Alternative and nutritional therapies that don’t work, should be used with caution, or completely avoided in patients with Sweet’s syndrome

Reposted on 13/10/16, updated on 16/06/17.

Can alternative or nutritional therapies be used to treat or cure Sweet’s syndrome?

No. There is absolutely no medical evidence to show that Sweet’s syndrome can be successfully treated or cured with alternative or nutritional therapies. However, some of these therapies may be helpful in promoting overall psychological or physical good health and well-being.

Are you sure that alternative or nutritional therapies can’t be used to treat or cure Sweet’s syndrome, or is this simply a lie that ‘Big Pharma’ wants us to believe?

Yes. At present, the general consensus of the medical community is that there is no alternative or nutritional therapy that can be used to treat or cure Sweet’s syndrome. However, some people are being lied to, and told that there are natural and alternative cures for Sweet’s syndrome, but that ‘Big Pharma’ doesn’t want them to know about it.

Who or what is ‘Big Pharma’?

‘Big Pharma’ is a term that’s used to refer to the pharmaceutical industry. Some conspiracy theorists believe that doctors, the pharmaceutical industry and the government, are trying to keep us sick and prevent or discourage us from accessing alternative ‘miracle cures’. This is supposedly being done so that we’ll be forced to buy and use the medications that ‘Big Pharma’ produce and sell, which will continue to make them very rich. There is no evidence to support this theory, but it is not unusual for those selling bogus treatments to resort to the ‘Big Pharma’ conspiracy simply to try and back up their false claims. This is done to try and convince you that their treatments really do work, but that ‘Big Pharma’ never wants you to discover this secret truth, because it will negatively affect their profits. If someone does resort to the ‘Big Pharma’ conspiracy to back up their claims, then it’s a red flag and a strong indication that they probably can’t be trusted.

Are alternative and nutritional therapies always safe to use?

Alternative and nutritional therapies are sometimes safe to use, but not always. Some of these therapies are potentially harmful, or could make Sweet’s syndrome worse. Herbal supplements in particular, can cause lots of problems. One real concern is that they can interact with medications or reduce their effectiveness, and sometimes, any interactions that do occur can be dangerous. Before trying an alternative or nutritional therapy, please check with your doctor first.

Alternative and nutritional therapies that don’t work, should be used with caution, or completely avoided in patients with Sweet’s syndrome.

This is list of alternative and nutritional therapies that don’t work, should be used with caution, or completely avoided. Despite this fact, they are still being advocated or sold as treatments or cures for Sweet’s syndrome by alternative therapists, other individuals and businesses. These treatments include:

Acupuncture.

No evidence to show that acupuncture works, and should be used with caution. This is because the skin damage caused by the treatment, i.e. the skin being punctured by the needles, may trigger the development of new skin lesions, and this is referred to as pathergy. However, not all Sweet’s syndrome patients demonstrate pathergy. Read more here.

Baking soda (sodium bicarbonate).

Baking soda is being advocated as a treatment for Sweet’s syndrome, myelodysplastic syndromes and leukaemia, and other cancers – in 15-20% of patients, Sweet’s syndrome develops secondary to some form of cancer. This is an incredibly dangerous pseudoscientific claim, i.e. a false or made-up claim that appears to be scientifically-based, but is not. Anyone who makes such claims should not be believed, and treated with caution. Read more here.

Change of diet or elimination of dietary toxins.

There is no evidence to show that Sweet’s syndrome is caused by diet or dietary toxins, or that a change in diet can directly improve or cure it. Sweet’s syndrome is caused by errors in the innate immune system and involves factors such as hypersensitivity reaction, cytokine dysregulation and genetic susceptibility. Special diets, e.g. alkaline, anti-inflammatory, detox, gluten-free, Palaeolithic, dairy-free and vegan, are not treatments for Sweet’s syndrome, and could increase the risk of nutritional deficiency in some people.

If possible, try to avoid a dairy-free diet, particularly a vegan diet, if you have been taking systemic steroid medication for more than 3 months. This kind of diet may be lower in calcium, and if you are taking steroids, it is very important that you meet your daily calcium requirements (Clarys et al, 2014: 1319, 1321, 1324, 1327). This is because you will be at increased risk of developing steroid-induced osteoporosis.

You may also need to be careful about nutritional deficiency if you have other types of health condition, are pregnant, or on a low income. In regards to the latter, you might not have that much money to spend on food and may struggle to meet your nutritional needs as a result.

Chiropracty and osteopathy.

Sweet’s syndrome frequently causes joint pain (arthralgia) or joint pain and swelling (arthritis), and can sometimes develop secondary to autoimmune conditions that affect the joints, e.g. ankylosing spondylitis, rheumatoid arthritis, systemic lupus erythematosus, or Sjögren’s syndrome. However, there is no evidence to show that chiropracty or osteopathy can be used to treat or cure Sweet’s syndrome, and if the joints are painful and swollen, osteopathy and chiropracty should be avoided, at least, until the swelling has reduced and been brought under control (Baxter, 2017; NHS Choices, 2014; NHS Choices, 2015b). This is because joint manipulation could make symptoms worse.

In people with osteoporosis, or ankylosing spondylitis where the joints are fused, joint manipulation can lead to fracture (Baxter, 2017).

In those with rheumatoid arthritis who have upper neck instability, joint manipulation can be very dangerous due to the increased risk of spinal cord compression.

Physiotherapy, which is not the same as osteopathy or chiropracty, is completely safe.

EAV or bioenergetics.

EAV or bioenergetics are tests that involve using electrodiagnostic devices to supposedly determine the cause of a disease by detecting the ‘energy imbalance’ causing the problem, or even cure a condition by correcting this imbalance. These tests and treatments are a scam, and there is absolutely no medical evidence to show that they work. In the United States (US), the importation of EAV devices has been banned. If you are in the US and someone offers you, or refers you for EAV testing, please report them to the relevant authorities.

