Papulosquamous Drug Eruption and Nail Disorder Due to Use Entecavir

�zu�uz, P�nar; Erarslan, Elife; �nverdi, Hatice; �zu�uz, Ufuk

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Papulosquamous Drug Eruption and Nail Disorder Due to Use Entecavir [Turkderm-Turk Arch Dermatol Venereol]

Turkderm-Turk Arch Dermatol Venereol. 2013; 47(4): 232-235 | DOI: 10.4274/turkderm.53254

Papulosquamous Drug Eruption and Nail Disorder Due to Use Entecavir

P�nar �zu�uz¹, Elife Erarslan², Hatice �nverdi³, Ufuk �zu�uz⁴
¹Ministry Of Health, Ankara Etlik Research And Training Hospital, Department Of Dermatology
²Ministry Of Health, Ankara Etlik Research And Training Hospital, Department Of Gastroenterology
³Ministry Of Health, Ankara Etlik Research And Training Hospital, Department Of Patology.
⁴Ministry Of Health, Ankara Numune Research And Training Hospital, Department Of Endocrinology And Metabolism,

Introduction: Papulosquamous drug eruptions are a group of skin lesions, triggered by various drugs. Hepatitis B is an important health problem all over the world as well as in our country. Entecavir is a nucleoside analogue used in the treatment of chronic hepatitis B.
Case: A 56-year-old female patient using entecavir for chronic hepatitis B for four years admitted to our outpatient clinics with dystrophic changes on the finger nails and toe nails, and scaling erythematous lesions of fingers and toes for one year. She had no drug history other than entecavir. Laboratory examination revealed: HbsAg: positive, HBeAg: negative, anti-HBe: positive, HBV DNA: negative, total anti-HDV: negative, and alanine aminotransferase: 32 U/L. Biopsies were taken from the patient's finger and toe nails after three negative fungal examination of native smears. Biopsy results were consistent with drug eruptions and according to these results, the lesions were thought to be a side effect of entecavir. Entecavir treatment was terminated and transaminase levels were followed at regular intervals. Mometasone fruat ointment and moisturizer containing urea (2 times a day/seven days) were started for the treatment of skin lesions. Two weeks later the lesions were showed improvement and the patient was called to follow up at regular intervals.
Conclusion: To our best knowledge there was only one case report in the literature so far, about drug eruptions with entecavir. Here we described the first case who developed papulosquamous skin eruptions and nail disorders due to treatment of entecavir.

Keywords: Chronic hepatitis B, entecavir, drug eruptions

Entecavir Kullan�m�na Ba�l� Geli�en Pap�loskuam�z �la� Er�psiyonu ve T�rnak Bozuklu�u

P�nar �zu�uz¹, Elife Erarslan², Hatice �nverdi³, Ufuk �zu�uz⁴
¹Etlik �htisas E�itim Ve Ara�t�rma Hastanesi, Deri Ve Z�hrevi Hastal�klar A.d
²Etlik �htisas E�itim Ve Ara�t�rma Hastanesi, Gastroenteroloji A.d
³Etlik �htisas E�itim Ve Ara�t�rma Hastanesi, Patoloji A.d
⁴Ankara Numune E�itim Ve Ara�t�rma Hastanesi, Endokrinoloji Ve Metabolizma B�l�m�.

Giri�: Pap�loskuam�z ila� er�psiyonlar�, bir�ok ila�la tetiklenebilen deri lezyonlar�d�r. Hepatit B t�m d�nyada oldu�u gibi �lkemizde de �nemli bir sa�l�k sorunudur. Entecavir, kronik hepatit B tedavisinde kullan�lan bir n�kleozid analo�udur. 
Olgu: 10 y�ld�r kronik hepatit B tan�s� olan, 4 y�ld�r entecavir tedavisi alan 56 ya��ndaki bayan hasta, bir y�ld�r el-ayak t�rnaklar�nda distrofik de�i�iklikler ve el-ayak parmaklar�nda eritemli skuaml� lezyonlarla poliklini�imize ba�vurdu. Hasta entecavir d��nda ba�ka bir ila� kullanm�yordu. Laboratuvar tetkikleri: HBsAg: pozitif, HBeAg: negatif, anti-HBe: pozitif, HBV DNA: negatif, total anti-HDV: negatif ve alanin aminotransferaz: 32 IU/L. �� kez t�rnaktan al�nan �rneklerde native preparat�n negatif olmas� ve mantar k�lt�r�nde �reme olmamas� �zerine hastan�n el ba�parmak t�rna��ndan ve ayak parma�� derisinden biyopsi al�nd�. Biyopsi sonucunun ila� er�psiyonu ile uyumlu bulunmas� nedeni ile bu lezyonlar�n entecavirin yan etkisi olabilece�i d��n�ld�. Entecavir tedavisi kesilerek transaminaz de�erlerine d�zenli aral�klarla bak�ld�. Hastaya deri lezyonlar� i�in 7 g�n 2x1 mometazon fruat pomad ve �re i�eren nemlendiriciler ba�land�. �ki hafta sonra lezyonlarda iyile�me g�r�lmesi �zerine hasta d�zenli aral�klarla takibe �a�r�ld�. 
Sonu�: Bilgilerimize g�re, �u ana kadar entecavir tedavisi ile deri er�psiyonu geli�en sadece 1 olgu vard�r. Burada entecavir tedavisine ba�l� papuloskuam�z deri er�psiyonu ile birlikte t�rnak bozuklu�u geli�en ilk olgu sunulmaktad�r.

Anahtar Kelimeler: Kronik hepatit B, entecavir, ila� er�psiyonu

P�nar �zu�uz, Elife Erarslan, Hatice �nverdi, Ufuk �zu�uz. Papulosquamous Drug Eruption and Nail Disorder Due to Use Entecavir. Turkderm-Turk Arch Dermatol Venereol. 2013; 47(4): 232-235

Corresponding Author: P�nar �zu�uz, T�rkiye

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