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TEN: A prospective comparative study
Abstracts from the 41st Annual Meeting / Journal of Dermatological Science 86 (2017) e1–e95
P04-21[O2-04] The characteristics of patients with persistent HHV-6 infection after drug-induced hypersensitivity syndrome (DIHS) Yuki Nakamura ∗ , Kazuya Miyashita, Rie Onmori, Fumi Miyagawa, Hiroaki Azukizawa, Hideo Asada The Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan Drug-induced hypersensitivity syndrome (DIHS) is characterized by fever, cutaneous eruptions, haematological abnormalities, organ functional disorder, and reactivation of human herpesvirus 6 (HHV-6). It has been reported that reactivation of HHV-6 occurs 2–3 weeks after onset and closely relates to flaring symptoms such as fever and hepatitis. However, there have been few studies regarding kinetics of HHV-6 DNA in DIHS patients beyond the acute stage. We examined HHV-6 DNA by quantitative PCR in the peripheral blood mononuclear cells sequentially in the acute and convalescent stage for more than 4 months. We found 7 patients who showed high levels of HHV-6 DNA continuously (1000–15,000 copies/ml blood). We compared clinical symptoms, laboratory data, reactivation of other herpesvirus, levels of serum cytokine (interleukin (IL)-4, IL-5, IL-10) and soluble IL-2 receptor (sIL-2R) between persistent HHV-6 infection group (n = 7) and transient HHV-6 infection group (n = 6). There were no significant differences in fever, hepatic dysfunction, the percentage of atypical lymphocyte, the levels of serum thymus and activation-regulated chemokine (TARC), IL-5, and sIL-2R between persistent infection group and transient infection group. Cutaneous eruptions were significantly more severe in persistent infection group than in transient infection group (p = 0.031). The levels of IL-10 and HHV-6 DNA in the acute phase were significantly higher in the persistent infection group compared to the transient infection group (IL-10: p = 0.027, HHV-6 DNA: p = 0.004). The rate of CMV reactivation was higher in the persistent infection group compared to the transient infection group. These results suggest that persistent HHV-6 infection may have some influence on the pathological condition of DIHS. http://dx.doi.org/10.1016/j.jdermsci.2017.02.096 P04-22[O2-05] Higher frequency of sensitive skin in extrinsic type of atopic dermatitis than intrinsic type as assessed by lactic acid stinging test Tsuyoshi Yatagai 1,∗ , Hayato Yamaguchi 2 , Masahiro Aoshima 1 , Shigeki Ikeya 1 , Kazuki Tatsuno 1 , Takatoshi Shimauchi 1 , Toshiharu Fujiyama 1 , Taisuke Ito 1 , Yoshiki Tokura 1 1 The Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan 2 Department of Dermatology, Self-Defense Forces Central Hospital, Tokyo, Japan Sensitive skin is characterized by the sensations such as tingling, pricking, heat, burning, pain and itching. To assess sensitive skin, 1% lactic acid stinging test (LAST) is mostly used, and sensitivity following the application of lactic acid is evaluated by the degrees of four distinct sensations (pain, warm sensation, itching, and crawly feeling). Atopic dermatitis (AD) is classified into intrinsic type (IAD) with normal serum IgE levels and extrinsic type (EAD) with high serum IgE levels. The skin barrier disruption is higher in EAD than in IAD. The relationship between sensitive skin and barrier disruption in patients with IAD and EAD remains unclear. To address this issue,
