Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

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A recent study suggests that discontinuation of dexamethasone premedication after two uneventful infusions or reduction in the dose of dexamethasone paclitaxel premedication are both safe alternatives to high-dose steroid premedications recommended in product labelling.
01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute. 

What are the distinct features of MTX-induced epidermal necrosis?

14 Aug 2017
Xander was diagnosed with Stevens-Johnson syndrome, a life-threatening skin condition in which cell death causes the skin layers to separate. Photo credit: PA REAL LIFE/ The Sun UK

Methotrexate-induced epidermal necrosis (MEN) presents clinicopathologic features that are different from Stevens‒Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), according to a study.

“Recognition of the early signs and prognostic factors is important, because the rapid institution of leucovorin may be helpful,” researchers said.

A total of 24 patients with MEN and 150 controls were included in this study, which examined the clinicopathology, risk factors and prognostic factors of MEN. The authors analysed the demographics, pathology and plasma concentrations of methotrexate (MTX).

Extensive skin necrosis (mean 33.2 percent total body surface), but no target lesion, was present in patients with MEN. The histopathology exhibited keratinocyte dystrophy. Furthermore, painful skin erosions, oral ulcers and leukopaenia/thrombocytopaenia were early indicators of MEN.

There was 16.7-percent mortality despite administration of leucovorin to majority of the patients (79.2 percent).

Older age (>60 years), chronic kidney disease and high initial dosage of MTX without folic acid supplementation predicted MEN. MTX clearance was delayed by renal insufficiency.

Severe renal disease and leukopaenia were predictors of poor prognosis in MEN, but none of the Score of Toxic Epidermal Necrosis criteria correlated with mortality of MEN.

The major limitation of this study was its small sample size.

According to researchers, physicians should avoid prescribing MTX to high-risk patients and titrate the dosage slowly upward with folic acid supplementation to lower the risk of MEN, which is a rare but life-threatening cutaneous reaction that mimics SJS/TEN.

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Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

2 days ago
A recent study suggests that discontinuation of dexamethasone premedication after two uneventful infusions or reduction in the dose of dexamethasone paclitaxel premedication are both safe alternatives to high-dose steroid premedications recommended in product labelling.
01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute.