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Chap. 20 - GRAFT VERSUS HOST DISEASE
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- By Jasna Lipozenčić, University of Zagreb, Ronni Wolf, Hebrew University–Hadassah Medical School
- Edited by Ronni Wolf, Batya B. Davidovici, Jennifer L. Parish, Lawrence Charles Parish
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- Book:
- Emergency Dermatology
- Published online:
- 07 September 2011
- Print publication:
- 17 January 2011, pp 194-201
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- Chapter
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Summary
THE SKIN is a major target organ for both acute and chronic graft versus host disease (GVHD) after stem cell transplantation (SCT). Although SCT is a life-saving measure and the treatment of choice for many patients with various hematologic malignancies, a high incidence of complications and a transplantation-associated mortality of approximately 30% are to be expected. GVHD is the major cause of morbidity and mortality at any time following SCT. The acute form occurs during the first 100 days after transplantation in up to 50% of graft recipients, whereas chronic GVHD develops in approximately 30%–50%, usually within 100–500 days following allogenic SCT. Target organs in GVHD can be all of those with lymphoid cells as well as epithelial structures, especially the skin, liver, gastrointestinal (GI) tract, lung, eyes, and neuromuscular system. Early diagnosis of GVHD can be difficult because drug reactions, viral infections, and cutaneous reactions to radiation therapy may have similar clinical and histological similarities. Histological findings of GVHD correlate poorly with clinical severity of the disease and have a limited role in predicting disease stage and progression. The skin manifestations, histopathologic features, prophylaxis, and therapy of acute and chronic GVHD are presented in this chapter.
Chap. 17 - SEVERE, ACUTE COMPLICATIONS OF DERMATOLOGIC THERAPIES
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- By Ronni Wolf, Hebrew University–Hadassah Medical School, Jasna Lipozenčić, University of Zagreb, Batya B. Davidovici, Kaplan Medical Center
- Edited by Ronni Wolf, Batya B. Davidovici, Jennifer L. Parish, Lawrence Charles Parish
-
- Book:
- Emergency Dermatology
- Published online:
- 07 September 2011
- Print publication:
- 17 January 2011, pp 168-177
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- Chapter
- Export citation
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Summary
ALTHOUGH PHYSICIANS from other specialties, like the population at large, still consider cutaneous maladies as being mainly aesthetic, skin deep, and insignificant, they are generally aware that treating these diseases often requires a variety of potent systemic drugs and not only topical treatments. These powerful medications may cause many adverse reactions, some of them severe, acute, or even life threatening.
“There are no really ‘safe’ biologically active drugs. There are only ‘safe’ physicians.” A “safe” physician must, first and foremost, be well informed about adverse reactions at the time of prescribing a drug, during the follow-up period, and especially when one of these rare catastrophes suddenly occurs. Because the diversity of severe adverse reactions to dermatologic therapies is almost endless, we focus on new drugs and the less known adverse effects.
TARGETED IMMUNE MODULATORS/BIOLOGICS
Targeted immune modulators (TIMs) – commonly referred to as biological response modifiers or simply “biologics” – are a relatively new category of medications used in the treatment of certain types of immunologic and inflammatory diseases, including dermatologic diseases, most notably psoriasis.
Overall, TIMs appear to have a good tolerability profile, although some rare but acute serious adverse events, such as infections, hematologic events, neurologic events, infusion reactions, congestive heart failure, nephrotic syndrome, and others, are of concern. The following sections describe adverse events associated with TIMs.