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we performed 1% LAST in 42 Japanese AD patients (32 EAD and 10 IAD) and 10 normal healthy volunteers in this study. Skin surface hydration, transepidermal water loss (TEWL), skindex-16, visual analogue scale (VAS) for pruritus were also measured. Compared to normal controls, AD patients showed a significantly higher positive frequency in LAST as well as the values of pruritus and TEWL. In particular, crawly feeling positively correlated with VAS, IgE, and LDH, but inversely correlated with skin surface hydration in AD patients. In comparison between IAD and EAD, EAD patients showed a significantly higher positive frequency for LAST (crawly feeling) as well as VAS, TEWL, and skindex-16 symptom score. These findings suggest that sensitive skin is associated at least with epidermal barrier condition in AD patients, as typically seen in EAD. http://dx.doi.org/10.1016/j.jdermsci.2017.02.097 P04-23[O2-06] Long-term sequelae of DRESS and SJS/TEN: A prospective comparative study Che-Wen Yang ∗ , Chia-Yu Chu The Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan As two distinct forms of severe cutaneous adverse reactions (SCARs), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) demonstrate different immunological mechanisms and clinical manifestations. Based on previous reports, they also exhibit unique patterns of long-term complications after clinical resolution. To compare the immune response during the acute stage and incidence rates of long-term sequelae in the two diseases, we prospectively collected cases of DRESS and SJS/TEN from 2010 to 2015. In total, 61 DRESS patients and 36 SJS/TEN patients were included. Lymphocyte subset analysis by flow cytometry in 30 of 61 DRESS cases and 20 of 36 SJS/TEN cases revealed a significant decrease in CD19+ B cells in DRESS group but not in SJS/TEN group. The average CD4:CD8 ratio was 1.06 ± 0.63 in DRESS group and 1.32 ± 0.64 in SJS/TEN group. Among the DRESS group, 7 patients were found to have 9 complications, including autoimmune thyroiditis (n = 2), thyroid papillary carcinoma (n = 1), newly diagnosed type 1 (n = 1) or type 2 diabetes mellitus (n = 2), progression of preexisting chronic kidney disease to end stage renal disease (n = 2) and epilepsy with psychomotor retardation (n = 1). For patients who had recovered from SJS/TEN, ocular problems and cutaneous problems were the most common sequelae. In conclusion, both DRESS and SJS/TEN patients should be carefully followed up for the risk of developing long-term sequelae. http://dx.doi.org/10.1016/j.jdermsci.2017.02.098
P04-21[O2-04] The characteristics of patients with persistent HHV-6 infection after drug-induced hypersensitivity syndrome (DIHS) Yuki Nakamura ∗ , Kazuya Miyashita, Rie Onmori, Fumi Miyagawa, Hiroaki Azukizawa, Hideo Asada The Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan Drug-induced hypersensitivity syndrome (DIHS) is characterized by fever, cutaneous eruptions, haematological abnormalities, organ functional disorder, and reactivation of human herpesvirus 6 (HHV-6). It has been reported that reactivation of HHV-6 occurs 2–3 weeks after onset and closely relates to flaring symptoms such as fever and hepatitis. However, there have been few studies regarding kinetics of HHV-6 DNA in DIHS patients beyond the acute stage. We examined HHV-6 DNA by quantitative PCR in the peripheral blood mononuclear cells sequentially in the acute and convalescent stage for more than 4 months. We found 7 patients who showed high levels of HHV-6 DNA continuously (1000–15,000 copies/ml blood). We compared clinical symptoms, laboratory data, reactivation of other herpesvirus, levels of serum cytokine (interleukin (IL)-4, IL-5, IL-10) and soluble IL-2 receptor (sIL-2R) between persistent HHV-6 infection group (n = 7) and transient HHV-6 infection group (n = 6). There were no significant differences in fever, hepatic dysfunction, the percentage of atypical lymphocyte, the levels of serum thymus and activation-regulated chemokine (TARC), IL-5, and sIL-2R between persistent infection group and transient infection group. Cutaneous eruptions were significantly more severe in persistent infection group than in transient infection group (p = 0.031). The levels of IL-10 and HHV-6 DNA in the acute phase were significantly higher in the persistent infection group compared to the transient infection group (IL-10: p = 0.027, HHV-6 DNA: p = 0.004). The rate of CMV reactivation