Essential oils.

No evidence to show that essential oils work, and should be used with caution when applied to the skin. This is because of potential skin irritation and pathergy response. Read more here.

Homeopathy.

Homeopathy is being advocated as a treatment for Sweet’s syndrome by some alternative therapists. This is a pseudoscientific claim, and there is no evidence to support this claim. In fact, in 2010, the House of Commons Science and Technology on Homeopathy, made it clear that homeopathic remedies perform no better than placebos, and that the principles on which homeopathy is based are ‘scientifically implausible’ (NHS Choices, 2015a). Please take this into consideration before choosing to try homeopathy. However, if you do choose to try it, then it is probably safe.

Probiotics.

There is no evidence to show that probiotics can be used to directly treat Sweet’s syndrome, but they are generally very safe to use. Research into probiotics is limited, but they can be useful in preventing antibiotic-associated diarrhoea, treating infectious diarrhoea, protecting premature babies from gut disease, irritable bowel syndrome, lactose intolerance, and pouchitis in people with the inflammatory bowel disease (IBD), ulcerative colitis (NHS Choices, 2016). Sometimes, Sweet’s syndrome can develop secondary to the IBDs, ulcerative colitis and Crohn’s disease, and if the IBD flares up, then the Sweet’s syndrome often will too. However, at present, there is a lack of evidence to prove conclusively that probiotics can be useful in the management of Crohn’s disease or ulcerative colitis without pouchitis.

Red root (blood root, bloodwort). 

Red root is being advocated as a treatment for Sweet’s syndrome by some alternative therapists in the US. There is no evidence to support this claim, and it should be avoided or used with caution as it may not always be safe to use. Red root is a debriding agent (removes skin tissue) which means it should never be applied to the skin lesions of patients with Sweet’s syndrome, as there is an increased likelihood that it will trigger the development of new lesions. It should also be completely avoided by those with certain health conditions or taking medication. Read more here.

Some other herbs and supplements to be used with caution.

There is no evidence to show that the following supplements can be used to treat Sweet’s syndrome. The algae chlorella is not suitable for those taking certain medications and could make the symptoms of autoimmune conditions, and possibly Sweet’s syndrome worse, particularly if the Sweet’s syndrome has developed secondary to an autoimmune condition. Alfalfa, astragalus, echinacea, and oral zinc should also be used with caution. Read more here.

Keep safe!

References.

Baxter, S. (2017) Healing with Chiropractic Medicine. Arthritis Foundation (online). Accessed 16/06/17.

Clarys, P., Deliens, T., Huybrechts, I., Deriemaeker, P., Vanaelst, B., De Keyzer, W., Hebbelinck, M. and Mullie, P. (2014) Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet. Nutrients, Mar 24;6(3):1318-32 (online).

NHS Choices (2014) Chiropractic (online). Reviewed 20/08/15, and accessed 30/03/17.

NHS Choices (2015a) Homeopathy (online). Reviewed 15/02/15, and accessed 30/03/17.

NHS Choices (2015b) Osteopathy (online). Reviewed 10/06/15, and accessed 30/03/17.

NHS Choices (2016) Probiotics (online). Reviewed on 28/01/16, and accessed 16/06/17.

Other information.

Arthritis Research UK (2017) Complementary and Alternative Medicines (online). Accessed 25/04/17.

Arthritis Research UK (2017) Diet and Nutritional Supplements (online). Accessed 25/04/17.

A warning about Polly Heil-Mealey! Sweet’s syndrome cannot be cured with herbs or homeopathic remedies.

Can vaccination trigger Sweet’s syndrome?

What is the treatment for Sweet’s syndrome?

Additional note.

Sweet’s Syndrome UK does not promote the use of alternative or nutritional therapies. This is because there is no medical evidence to show that these therapies are effective, or sometimes even safe to use in those with Sweet’s syndrome. If anyone does have information that proves that alternative or nutritional therapies can be used to treat Sweet’s syndrome, I will be more than happy to read it. However, only peer-reviewed medical articles and case-studies will be accepted as evidence. The following will not be accepted as evidence: anecdotal evidence and personal stories; testimonials; YouTube videos; information on blogs or websites where there are no references or links to peer-reviewed medical articles or case-studies, or where the author is not willing to provide this information; blogs or websites where someone tries to pass off their feelings or instincts, beliefs or opinions as facts or evidence.

Thank you,

Michelle Holder.

© 2012-2017 Sweet’s Syndrome UK

Two neutrophilic dermatoses captured simultaneously on histology (Sweet’s syndrome and neutrophilic eccrine hidradenitis)

Links checked on 2/03/17.

This is the second reported case of Sweet’s syndrome and neutrophilic eccrine hidradenitis occurring in a patient with acute myeloid leukaemia at the same time (Wlodek et al, 2016).

Key points.

  • Sweet’s syndrome (SS) is a rare autoinflammatory (not autoimmune) condition and form of neutrophilic dermatosis (ND), and in 15-20% of patients can be triggered by cancer, including blood cancers.
  • Other forms of ND include neutrophilic dermatosis of the dorsal hands, Behcet’s syndrome, pyoderma gangrenosum, neutrophilic eccrine hidradenitis (NEH), erythema elevatum diutinum, and bowel-associated dermatitis-arthritis syndrome.
  • ND are skin conditions that occur as a result of lots of white blood cells called neutrophils infiltrating the tissues.
  • A number of ND are associated with cancer and their treatment, but more than one kind of ND rarely occurs together in the same patient at the same time.

Case-study.

