title: Genetically determined susceptibility to COX-2 inhibitors: a report of exaggerated responders to diclofenac 3% gel in the treatment of actinic keratoses.
abstract: Diclofenac 3% gel is an effective treatment for actinic keratoses (AKs) and is reported to be generally well tolerated with only mild local reactions. However, there is a subset of patients that seem to be susceptible to developing severe local reactions following application of diclofenac 3% gel. Although some of these reactions can be explained as being allergic contact dermatitis and/or photoallergic contact dermatitis, others cannot. We report a series of 10 patients who all developed severe local reactions following application of diclofenac 3% gel, despite negative diclofenac patch testing. This raises the question as to whether there is a subset of patients with skin cancer or AK lesions that are highly/more susceptible to local reactions caused by cyclo-oxygenase-2 (COX-2) inhibitors and peroxisome proliferator-activated receptor (PPAR) agonists? We speculate that underlying molecular differences exist in these patients that make the skin more susceptible to COX-2 inhibitors.
authors.affiliation: Department of Dermatology, Charité, Skin Cancer Centre Charité, University Hospital of Berlin, Berlin, Germany.
authors.forename: M J
authors.initials: MJ
authors.lastname: Patel
authors.forename: C
authors.initials: C
authors.lastname: Ulrich
authors.forename: T
authors.initials: T
authors.lastname: Forschner
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D004008:Diclofenac / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D003875:Drug Eruptions / Q000235:genetics*; D005260:Female; D005782:Gels; D006801:Humans; D007642:Keratosis / Q000188:drug therapy* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D047492:Peroxisome Proliferator-Activated Receptors / Q000235:genetics*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D005782:Gels; D047492:Peroxisome Proliferator-Activated Receptors; D004008:Diclofenac