was higher in the persistent infection group compared to the transient infection group. These results suggest that persistent HHV-6 infection may have some influence on the pathological condition of DIHS. http://dx.doi.org/10.1016/j.jdermsci.2017.02.096 P04-22[O2-05] Higher frequency of sensitive skin in extrinsic type of atopic dermatitis than intrinsic type as assessed by lactic acid stinging test Tsuyoshi Yatagai 1,∗ , Hayato Yamaguchi 2 , Masahiro Aoshima 1 , Shigeki Ikeya 1 , Kazuki Tatsuno 1 , Takatoshi Shimauchi 1 , Toshiharu Fujiyama 1 , Taisuke Ito 1 , Yoshiki Tokura 1 1 The Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan 2 Department of Dermatology, Self-Defense Forces Central Hospital, Tokyo, Japan Sensitive skin is characterized by the sensations such as tingling, pricking, heat, burning, pain and itching. To assess sensitive skin, 1% lactic acid stinging test (LAST) is mostly used, and sensitivity following the application of lactic acid is evaluated by the degrees of four distinct sensations (pain, warm sensation, itching, and crawly feeling). Atopic dermatitis (AD) is classified into intrinsic type (IAD) with normal serum IgE levels and extrinsic type (EAD) with high serum IgE levels. The skin barrier disruption is higher in EAD than in IAD. The relationship between sensitive skin and barrier disruption in patients with IAD and EAD remains unclear. To address this issue,
e33
we performed 1% LAST in 42 Japanese AD patients (32 EAD and 10 IAD) and 10 normal healthy volunteers in this study. Skin surface hydration, transepidermal water loss (TEWL), skindex-16, visual analogue scale (VAS) for pruritus were also measured. Compared to normal controls, AD patients showed a significantly higher positive frequency in LAST as well as the values of pruritus and TEWL. In particular, crawly feeling positively correlated with VAS, IgE, and LDH, but inversely correlated with skin surface hydration in AD patients. In comparison between IAD and EAD, EAD patients showed a significantly higher positive frequency for LAST (crawly feeling) as well as VAS, TEWL, and skindex-16 symptom score. These findings suggest that sensitive skin is associated at least with epidermal barrier condition in AD patients, as typically seen in EAD. http://dx.doi.org/10.1016/j.jdermsci.2017.02.097 P04-23[O2-06] Long-term sequelae of DRESS and SJS/TEN: A prospective comparative study Che-Wen Yang ∗ , Chia-Yu Chu The Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan As two distinct forms of severe cutaneous adverse reactions (SCARs), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) demonstrate different immunological mechanisms and clinical manifestations. Based on previous reports, they also exhibit unique patterns of long-term complications after clinical resolution. To compare the immune response during the acute stage and incidence rates of long-term sequelae in the two diseases, we prospectively collected cases of DRESS and SJS/TEN from 2010 to 2015. In total, 61 DRESS patients and 36 SJS/TEN patients were included. Lymphocyte subset analysis by flow cytometry in 30 of 61 DRESS cases and 20 of 36 SJS/TEN cases revealed a significant decrease in CD19+ B cells in DRESS group but not in SJS/TEN group. The average CD4:CD8 ratio was 1.06 ± 0.63 in DRESS group and 1.32 ± 0.64 in SJS/TEN group. Among the DRESS group, 7 patients were found to have 9 complications, including autoimmune thyroiditis (n = 2), thyroid papillary carcinoma (n = 1), newly diagnosed type 1 (n = 1) or type 2 diabetes mellitus (n = 2), progression of preexisting chronic kidney disease to end stage renal disease (n = 2) and epilepsy with psychomotor retardation (n = 1). For patients who had recovered from SJS/TEN, ocular problems and cutaneous problems were the most common sequelae. In conclusion, both DRESS and SJS/TEN patients should be carefully followed up for the risk of developing long-term sequelae. http://dx.doi.org/10.1016/j.jdermsci.2017.02.098