This is a case of a 72-year-old man who was being treated for acute myeloid leukaemia (AML) with chemotherapy – daunorubicin and cytarabine. Within 48 hours of starting treatment he developed a fever, and two days later, wide-spread non-tender pink plaques (skin lesions that appear in the form of large raised areas) on the limbs and trunk. A skin biopsy showed lots of white blood cells in the tissues – lymphocytes and histiocytoid cells, but mainly neutrophils. Neutrophils had also infiltrated the fatty tissue under the skin, and this is known as panniculitis. All of these finding were consistent with SS. In addition, neutrophils and lymphocytes were also present around the sweat glands, and this is consistent with NEH. NEH is commonly caused by chemotherapy, including cytarabine, but can sometimes occur for other reasons.

The authors of this study have determined that the neutrophilic infiltrate that is found in a patient with SS has the potential to extend around the sweat glands, thus leading to NEH.

References.

Wlodek, C., Bhatt, N. and Kennedy, C. (2016) Two neutrophilic dermatoses captured simultaneously on histology. Dermatology Practical & Conceptual, Jul; 6(3): 55–57 (online).

Other information.

Copaescu, A., Castilloux, J., Chababi-Atallah, M., Sinave, C. and Bertand, J. (2013) A Classic Clinical Case: Neutrophilic Eccrine Hidradenitis. Case Reports in Dermatology, Sep-Dec; 5(3): 340–346 (online).

Tan, E. (2007) Skin toxicity of chemotherapy drugs. DermNet NZ (online). Accessed 2/03/17.

© 2012-2017 Sweet’s Syndrome UK

Mouth Ulcers and Sweet’s Syndrome

Updated 31/03/17.

Does Sweet’s syndrome cause mouth ulcers?

Yes. Occasionally, Sweet’s syndrome can cause mouth/oral ulcers (aphthous-like ulcers), but this is a symptom that is more commonly associated with the similar condition, Behcet’s syndrome.

Can Sweet’s syndrome cause other mouth problems?

Yes. On rare occasions, Sweet’s syndrome can cause other mouth problems, and also affect the throat. Symptoms include:

  • Cracks or fissures on the corners of the mouth (Contrucci and Martin, 2015).
  • Lesions on the inside of the lips (haemorrhagic bullae and vesicles, and necrotic nodules) (Cohen, 2007).
  • Lesions on the gums (haemorrhagic bullae and vesicles).
  • Necrotizing ulcerative periodontitis.
  • Enlargement of the gums (gingival hyperplasia) (Ibid).
  • Lesions on the tongue (aphthous-like ulcers, ulcers, and macerated papules) (Cohen, 2007; Kasirye et al, 2011: 135) .
  • Tongue pain, and swollen or enlarged tongue in association with lesions (Cohen, 2007; Contrucci and Martin, 2015; Kasirye et al, 2011: 135).
  • Lesions on the roof of the mouth (macerated papules, individual and grouped pustules, ulcers, and bullae) (Cohen, 2007; Contrucci and Martin, 2015).
  • Lesions affecting the pharynx (individual and grouped pustules) (Cohen, 2007).
  • Lesions on the inside of the cheeks (aphthous-like ulcers, and ulcers).
  • Inflammation of the saliva glands in the cheeks (parotitis) and associated cheek swelling (Jo et al, 2012).
  • Throat pain, painful swallowing, and hoarseness (Contrucci and Martin, 2015).

Read more about the symptoms of Sweet’s syndrome here.

Can mouth ulcers be treated or managed?

Yes. Mouth ulcers can be treated or managed, and the UK charity, the Behcet’s Syndrome Society (BSS), has put together a patient-information-leaflet to show you how. The information in this leaflet has been written for those with Behcet’s syndrome, but is also relevant to those with Sweet’s syndrome.


Information taken from the Behcet’s Syndrome Society leaflet – Behcet’s Disease and Mouth Ulcers (Birmingham Centre of Excellence, 2013).

Treatment.

General good oral hygiene is important with Behcet’s disease (*and Sweet’s syndrome), even when the mouth or gums are painful. Rinsing with mouthwash alone will not remove the dental plaque and is no substitute for brushing the teeth and flossing.

Typical adult toothpastes include detergents such as sodium lauryl sulphate (SLS) and flavouring agents that can exacerbate pain associated with oral ulceration. Toothpastes without SLS or prepared specifically for the ‘sore mouth’ are available. An alternative option is to use a children’s toothpaste. Toothpastes used by adults should include 1450 ppm fluoride.

Before considering the options listed below, you should discuss topical solutions with your specialist or doctor. Some of the remedies listed below are not licensed specifically for use in Behcet’s disease (*doxycycline and colchicine are recognised treatments for Sweet’s syndrome) so will need consideration by your medical professional. Many are prescription-only and will require ongoing monitoring.

Relief of pain.

Topical analgesia for oral ulceration is available as mouthwash and spray (Difflam). The mouthwash potentially allows more parts of the mouth to be reached than the spray but is less portable. A normal dose would be to rinse or gargle with 15 ml of the mouthwash every 1–3 hours as needed and spit it out. The preparation contains 10% alcohol, which can cause stinging when used with a sore mouth. Dilution with an equal volume of water can help. For the spray preparation, 4–8 sprays should be directed onto the affected area every 1–3 hours as needed.

Relief of inflammation and reduction in ulceration.

Topical corticosteroids reduce inflammation and are the mainstay of topical treatment. All topical corticosteroid therapies are best applied as soon as the ulcer starts to develop and should be continued until the ulcer has completely disappeared. A wide range of topical corticosteroids may be considered and food and drink should be avoided for at least 30 minutes following application.

For the treatment of a single or low number of ulcers.

Mucoadhesive buccal tablets (previously known as Corlan pellets) can be placed on the ulcers and allowed to dissolve. This should be done up to four times daily. However, some patients may find the tablets difficult to position in the correct place.

