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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute localized exanthematous pustulosis &#40;ALEP&#41; is an atypical variant of acute generalized exanthematous pustulosis &#40;AGEP&#41;&#44; a rare drug reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is an acute&#44; localized subcorneal aseptic pustular eruption&#44; usually affecting the face&#44; cervical region&#44; or thorax&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The pathophysiological mechanisms remain unclear&#44; although 90&#37; of ALEP cases are drug-induced&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This case report describes a paclitaxel-induced ALEP case in a patient undergoing breast cancer treatment&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 63-year-old woman complained of the appearance of pustules on an erythematous base&#44; symmetrically distributed on the face &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; one week after paclitaxel infusion used as neoadjuvant treatment for breast cancer&#46; She reported pruritus and a local burning sensation and denied having a fever&#46; No mucous membrane lesions were observed&#46; The laboratory tests showed normal values &#8203;&#8203;for leukocytes &#40;8&#44;500&#8239;mm<span class="elsevierStyleSup">3</span>&#41; and serum C-reactive protein&#46; The pustule secretion culture was negative&#46; The skin biopsy revealed intraepidermal subcorneal pustules and a superficial perivascular lymphocytic infiltrate &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Based on the clinical presentation and histopathological findings&#44; the diagnosis of ALEP was made&#46; The patient was treated with 40&#8239;mg of prednisone per day&#44; and chemotherapy was discontinued&#44; with complete remission of the lesions after 14 days &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The follow-up continued by slowly decreasing the dose of corticosteroids&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Acute localized exanthematous pustulosis &#40;ALEP&#41; is a particular form of AGEP&#46; Approximately 25 reports have been published in the literature&#44; confirming that it is a rare drug reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Initially&#44; the condition presents with sterile pustules located on the face&#44; cervical region&#44; or thorax after exposure to the drug&#44; with spontaneous remission after discontinuation of the causative drug&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Fever and leukocytosis may be present&#44; accompanied by pruritus or a burning sensation&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> About 90&#37; of cases are drug-induced&#44; with antibiotics&#44; especially beta-lactams and macrolides&#44; being the most common causative drugs&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> Associations with docetaxel&#44; a chemotherapeutic drug of the taxane class&#44; have also been reported in two patients with breast cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As ALEP is a self-limited disease&#44; the mainstay of treatment is the withdrawal of the suspected drug&#44; promoting symptom improvement within a few days&#46; Support therapy with topical or oral corticosteroids may be appropriate for the treatment of pruritus and inflammation in prolonged cases&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; ALEP is an unusual drug-induced skin reaction&#44; and the majority of published cases were secondary to the use of antibiotics&#46; However&#44; it is important to emphasize that chemotherapeutic agents of the taxane class may also be responsible for this skin reaction&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Ana Carolina Tardin Rodrigues de Medeiros&#58; Statistical analysis&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and therapeutic conduct of the studied cases&#59; critical review of the literature&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Juliana Lopes Correa&#58; Collection&#44; analysis&#44; and interpretation of data&#59; drafting and editing of the manuscript&#59; critical review of the literature&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ademar Schultz Junior&#58; Collection&#44; analysis&#44; and interpretation of data&#59; design and planning of the study&#59; drafting and editing of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Karina Demoner de Abreu Sarmenghi&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Acute localized exanthematous pustulosis induced by paclitaxel
Ana Carolina Tardin Rodrigues de Medeiros
Autor para correspondência
anacarolinatardin@hotmail.com

Corresponding author.
, Juliana Lopes Corrêa, Ademar Schultz Junior, Karina Demoner de Abreu Sarmenghi
Dermatology Outpatient Clinic, Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Post-inflammatory hyperchromia without the presence of pustular lesions&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute localized exanthematous pustulosis &#40;ALEP&#41; is an atypical variant of acute generalized exanthematous pustulosis &#40;AGEP&#41;&#44; a rare drug reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is an acute&#44; localized subcorneal aseptic pustular eruption&#44; usually affecting the face&#44; cervical region&#44; or thorax&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The pathophysiological mechanisms remain unclear&#44; although 90&#37; of ALEP cases are drug-induced&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This case report describes a paclitaxel-induced ALEP case in a patient undergoing breast cancer treatment&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 63-year-old woman complained of the appearance of pustules on an erythematous base&#44; symmetrically distributed on the face &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; one week after paclitaxel infusion used as neoadjuvant treatment for breast cancer&#46; She reported pruritus and a local burning sensation and denied having a fever&#46; No mucous membrane lesions were observed&#46; The laboratory tests showed normal values &#8203;&#8203;for leukocytes &#40;8&#44;500&#8239;mm<span class="elsevierStyleSup">3</span>&#41; and serum C-reactive protein&#46; The pustule secretion culture was negative&#46; The skin biopsy revealed intraepidermal subcorneal pustules and a superficial perivascular lymphocytic infiltrate &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Based on the clinical presentation and histopathological findings&#44; the diagnosis of ALEP was made&#46; The patient was treated with 40&#8239;mg of prednisone per day&#44; and chemotherapy was discontinued&#44; with complete remission of the lesions after 14 days &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The follow-up continued by slowly decreasing the dose of corticosteroids&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Acute localized exanthematous pustulosis &#40;ALEP&#41; is a particular form of AGEP&#46; Approximately 25 reports have been published in the literature&#44; confirming that it is a rare drug reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Initially&#44; the condition presents with sterile pustules located on the face&#44; cervical region&#44; or thorax after exposure to the drug&#44; with spontaneous remission after discontinuation of the causative drug&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Fever and leukocytosis may be present&#44; accompanied by pruritus or a burning sensation&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> About 90&#37; of cases are drug-induced&#44; with antibiotics&#44; especially beta-lactams and macrolides&#44; being the most common causative drugs&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> Associations with docetaxel&#44; a chemotherapeutic drug of the taxane class&#44; have also been reported in two patients with breast cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As ALEP is a self-limited disease&#44; the mainstay of treatment is the withdrawal of the suspected drug&#44; promoting symptom improvement within a few days&#46; Support therapy with topical or oral corticosteroids may be appropriate for the treatment of pruritus and inflammation in prolonged cases&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; ALEP is an unusual drug-induced skin reaction&#44; and the majority of published cases were secondary to the use of antibiotics&#46; However&#44; it is important to emphasize that chemotherapeutic agents of the taxane class may also be responsible for this skin reaction&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Ana Carolina Tardin Rodrigues de Medeiros&#58; Statistical analysis&#59; design and planning of the study&#59; drafting and editing of the manuscript&#59; intellectual participation in the propaedeutic and therapeutic conduct of the studied cases&#59; critical review of the literature&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Juliana Lopes Correa&#58; Collection&#44; analysis&#44; and interpretation of data&#59; drafting and editing of the manuscript&#59; critical review of the literature&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ademar Schultz Junior&#58; Collection&#44; analysis&#44; and interpretation of data&#59; design and planning of the study&#59; drafting and editing of the manuscript&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Karina Demoner de Abreu Sarmenghi&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Informação do artigo
ISSN: 03650596
Idioma original: Inglês
DOI:10.1016/j.abd.2021.05.015
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