitalo-universitaire (CHU), service d’hépatogastroentérologie, Monastir, Tunisie 2 Centre hospitalo-universitaire (CHU), service de chirurgie générale, Monastir, Tunisie

tome 41 > n89 > septembre 2012

A 45-year-old woman, with an unremarkable past medical history, was referred to our department for toenail dystrophy. Physical examination revealed pachyonychia of all toenails, while fingernails were normal. Mycological examination showed multiple hyphae with direct microscopy and culture was positive

879

1

Lettres a` la re´daction

Box 1 Main drugs reported to induce photo-onycholysis Tetracycline antibiotics (1) Psoralens (2) Fluoroquinolones (3) Quinine (4) Clorazepate dipotassium (5) Indapamide (6) Benoxaprofen (7) Olanzapine and aripiprazole (8) Amino-laevulinic acid (photodynamic therapy) (9)

Figure 1 Bilateral distal nail detachment surrounded by pigmentation

to Trichophyton rubrum. Terbinafin, as first-line therapy, was refused by the patient for economic reasons. Subsequently, griseofulvin (1 g daily) was prescribed. Four weeks later, the patient noticed a painful change in her two thumbnails. There was no history of trauma or simultaneous drug intake that preceded the occurrence of the symptoms. On examination, there was a half-moon-shaped yellowish detachment of the distal nail plate of both thumbs, with under-nail bleeding striations (figure 1). Examination was normal elsewhere, apart the onychomycosis of toenails. The mycological sample taken from thumbnails was sterile. The diagnosis of griseofulvin-induced photo-onycholysis was suspected in the presence of typical clinical nail change with drug intake. We reviewed the patient 12 weeks after stopping griseofulvin, thumbnail appearance returned to normal. Discussion

880

To our knowledge, this is the first reported case of photoonycholysis induced by griseofulvin. Photo-onycholysis is an uncommon manifestation of phototoxicity that may follow the use of various medications or may occasionally be idiopathic. The most reported drugs that may cause this condition are tetracycline antibiotics, psoralens and fluoroquinolones, as well as some psychotics and diuretics (Box 1) [1–9]. Three subtypes of photo-onycholysis may be observed [10]:  Type I: a half-moon shaped distal onycholysis surrounded by a pigmented zone (as observed in our patient);  Type II: a proximal circular notch;  Type III: lesions in the central part of the nail. Griseofulvin is the first used systemic antifungal drug, discovered in 1939 [11]. It is still the first-line therapy for ringworm and it is worldwide prescribed in this indication. This drug is, however, no longer the gold standard for the treatment of other dermatophytoses since the discovery of new antifungal treatments, such as terbinafin. Nevertheless, in some countries, griseofulvin

continues to be prescribed for onychomycosis, because it is a cost-effective drug, which is the case in our observation [11]. Griseofulvin is known to cause photosensitizing effects that remain rare [11]. Our patient developed few weeks after the initiation of griseofulvin and in the absence of any other drug intake, a typical clinical aspect of photo-onycholysis without cutaneous eruption. This elective nail involvement without cutaneous lesions may be explained by the fact that nail bed is relatively unprotected from sunlight and contains less melanin (implicating less ultraviolet protection) than other skin sites. As seen in our patient, onycholysis could be the only expression of photosensitivity reaction [12]. The improvement of nail changes, few weeks after stopping the drug intake, also confirms the role of griseofulvin in the genesis of our patient’s condition. Photo-onycholysis should, therefore, be considered as a possible side-effect of griseofulvin therapy. Disclosure of interest: the authors declare that they have no conflicts of interest concerning this article.

