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CORRESPONDENCE |
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| Year : 2012 | Volume
: 57
| Issue : 6 | Page : 498-499 |
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| The remarkable paradigm of segmental (mosaic) drug eruptions |
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Daniele Torchia
Via della Scala 58, 50123 Florence, Italy
| Date of Web Publication | 1-Nov-2012 |
Correspondence Address:
Daniele Torchia
Via della Scala 58, 50123 Florence
Italy
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-5154.103075
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How to cite this article:
Torchia D. The remarkable paradigm of segmental (mosaic) drug eruptions. Indian J Dermatol 2012;57:498-9 |
Sir,
Vetrichevvel et al. recently described a case of linearly arranged fixed drug eruption (FDE) co-existing with non-segmental lesions. [1] I wish to highlight that such linear pattern is not zosteriform/dermatomal as claimed by the Authors, but rather Blashko-linear as clearly evident from its S-shaped fashion (typical of antero-lateral thoracic Blashko lines). Hence, the diagnosis should be redirected towards "superimposed segmental FDE". In fact, according to a recently proposed paradygm, segmental manifestations of acquired polygenic skin disorders, such as drug-induced inflammatory dermatoses, can manifest as either "isolated" (segmental lesions as the sole manifestation of a dermatosis) or "superimposed" (segmental lesions co-existing with non-segmental, otherwise typical manifestations of a dermatosis). [2] Both forms originate from a postzygotic mutational event but do not imply nor exclude any specific type of such mutation (e.g. loss of heterozygosity). [2]
Vetrichevvel et al.'s case adds up to already reported, yet exceptional instances of drug eruptions occurring in a mosaic form, which include, beside FDE, [1],[3],[4],[5] lichenoid dermatitis, [6],[7],[8],[9],[10] spongiotic dermatitis [11],[12],[13],[14] and pigmented purpuric dermatosis [Table 1]. [15],[16] Segmental lesions were distributed along with Blashko lines in all cases. The superimposed segmental pattern was - somehow surprisingly - frequent (33.3% vs. the 66.7% of the isolated segmental one).
Dermatoses due to drugs are a remarkable model to study the interaction between the environment (i.e. drugs) and genotype (i.e. the [immuno] genetic predisposition to develop a cell-mediated hypersensitivity reaction). Although rare, the occurrence of acquired, non-mendelian skin disorders in a segmental (mosaic) fashion represents an experimentum naturae showing that: 1) such disorders depend not only on environmental factors but also on gene defects; 2) among the allegedly pre-disposing postzygotic mutations, at least some are harbored within resident skin cells.
 References | |  |
| 1. | Vetrichevvel TP, Sudha R, Shobana S, Anandan A. Zosteriform fixed drug eruption to levofloxacin. Indian J Dermatol 2012;57:327-8. 
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| 2. | Happle R. Superimposed segmental manifestation of polygenic skin disorders. J Am Acad Dermatol 2007;57:690-9.
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| 3. | Sigal-Nahum M, Konqui A, Gaulier A, Sigal S. Linear fixed drug eruption. Br J Dermatol 1988;118:849-51.
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| 4. | Ozkaya-Bayazit E, Baykal C. Trimethoprim-induced linear fixed drug eruption. Br J Dermatol 1997;137:1028-9.
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| 6. | Shaffer L. A case for diagnosis. Arch Dermatol Syph 1939;40:305.
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| 7. | Stransky L. Unilateral multiplex naevoid zosteriform Lichen ruber planus following oral administration of salazopyrine. Derm Beruf Umwelt 1991;39:2:54-5.
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| 8. | Muñoz MA, Pérez-Bernal AM, Camacho FM. Lichenoid drug eruption following the Blaschko lines. Dermatology 1996;193:66-7.
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| 9. | Krasowska D, Schwartz RA, Lecewicz-Torun B. Generalized lichenoid drug eruption following Blaschko lines. Int J Dermatol 2001;40:774-6.
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| 10. | Gencoglan G, Ceylan C, Kazandi AC. Linear lichenoid drug eruption induced by valsartan. Clin Exp Dermatol 2009;34:e334-5.
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| 11. | Plantin P, Le Noach E, Abgrall JF, Le Roy JP. Cas pour diagnostic. Ann Dermatol Venereol 1993;120:251-2.
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| 12. | Alfonso R, Belinchon I. Linear drug eruption. Eur J Dermatol 2001;11:122-3.
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| 13. | Brinkmeier T, Herbst RA, Schaller J, Kuegler K, Pirker C, Beiteke U, et al. Drug-induced blaschkitis. Acta Derm Venereol 2004;84:314-5.
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| 14. | Grape J, Frosch P. Papulöse Arzneimittelreaktion entlang der Blaschko-Linien durch Lenalidomid. Hautarzt 2011;62:618-20.
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| 15. | Kwon SJ, Lee CW. Figurate purpuric eruptions on the trunk: Acetaminophen-induced rashes. J Dermatol 1998;25:756-8.
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| 16. | Taketuchi Y, Chinen T, Ichikawa Y, Ito M. Two cases of unilateral pigmented purpuric dermatosis. J Dermatol 2001;28:493-8.Authors' Reply
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[Table 1] |
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| This article has been cited by | | 1 |
Congenital vulnerability of cutaneous segments arising from skin mosaicism: A genetic basis for locus minoris resistentiae |
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| Rami N. Al-Rohil,David Leung,J. Andrew Carlson | | Clinics in Dermatology. 2014; 32(5): 577 | | [Pubmed] | [DOI] | |
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