Alternatively, an aerosol preparation such as a steroid inhaler used in the management of asthma or allergic rhinitis (e.g. hay fever) may be considered. The aerosol can be sprayed directly onto ulcers. Suitable inhalers are beclometasone metered-dose inhaler 50–100 micrograms sprayed twice daily onto the affected area or fluticasone propionate aqueous spray 50 micrograms, 2 puffs sprayed on to the ulcers three times daily.

For treating several ulcers.

Corticosteroid mouthwashes can be used where there is widespread development of crops of ulcers. Betamethasone soluble 500 microgram tablets are licensed for the management of oral ulcers. One tablet should be dissolved in 10–15 ml of warm water and then gargled ensuring affected parts of the mouth are covered for up to 4 minutes. The solution should not be swallowed. The mouthwash should be used up to three times a day. Alternatively, soluble prednisolone 5 mg tablets dissolved in 10–15 ml of warm water can be used up to three times a day.

Protective barriers.

Mucosal coating agents are used to physically cover ulcerated areas to reduce unpleasant symptoms associated with activities such as speaking, smiling swallowing or yawning.

Pastes.

Carmellose sodium (Orabase) can be used to protect the sore areas of the mouth. It should be applied sparingly directly onto the ulcer when required. Application can be difficult to the tongue and the back of the mouth.

Topical gels.

Gelclair is a viscous gel specifically formulated to aid the management of inflammation of the oral mucosa. The gel can be used as a mouthwash up to three times daily after dilution or applied directly to the affected site using a clean finger or swab such as a cotton bud. The mouthwash is prepared by diluting the contents of one sachet with 3 tablespoons of water. The solution is then rinsed around the mouth for 1 minute and provides a protective coat over the mucosa.

Anti-microbial agents.

Anti-microbial agents are used to control pain by reducing the secondary infection associated with mucosal ulceration.

Chlorhexidine mouthwash, gel or spray.

Chlorhexidine has a broad anti-microbial spectrum. Preparations are licensed for the management of aphthous ulcers.

For chlorhexidine 0.2% mouthwash, 10 ml of solution should be rinsed around the mouth for 1 minute twice daily and then spat out. Alternatively, an oral spray – Corsodyl (chlorhexidine 0.2%) – may be used with up to 12 applications of spray used twice daily. Chlorhexidine gel preparations can be applied directly to the ulcer or brushed on the teeth once or twice daily. Preparations available include Corsodyl gel (chlorhexidine 1%) and Curasept gel (chlorhexidine 5%).

A number of chlorhexidine preparations contain alcohol, which can irritate the oral mucosa. However, alcohol-free mouthwashes can be found, including Corsodyl, Curasept and Periogard. The Curasept gel formulation is also alcohol-free.

Doxycycline.

Doxycycline has antibacterial and anti-inflammatory properties and can be used when the use of chlorhexidine has failed. Its main value in treating mouth ulcers comes from its anti-inflammatory action. The contents of one doxycycline 100 mg capsule should be dissolved in 10–15 ml water. Again, the solution should be held in the mouth for up to 4 minutes, ensuring that the solution comes into contact with the affected parts of the mouth. This should be done at least four times a day for 3 days. The solution should not be swallowed, and food and drink should be avoided for 30 minutes after use of the preparation. Prolonged use should be avoided, as this can increase the risk of oral infections such as candidiasis (thrush).

Colchicine.

For recurrent oral ulceration that has failed to respond to topical treatments alone, oral colchicine may be prescribed by your doctor.

* Additional notes added to the text – Michelle Holder, Sweet’s Syndrome UK.


For patients in the United States with an autoinflammatory condition, including Sweet’s syndrome.

Information taken from the SAID Support blog – Mouth Ulcer Treatment and Prevention (Tousseau, 2013).

Prescription Magic Mouthwash.

Magic mouthwash (*not available in the UK) is a prescription mouthwash that you use to rinse and then spit. It primarily contains lidocaine, which numbs the mouth. There are different brands available that may also contain hydrocortisone to reduce inflammation, the antifungal medication nystatin, an antibiotic, and/or the antacid magnesium hydroxide to coat the mucus membranes inside the mouth.

Milk of Magnesia and Liquid Benadryl.

This is a liquid mouthwash you can make at home, but discuss this with your doctor before you begin using this treatment. Mix 1/2 teaspoon each of milk of magnesium and liquid Benadryl. Swish it in the mouth and then spit it out. Do not drink it. Some people mix it up, and squirt it into the mouth with an oral medicine syringe to coat the mouth, then spit it out.

Hydrogen Peroxide and Milk of Magnesia.

Dab a drop of hydrogen peroxide mixed with water directly on the ulcer with a cotton swab. The National Institutes of Health (NIH) recommends mixing one part hydrogen peroxide to one part water followed by a dab of Milk of Magnesia directly onto the sore. You can do this three to four times a day.

B Vitamins.

Folic acid and vitamin B12 deficiencies can cause mouth ulcers. A daily B vitamin supplement may help reduce or prevent mouth sores.

*Sweet’s syndrome-related mouth ulcers are not caused by vitamin deficiency, but a daily B vitamin may help to reduce your overall risk of developing non-Sweet’s syndrome-related mouth ulcers.

A Benzocaine Warning.

In 2011, the FDA released a warning that using products containing benzocaine could lead to methemoglobinemia, a rare blood disorder. Most of the cases reported were in children under that age of two who were treated with benzocaine gel products for teething pain. Adult cases have also been reported. The FDA recommends that benzocaine products not be used on children younger than two without medical supervision.

*In the UK, the National Institute for Health and Care Excellence (NICE) does not recommend the use of benzocaine or any other topical anaesthetic in children under the age of two, unless on the advice of a health professional or under medical supervision (CKS, 2014).

* Additional notes added to the text – Michelle Holder, Sweet’s Syndrome UK.


New research.

Anakinra.

