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Title: Fresh Research - CH & Lymphomatoid Papulosis Post by floridian on Apr 15th, 2004, 9:43am No abstract on this, so we are left guessing - are clusterheads at increased risk of lymphomatoid papulosis or not?? Lymphomatoid papulosis is a skin condition marked by red spots that heal over a few weeks or months, but leave spots (either overpigmented or underpigmented). There is no agreement whether LP is a malignant condition or an autoimmune/inflammitory condition. For most people it seems to be benign but it sometimes is linked to cancers. Also, what's the link to verapamil?? Does it help treat it, or is it a possible cause of LP?? Link on LP: http://www.emedicine.com/derm/topic254.htm Quote:
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by floridian on Apr 15th, 2004, 9:58am Lymphomatoid papulosis is far less common than CH - only about 1 or 2 people per million in the U.S. have LP. That's in comparison to 2 people per thousand for CH. |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by Superpain on Apr 15th, 2004, 2:48pm Oh fuck... I hope that's not what I have! :o Mine's not quite as bad as the pics, and it's only on my chest, back and head, but it's similar... :( And I've noticed the lymph nodes under my arms are tender lately... Should I be worried? [smiley=huh.gif] |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by floridian on Apr 15th, 2004, 3:32pm Worth getting it looked at. You probably have something that is more common and treatable. Then you won't have to worry. |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by JJA on Apr 19th, 2004, 10:08am I got a copy of this from work. I could only get a pdf so I used OCR to get text. (It may look funny.) Also, I had to clip the figures and references. Theres no abstract, but the article is pretty short. E-mail me and I will send you the pdf as an attachment. Also let me know if this type of post is a no-no. Shazia Afridi Chris M. Bacon Jonathan Bowling Peter J. Goadsby Verapamil and lymphomatoid papulosis in chronic cluster headache Received: 27 June 2003 Received in revised form: 11 August 2003 Accepted: 18 September 2003 Sirs: Lymphomatoid papulosis is a clinically benign, atypical lympho-proliferation [1] that forms part of the spectrum of primary cutaneous CD30 positive T cell lymphoproliferative disorders. It has an estimated prevalence rate of 1.2-1.9 per 100,000 and is more common in the third to fifth decades [2]. Clinically it is characterised by re- current crops ofhaemorrhagic or necrotic, erythematous papules that regress without treatment after two to eight weeks. The disease may evolve into a malignant lymphoma. In some cases this represents progression of the T celclone present in the initial lesion, such as when cutaneous anaplastic large cell lymphoma develops. In other cases the subsequent lymphoma may be clonally unrelated,to the lymphomatoid papulosis, such as when classical Hodgkin lymphoma develops. Estimations of the risk of development of frank lymphoma vary from 10-80 after 15 years of follow-up [3]. We report a 71 year old male with chronic cluster headache [4] treated with verapamil who developed a skin rash consistent with a lymphomatoid papulosis. Such an association has not previously been reported. He gave a history of bouts of headache beginning in 1950. Since 1994 he had been get- ting 1-2 bouts annually each bout lasting three months. The most recent bout had persisted for a year. He experienced 1-2 headaches a day each lasting 1 hour. A typical attack was right-sided retro-orbital pain with associated features, including ipsilateral eyelid oedema, lacrimation, nasal blockage and rhinorrhoea. He was started on verapamil in December 2000 at 240 mg daily followed by doses varying between 120 mg and 480 mg daily. It was stopped in September 2001 and restarted November 19th 2001 at 240 mg daily because of recurrence of headaches. Within a week of restarting he developed a distinctive rash that took the form of 0.5 cm pruritic, erythematous papules on his neck, armpits and groin. The papules eventually transformed into ulcerated nodules (Fig. 1). They persisted for about 2 weeks and then regressed when the dose of verapamil was reduced from 240 mg to 200 mg. He remained systemically well on 200 mg daily. Past medications included an eight month course of prednisolone that ended in December 2000. He used sumatriptan 6 mg s/c. He had had cancer of the prostate in 1997 treated with