References [1]

Badri T, Ben Tekaya N, Cherif F, Ben Osman Dhahri A. Photo-onycholysis: two cases induced by doxycycline. Acta Dermatovenerol Alp Panonica Adriat 2004;13:135-6. [2] Prasad PV. Psoralen induced photo-onycholysis. Indian J Dermatol Venereol Leprol 2002;68:116-7. [3] Mahajan VK, Sharma NL. Photo-onycholysis due to sparfloxacin. Australas J Dermatol 2005;46:104-5. [4] Tan SV, Berth-Jones J, Burns DA. Lichen planus and photo-onycholysis induced by quinine. Clin Exp Dermatol 1989;14:335. [5] Torras H, Manuel Mascaro´ JJr, Mascaro´ JM. Photo-onycholysis caused by clorazepate dipotassium. J Am Acad Dermatol 1989;21:1304-5. [6] Rutherford T, Sinclair R. Photo-onycholysis due to indapamide. Australas J Dermatol 2007;48:35-6. [7] McCormack LS, Elgart ML, Turner ML. Benoxaprofen-induced photoonycholysis. J Am Acad Dermatol 1982;7:678-80. [8] Gregoriou S, Karagiorga T, Stratigos A, Volonakis K, Kontochristopoulos G, Rigopoulos D. Photo-onycholysis caused by olanzapine and aripiprazole. J Clin Psychopharmacol 2008;28:219-20. [9] Hanneken S, Wessendorf U, Neumann NJ. Photodynamic onycholysis: first report of photo-onycholysis after photodynamic therapy. Clin Exp Dermatol 2008;33:659-60. [10] Baran R, Juhlin L. Drug-induced photo-onycholysis. Three subtypes identified in a study of 15 cases. J Am Acad Dermatol 1987;17:1012-6.

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Lettres à la rédaction

[11] Bai Kirubha MH. Prescription auditing of griseofulvin in a tertiary care teaching hospital. Indian J Dermatol Venereol Leprol 2009;75:588-92. [12] Baran R, Juhlin L. Photo-onycholysis. Photodermatol Photoimmunol Photomed 2002;18:202-7. Imene Bentabet Dorbani, Talel Badri, Rym Benmously, Samy Fenniche, Inçaf Mokhtar University of Tunis-El Manar, Faculty of medicine, Habib Thameur Hospital, Dermatology Department, Tunis, Tunisia Correspondence: Talel Badri, Habib Thameur Hospital, Dermatology Department, 8, rue Ali Ben Ayed, 1008 Montfleury, Tunis, Tunisia. [email protected] Received 13 September 2011 Accepted 2 November 2011 Available online 13 January 2012

ß 2012 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.lpm.2011.11.014

Figure 1 Coupe tomodensitométrique sagittale

Infarctus du grand épiploon Infarction of the grand omentum Cas Un patient de 28 ans, sans antécédent particulier, est arrivé aux urgences pour un syndrome douloureux abdominal aigu évoluant depuis 24 h, sans trouble du transit et sans nausées. L’examen clinique trouvait un patient apyrétique, avec des constantes hémodynamiques stables ; son abdomen était souple, dépressible, sensible en régions épigastrique et périombilicale, mais sans défense et avec des bruits hydroaériques présents. Le reste de l’examen était sans particularité. Les analyses biologiques retrouvaient une protéine C réactive à 48 mg/mL, isolée, sans hyperleucocytose. Devant ce tableau atypique, une tomodensitométrie abdominopelvienne réalisé en urgence montrait un infarctus primitif du grand épiploon (figure 1 et 2). Un traitement médical associant antalgiques, anti-inflammatoires non stéroïdiens et surveillance en milieu chirurgical permettait une résolution des douleurs en 24 h.

Figure 2 Coupe tomodensitométrique transverse

Discussion

tome 41 > n89 > septembre 2012

La pathogenèse de la torsion de l’épiploon, à l’origine de son infarcissement, est méconnue. Cette torsion est le plus souvent segmentaire et peut survenir de façon idiopathique ou secondairement à une maladie intra-abdominale (hernie interne, adhérences, tumeur. . .). Différents facteurs prédisposant ont

881

L’infarctus segmentaire du grand épiploon est une cause rare et probablement sous-estimée de syndrome douloureux abdominal aigu. Sa première description est attribuée à Bush en 1896 [1]. Il survient préférentiellement chez l’homme (sex-ratio de 2/1), entre 40 et 50 ans [2], mais peut être observé à tout âge [3].