Anakinra (Kineret) is a useful treatment in refractory (chronic or persistent, or difficult-to-treat) Sweet’s syndrome and other neutrophilic dermatosesand autoinflammation of unknown cause (Kluger et al, 2011: Simon et al, 2014). The results of a recent trial have also shown that anakinra at an optimal dose of 200mg daily is partially effective in the treatment of resistant oral and genital ulcers in Behcet’s syndrome (Grayson et al, 2017).


References.

Birmingham Centre of Excellence (2013) Behcet’s Disease and Mouth Ulcers. Behcet’s Syndrome Society (PDF).

CKS: Clinical Knowledge Summaries (2014) Teething – Topical Anaesthestics. NICE: National Institute for Health and Care Excellence (online).

Cohen, P. (2007) Extracutaneous Manifestations: Table 4. In Sweet’s syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis, Orphanet Journal of Rare Diseases (online).

Contrucci, R. and Martin, D. (2015) Sweet syndrome: A case report and review of the literature. ENT Journal, July;94(7):282-284 (online). Sign-up to the ENT Journal for free to access the full article.

Grayson, P. Yazici, Y., Merideth, M., Sen, H., Davis, M., Novakovich, E., Joyal, E., Goldbach-Mansky, R. and Sibley, C. (2017) Treatment of mucocutaneous manifestations in Behçet’s disease with anakinra: a pilot open-label study. Arthritis Research & Therapy, Mar 24;19(1):69 (online).

Jo, M., Lim, Y., Shin, H., Choe, J., Seul, J. and Jang T. (2012) A Case Report of Sweet’s Syndrome with Parotitis. Archives of Plastic Surgery, Jan;39(1):59-62 (online).

Kasirye, Y., Danhof, R., Epperla, N. and Garcia-Montilla, R. (2011) Sweet’s Syndrome: One Disease, Multiple Faces. Clinical Medicine & Research, Nov;9(3-4):134-136 (online).

Kluger, N., Gil-Bistes, D., Guillot, B. and Bessis, D. (2011) Efficacy of anti-interleukin-1 receptor antagonist anakinra (Kineret®) in a case of refractory Sweet’s syndrome. Dermatology (Basel, Switzerland), May;222(2):123-7 (PubMed).

Simon, A. et al (2014) Autoinflammation of Unknown Cause. AUTOINFLAMMATION.EU (online).

Tousseau, J. (2013) Mouth Ulcer Treatment and Prevention. SAID Support (online).

Other information.

Ngan, V. and Oakley, A. (2016) Aphthous Ulcers (online). Initially published in 2003, and updated by Professor A. Oakley, Jan 2016. Accessed 30/03/17.

© 2012-2017 Sweet’s Syndrome UK

Herbs and supplements that should be avoided or used with caution in Sweet’s syndrome

Reposted and updated 29/06/16.

Alternative therapists are recommending or using certain herbs and supplements to treat or cure Sweet’s syndrome, despite the fact that there is no medical evidence that any of these treatments work, and some may not be safe to use.

A list of some herbs and supplements that have been recommended or used by alternative therapists to treat Sweet’s syndrome.

Alfalfa – flowering plant.

There is no evidence to show that alfalfa is helpful in the treatment of Sweet’s syndrome. May not always to be safe to use.

Best avoided or used with caution if:

  • You have an autoimmune condition, particularly systemic lupus erythematosus (SLE), as it may increase the risk of a flare-up (see ‘Additional notes’). Also, be aware of the fact that alfalfa can sometimes cause symptoms that are similar to SLE.
  • You have an autoinflammatory condition such as Sweet’s syndrome, particularly if it has developed secondary to an autoimmune condition (see ‘Additional notes’).
  • You have diabetes as it may lower blood sugar levels.
  • You are taking medications that increase sensitivity to sunlight. For example, dapsone, and tetracycline antibiotics such as doxycycline and minocycline.

DO NOT use if:

  • You have a hormone sensitive condition, e.g. breast cancer or endometriosis, as alfalfa can make these conditions worse.
  • You have had a kidney transplant as it may lead to rejection.
  • You are taking any of these medications: immunosuppressants, e.g. prednisone (see ‘Additional notes), or warfarin, contraceptives, or oestrogens.

Astragalus – flowering plant.

There is no evidence to show that astragalus is helpful in the treatment of Sweet’s syndrome. May not always to be safe to use.

Best avoided or used with caution if:

  • You have an autoimmune condition.
  • You have an autoinflammatory condition, particularly if it has developed secondary to an autoimmune condition.

DO NOT use if:

  • You are taking these medications: immunosuppressants, or lithium.
  • You are pregnant or breast-feeding.

Chlorella – algae.

There is no evidence to show that chlorella is helpful in the treatment of Sweet’s syndrome. May not always to be safe to use. Read more here.


Echinacea – herbaceous flowering plant.

There is no evidence to show that echinacea is helpful in the treatment of Sweet’s syndrome. May not always to be safe to use.

Best avoided or used with caution if:

  • You have an autoimmune condition.
  • You have an autoinflammatory condition, particularly if it has developed secondary to an autoimmune condition.
  • You are taking the medication midazolam.
  • You drink caffeinated drinks. Echinacea decreases how quickly caffeine is broken down, and this leads to increased levels in the bloodstream.

DO NOT use if:

  • You are taking immunosuppressants .
  • You are taking any of these medications as echinacea can affect how they are broken down: clarithromycin, clozapine, cyclobenzaprine, cyclosporine, diltiazem, fluvoxamine, haloperidol, imipramine, indinavir, lovastatin, mexiletine, oestrogens, olanzapine, pentazocine, propranolol, tacrine, theophylline, triazolam, zileuton, zolmitriptan, and possibly others (check with your doctor).
  • You are prone to allergies, particularly if you have an allergy to ragweed pollen, chrysanthemums, marigolds, or daisies.
  • You are pregnant or breast-feeding.