radiotherapy and pulmonary tuberculosis at the age of 7 years. He smoked 50 cigarettes per day and drank 30-40 units of alcohol a week outside a bout. continued... |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by JJA on Apr 19th, 2004, 10:09am .... On examination he had a solitary erythematous nodule withcentral ulceration (Fig. 1). Fine atrophic scarring was present from previous lesions. His neurological examination was normal. He had no lymphadenopathy, fever or any evidence of systemic involvement. Normal investigations include,full blood count, urea, electrolytes, liver function tests, ESR, CRP, lymphocyte subsets, and skin swab from the lesion. The skin biopsy tissue showed an area of central epidermal ulceration beneath which was a wedge-shaped, florid, predominantly perivascular lymphoid infiltrate (Fig. 2) composed of numerous large atypical lymphoid cells with irregular nuclei and prominent nucleoli together with small CD3 positive, CD30 negative lymphocytes (Fig. 3). Occasional binucleate atypical cells expressing CD3, CD4 and CD30 (Fig. 4), but not ALK-1, were pres- ent, and several mitoses were identified. PCR-based analysis of T-cell receptor gamma gene rearrangement showed a monoclonal population. The histological features were consistent with the clinical diagnosis of lymphomatoid papulosis. There have not been any previous reports in the literature of an association between verapamil and lymphomatoid papulosis. Many drugs, including calcium channel antagonists and anticonvulsants have been reported in association with atypical cutaneous lymphoid infiltrates [5], such as cutaneous pseudolymphoma. These have been shown to occur after 2 weeks to 5 years of drug administration and resolution occurs within 1 to 32 weeks of cessation. Magro and colleagues [5] presented a series of drug-induced atypical cutaneous lymphoid infiltrates induced by calcium channel blockers, as well as other drugs. One case was of lymphomatoid papulosis but this was in association with fluoxetine (Prozac®) use (Magro, personal communication). There are three histological variants of lymphomatoid papulosis [6]. Type A, as present in our patient, accounts for -80 of cases. There is a dermal inflammatory infiltrate consisting of large CD30 positive, and often CD25 positive atypical cells with large nuclei and prominent nucleoli surrounded by a polymorphous infiltrate of neutrophils and small lymphocytes. Type B consists of smaller mononuclear cells with cerebriform, dark nuclei and is similar to mycosis fungoides. Type C is rare and is characterised by clusters of large cells and resembles frank lymphoma histologically. Lymphomatoid papulosis has been considered by some to be part of the spectrum of cutaneous pseudolymphoma [5]. Others consider the histopathological features, and the recent finding that the atypical CD30 cells are mono- clonal in almost all cases [7], indicate that lymphomatoid papulosis is a true, but indolent, lymphoma [8]. However, some drug-induced cutaneous pseudolymphomas also comprise a monoclonal population, and the actual status of lymphoma- toid papulosis remains controversial. There is evidence for verapamil affecting normal T cell function. It has been shown to suppress interleukin (IL)-2 roduction and in- hibit cytotoxic T cell activity in mitogen and alloantigen stimulated human T lymphocytes in a dose related fashion [9]. It has also been shown to prevent recipient CDS and CD4 lymphocytes passing through the allogenic graft endothelium in organ grafted patients [10] and inhibits the release ofIL4, IL10, interferon and tumour necrosis factor from stimulated blood cells [ 11 ]. By modulating the cellular immune system, verapamil may promote the expansion of an atypical T cell subpopulation with subsequent progression to the lesions of lymphomatoid papulosis. Lymphomatoid papulosis is an important condition to recognize because of its propensity to become malignant or to be misdiagnosed as a clinically more aggressive cutaneous lymphoma. The association with verapamil is important, as it is a drug used frequently in cluster headache at unusual doses. Early dermatological review of new, unusual rashes in patients on verapamil is good clinical practice for specialists managing cluster headache patients long term. |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by floridian on Apr 19th, 2004, 10:41am Thanks for posting that, JJA. One case of LA associated with verapamil isn't proof, but it is a possibility that should be considered if that type of rash appears in a cluster head taking that med. |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by Superpain on Apr 19th, 2004, 5:28pm So can someone break that down itno english for me? That stuff looks very similar to what I have, kinda like zits, but it's only on my chest, back, neck and head... The doc took me off verapamil, and since then it cleared up quite a bit untill I went to work and sweat all night, then it flared up again. Is this a chronic disease or just a temporary condition? Is it life threatening like cancer, or leukemia or something? Should I be worried? |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by JJA on Apr 20th, 2004, 8:40am Superpain, Of course I don't have any easy answers for you, but heres my take on it (I'm far from an expert in dermatology). It sounds like Lymphomatoid Papulosis isn't life threatening itself, but some people with it develop malignant lymphoma after many years. There's no evidence that the verapamil-induced case(s) have the same risks as spontaneous cases, especially since stopping the verap seems to make the condition disappear. I agree with Floridian. This is very rare (more rare than CH) so it is probably something more common. But still, it is worth getting checked out by a doctor. Let me know if you want a copy of the article to show the doc. -Jesse |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by notseinfeld on Apr 20th, 2004, 1:56pm As for virtually all skin conditions some moderate sun would be the best medicine. If you could join it with some salty water, a beach, and horseshoes over a one month span of time, you'd really be cooking! Seriously though, if you've got it get some sun on yer pale ass. Even those tanning booth UV's would help. |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by floridian on Apr 20th, 2004, 2:33pm Notseinfeld - Ya left out the BBQ! That's an important part of the salthingyer/horseshoe prescription. Then we'd really be cooking. |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by Anton on Apr 21st, 2004, 9:48am To put minds at rest, the article re LP refers to me ........ I was the guilty party! Although I am no medic, my father was an FIMLT, hence my interest in getting to the bottom of what I initially thought were insect bites, it was summer after all. Whilst taking the verapamil, those 'bites' came and went, but they irritated like mad. As time went on, it became obvious that they were not bites at all. Hence my search for a possible cause. Calcium channel blockers came up as a possible, of which verapamil is one. CH having ceased (for a while), I stopped verapamil AND the spots stopped appearing! Needless to say, the CH re-appeared and I was given the option to try different meds, but to prove my theory of the spot cause, I opted to restart verapamil. The spots re-appeared soon after, followed by a biopsy. The rest is in the article. Tony |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by Hamster on Apr 21st, 2004, 11:34am Good to see you over this side of the pond Tony, and many thanks for coming out of the closet, so to speak. Hope the lithium is working and all the best. Peter |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by floridian on Apr 21st, 2004, 11:34am Great first post and welcome, Tony. Keep us up to date on this issue. |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by JJA on Apr 21st, 2004, 12:31pm Yeah nice first post Tony. No need to give us background. We got it all written up for us. How's your head doing? |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by Anton on Apr 21st, 2004, 12:39pm Hi Peter, Not so sure about the 'closet' .......... more 'bi', i.e. bi-pond. It was through this list that I found Simon back in the early days. True, I am not here often ........ keep mislayng passwords etc!! Tony |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by pubgirl on Apr 21st, 2004, 1:00pm notseinfeld Good advice (There is sarcasm in my voice by the way) Anyone coming here with a possible skin condition. Don't bother getting the doctor to check it will you. Notseinfeld says use tanning booths and get skin cancer. >:( Give me strength and the control not to swear! Wendy |
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Title: Re: Fresh Research - CH & Lymphomatoid Papulos Post by broomhilda on Oct 12th, 2004, 1:29pm Bumping this so I can print article when I get home.... Thanks for all the info! ;;D |
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