Red root – herbaceous flowering plant.

There is no evidence to show that red root is helpful in the treatment of Sweet’s syndrome. May not always to be safe to use.

Dosage:

  • The appropriate dose of red root would depend on factors such as age, medication, and health conditions, but at this time, there is not enough medical evidence to determine an appropriate range of doses.

When taken by mouth, short-term side-effects include:

  • Nausea.
  • Vomiting.
  • Drowsiness, or grogginess.

Other short-term problems:

  • Skin contact with the fresh plant may cause a rash.
  • If it gets into your eyes it can cause irritation.

When taken by mouth and in high amounts (see ‘Dosage’), long-term side-effects include:

  • Increased risk of  developing white patches on the inside of the mouth if used as a toothpaste or a mouthwash.
  • Glaucoma.
  • Low blood pressure.
  • Shock.
  • Coma.

Red root is a debriding agent, i.e. removes skin tissue. DO NOT apply to the skin if:

  • You have Sweet’s syndrome, or any other condition that is associated with pathergy. This may trigger the development of skin lesions or make existing lesions worse.

Red root is an irritant. DO NOT use if:

  • You have any condition affecting the gastrointestinal tract, including an infection, inflammatory bowel disease, or an inflamed bowel caused by Sweet’s syndrome.

Also, DO NOT use if:

  • You have glaucoma.
  • Are pregnant or breastfeeding.
  • You are taking any medications. There is a lack of information relating to how red root may interact with medications, so it may not be safe to use. In fact, some of these interactions may be dangerous.

Zinc (oral) – a mineral.

There is no evidence to show that zinc is of any use in the treatment of Sweet’s syndrome. May not always to be safe to use.

Dosage:

  • Safest zinc dosage is 40mg daily or less.
  • Taking more than 100 mg of supplemental zinc daily or taking supplemental zinc for 10 or more years doubles the risk of developing prostate cancer.
  • Single doses of 10-30 grams (10,000-30,000 mg) of zinc can be fatal.

Best avoided or used with caution if:

  • You have diabetes as zinc may lower blood sugar levels.
  • You are pregnant or breastfeeding (high doses).

DO NOT use if:

  • You are taking tetracycline antibiotics. Zinc prevents them from being absorbed properly.
  • You are taking any of these medications: amiloride, cisplatin, penicillamine, quinolone antibiotics, e.g. ciprofloxacin.

Additional notes.

Why should some of the herbs and supplements listed above be avoided or used with caution in those with autoimmune or autoinflammatory conditions?

Autoimmune and autoinflammatory conditions are caused by an overactive and not an underactive immune system – an overactive adaptive immune system in autoimmune conditions and an overactive innate immune system in autoinflammatory conditions. Some herbs and supplements have been proven to ‘boost’ the immune system. This means that they can increase immune system activity or make it more active. In patients with autoimmune conditions, this has the potential to make their overactive immune systems even more overactive, making symptoms worse. Evidence is needed before we know if these same herbs and supplements can negatively affect autoinflammatory conditions such as Sweet’s syndrome, but as yet, no research has been conducted. However, it is important to remember that Sweet’s syndrome can develop secondary to autoimmune conditions, and if this is the case, when the autoimmune condition flares-up the Sweet’s syndrome often does too.

Why should some of the herbs and supplements listed above be avoided if you are taking immunosuppressants?

Immunosuppressants are medications that suppress or ‘dampen down’ the immune system to bring an overactive immune system under control and reduce levels of inflammation in the body. These medications include prednisone, azathioprine, cyclosporine, mycophenolate mofetil, and tacrolimus, but there are many others. Herbs and supplements that ‘boost’ the immune system prevent immunosuppressants from doing their job properly. This is because they increase immune system activity while the immunosuppressant is trying to suppress it.


Remember.

Just because something is ‘natural’ doesn’t mean that it’s safe or doesn’t have side-effects. There are plenty of herbs, plants and extracts that have side-effects, can cause allergic reaction, interact with medications, be poisonous, or even prove fatal.

Keep safe!


Further information.

A warning about Polly Heil-Mealey! Sweet’s syndrome cannot be cured with herbs or homeopathic remedies.

Baking soda is not a treatment for Sweet’s syndrome or myelodysplastic syndromes.

What is the treatment for Sweet’s syndrome?

© 2012-2017 Sweet’s Syndrome UK

What NOT to say to someone with Sweet’s syndrome!

Image: ‘You’ve got it backwards…’, someecards.

If  you know someone with Sweet’s syndrome (SS), please don’t say the following things to them. Unfortunately, they are things that people with SS hear all too often, and even though a few of them are well-meant, some are incredibly insulting.

What NOT to say to someone with Sweet’s syndrome!

1. ‘But you don’t look sick’ or ‘Are you faking it?’

The commonest symptom of SS is tender or painful skin lesions, but these are often covered up in some way, e.g. with make-up, by hair or clothing. Also, most of the symptoms of SS cannot be seen, but just because you can’t see them, doesn’t mean that someone with SS isn’t very sick or that they’re faking being ill.

2. ‘You should try this new diet or supplement. It can’t hurt to give it a try.’

SS is an autoinflammatory condition caused by errors in the innate system, and there is no special diet or supplement that can correct these errors. Sometimes, a change in diet or certain vitamins and supplements might help to improve overall health, but they are certainly not a replacement for proper medical treatment. Also, some diets and supplements can do more harm than good, and be very costly. For example, restrictive diets can lead to nutritional deficiency and health problems; certain supplements may not be safe to take or interact with medications; special diets and supplements can be something that many people with SS really can’t afford to buy, and their money could be better spent elsewhere.

3. ‘I’m too busy to get ill’ or ‘You need to keep busy and just get on with it!’

NEVER smugly say to someone with SS, ‘I’m too busy to get ill’. Being busy is not a protection against illness, and no matter how busy or in demand you are, illness can still affect you and stop you from doing the things that you want to do at any time. People with SS don’t choose to get ill, and even when they desperately want to just ‘get on with it!’, they can’t. Also, keeping busy isn’t going to make SS go away or lessen its impact, and doing too much can sometimes make symptoms worse.

 4. ‘I wish I had the luxury of being sick so that I could stay at home all day’.

Being sick is not a luxury, and most people with SS would give anything to be well again. They do not enjoy being ill (do you enjoy it?), and can get very frustrated and depressed because they can no longer work or do the things that they once did. In fact, many with long-term SS go through a grieving process where they mourn the loss of the person that they were and the life that they once had.

5. ‘If you learnt to cope better or didn’t get stressed then you wouldn’t be sick’.

As already mentioned, SS is caused by errors in the innate immune system, and at present, there is no evidence to show that it is directly caused by stress. Some people do find that their SS gets worse when they are stressed, but this might happen for a number of different reasons, including their steroid medication being reduced or stopped. However, in others, their condition flares-up when they are not feeling stressed at all. Also, it is ridiculous to expect those with SS to avoid stress completely. Living with SS can be very stressful in itself, and for all of us, stress is part of everyday life.

6. ‘Don’t give in’, ‘Stop complaining’ or ‘Why do you have to be so negative?’

People with SS are not giving in or being negative when they admit to having a bad day or struggling to cope with their condition. They have the right to have a bad day, just the same as anyone else. NO-ONE can be upbeat, positive and optimistic all of the time, and having a moan or rant or even a bit of a cry can sometimes be very healthy. It can help you to release your feelings and reduce emotional stress.

© 2012-2017 Sweet’s Syndrome UK

Can medication trigger Sweet’s syndrome?

Updated 05/06/17.

Can medication trigger Sweet’s syndrome?

Yes. In up to 5% of cases, Sweet’s syndrome is triggered by medication (Cohen, 2007). This is known as drug-induced Sweet’s syndrome.

How will you know if your Sweet’s syndrome has been triggered by medication?

In at least 95% of patients with Sweet’s syndrome, their condition is not triggered by medication. However, drug-induced Sweet’s syndrome should be considered if:

  • Your Sweet’s syndrome developed not long after a particular medication was started.
  • Your Sweet’s syndrome has continued to persist for many months or years, even after treatment.

What will happen if your doctor thinks you have drug-induced Sweet’s syndrome?

Unfortunately, there is no special test to tell you whether or not your Sweet’s syndrome is being triggered by medication. However, if it is suspected that your Sweet’s syndrome is drug-induced, your doctor will:

  • Stop the medication that is possibly causing your Sweet’s syndrome. Your Sweet’s syndrome should then start to settle down, but you may still need treatment.
  • Re-introduce the medication (rechallenge) to see if your Sweet’s syndrome flares-up again. Sometimes, your doctor will decide that this is not necessary.

Why does medication trigger Sweet’s syndrome in some people?

Drug-induced Sweet’s syndrome is sometimes a hypersensitivity reaction to medication, but it can happen for other reasons too, e.g. a treatment causing hormonal changes. Read more here.

Is hypersensitivity reaction exactly the same as allergic reaction?

No, not always. Allergic reaction is a type of hypersensitivity reaction, but not all hypersensitivity reactions are the same as allergic reaction.

What is hypersensitivity reaction in Sweet’s syndrome?

Sweet’s syndrome is caused by errors in the innate immune system  the body’s most primitive, ‘hard-wired’ immune system, and a part of the immune system that doesn’t produce antibodies. Because of these errors, in some people with Sweet’s syndrome, their innate immune system responds to antigens – mainly proteins or sugars on the surface of a cell or a non-living substance, that a part of your immune system called the adaptive immune system sees as a foreign invader and produces antibodies in response to – in a way that it shouldn’t, i.e. is hypersensitive and goes into overdrive, overreacting to the presence of infectious, inflammatory, drug, or tumour cell antigens (Bhat et al, 2015: 257; Kasirye et al, 2011: 135). This means that the presence of antigens associated with certain health conditions, medications and vaccinations can potentially trigger Sweet’s syndrome by stimulating the innate immune system to produce cytokines, which eventually leads to the activation of white blood cells called neutrophils (Gosheger et al, 2002: 70). The neutrophils migrate to skin tissues and sometimes other tissues, even though they shouldn’t, causing skin lesions or other symptoms of Sweet’s syndrome.

What is allergic reaction?

The most common type of allergy is an IgE-mediated allergy. This is an adverse reaction that the body has to a particular substance that is foreign to the body, e.g. a food, pollen, or pet hair, that does not normally cause harm. This substance is known as an allergen (a type of antigen). Allergic reaction occurs when the immune system mistakes an allergen for a foreign invader such as a bacteria or virus. The adaptive immune system then quickly produces allergen-specific immunoglobulin E (IgE) antibodies in response to this, in order to fight the allergen off. Chemicals such as histamine are also produced, with the overall immune response causing the symptoms of allergy.

What medications have been reported to have triggered Sweet’s syndrome?

Medications that have been reported to trigger Sweet’s syndrome include:

Analgesics (non-opioids).

  • Paracetamol (triggered a Sweet’s syndrome-like condition) (Culla et al, 2014).

Antibiotics.

  • Amoxicillin (possibly) (Volpe, 2016).
  • Clindamycin (Cruz-Velasquez et al, 2016).
  • Tetracycline.
  • Doxycycline (Ibid).
  • Minocycline (Cohen, 2007).
  • Nitrofurantoin.
  • Norfloxacin.
  • Ofloxacin.
  • Trimethoprim/sulfamethoxazole.
  • Quinupristin/dalfopristin (Ibid).
  • Piperacillin/tazobactam (Cruz- Velasquez et al, 2016).

Anti-epileptics.

  • Carbamazepine (Cohen, 2007).
  • Diazepam.

Anti-hypertensives.

  • Hydralazine (Cohen, 2007).

Anti-malarials.

  • Chloroquine (Cruz-Velasquez et al, 2016).

Anti-manic agents.

  • Lithium (Xenophontos et al, 2016).

Anti-neoplastics.

  • Bortezomib (Llamas-Velasco et al, 2015).
  • Decitabine (Kasirye et al, 2011: 134).
  • Imatinib mesylate (Cohen, 2007).
  • Ipilimumab (Gormley et al, 2014).
  • Lenalidomide (Cohen, 2007).
  • Obinutuzumab (triggered a Sweet’s syndrome-like condition) (Korman et al, 2016).

Anti-viral drugs.

  • Abacavir (Cohen, 2007).
  • Acyclovir (Cruz-Velasquez et al, 2016).
  • Interferon-α.

Colony stimulating factors.

  • Granulocyte-colony stimulating factor (G-CSF). This is the most common treatment to trigger Sweet’s syndrome (Cohen, 2007).
  • Granulocyte-macrophage-colony stimulating factor (GM-CSF).
  • Pegfilgrastim (Ibid).

Contraceptives.

  • Levonorgestrel/ethinyl estradiol (Triphasil) (Cohen, 2007).
  • Levonorgestrel-releasing intrauterine system (Mirena).

Diuretics.

  • Furosemide (Cohen, 2007).

Immunosuppressants.

  • Azathioprine (Salem et al, 2015). Sometimes, azathioprine-induced Sweet’s syndrome can be confused with azathioprine hypersensitivity syndrome (AHS) (Aleissa et al, 2017). This is a rare adverse reaction occurring a few days to weeks after azathioprine has been given. AHS can sometimes mimic Sweet’s syndrome, and an azathioprine rechallenge is not advised, as it may lead to a severe adverse reaction or even death.

Nonsteroidal anti-inflammatory drugs (NSAIDs).

  • Celecoxib (Cohen, 2007; Oh et al, 2016).
  • Rofecoxib (Cruz-Velasquez et al, 2016).
  • Diclofenac (Cohen, 2007; Gupta et al, 2015).
  • Flurbiprofen (Bodamyalızade and Özkayalar, 2017). Flurbiprofen-induced Sweet’s syndrome may be confused with flurbiprofen-induced hypersensitivity syndrome or erythema multiforme.

Platelet aggregation inhibitors.

  • Ticagrelor (Ikram and Veerappan, 2016).

Proton-pump inhibitors.

  • Esomeprazole (Cohen, 2015).
  • Omeprazole.

Psychotropics.

  • Clozapine (Cohen, 2007).
  • Amoxapine (Cruz-Velasquez et al, 2016).
  • Diazepam.
  • Lormetazepam (Ibid).

Retinoids.

  • All-trans retinoic acid (Cohen, 2007; Tam and Ingraffea, 2015).
  • 13-cis-retinoic acid (isotretinoin) (Cohen, 2007).

Sulfa drugs.

  • Sulfasalazine (Romdhane et al, 2016).

Thyroid drugs.

  • Propylthiouracil (Cruz-Velasquez et al, 2016).

Vaccinations.

  • Bacillus Calmette-Guerin (BCG or tuberculosis) (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases. One in 1986, occurring 15 days after vaccination, but the authors of the medical article that reported this did not control the tuberculin (Mantoux) test. One reported in 2002, occurring 10 days after vaccination.
  • Streptococcus pneumonia (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016; Pedrosa et al, 2013). Two cases. One reported in 1990, occurring 4 days after vaccination following a splenectomy. One reported in 2013, and the first with the 13-valent conjugate vaccine.
  • Smallpox (Carpentier et al, 2002: 82; Cruz-Velasquez et al, 2016). Two cases reported in 1975, occurring 3 days after vaccination.
  • Influenza (Cruz-Velasquez et al, 2016; Hali et al, 2010, Jovanovic et al, 2005; Tan el al, 2006; Wolf et al. 2009). Four cases. One reported in 2005; in 2006, one case of bullous Sweet’s syndrome following vaccination in a HIV-infected patient; in 2009, neutrophilic dermatosis of the hands occurring 12 hours after vaccination; in 2010, one case of Sweet’s syndrome after H1N1 influenza (swine fluvaccination.

Sweet’s syndrome triggered by vaccination is incredibly rare (only 10 cases reported in medical literature, globally, in the past 42 years), and a definite connection has not been established in all reported cases.

If someone tells you that Sweet’s syndrome is triggered by vaccines because they are toxic or contain dangerous chemicals, then they either have no understanding of Sweet’s syndrome and vaccination, are not telling you the truth or are trying to scare you, and will have no evidence to support their claims. Sweet’s syndrome triggered by vaccination occurs because of errors in the innate immune system, and this part of the immune system responding to antigens in the way that it shouldn’t. It is nothing to do with vaccines being toxic.

Xanthine oxidase inhibitors.

  • Allopurinol (Polimeni et al, 2015).

Other.

  • X-ray contrast agents (Cruz-Velasquez et al, 2016).

References.

Aleissa, M., Nicol, P., Godeau, M., Tournier, E., de Bellissen, F., Robic, M., Livideanu, C., Mazereeuw-Hautier, J. and Paul, C. (2017) Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine. Case Reports in Dermatology, Jan 19;9(1):6-11 (online).

Bhat, Y., Hassan, I., Sajad, P., Akhtar, S. and Sheikh, S. (2015) Sweet’s Syndrome: An Evidence-Based Report. Journal of the College of Physicians and Surgeons – Pakistan, Jul;25(7):525-7 (PubMed).

Bodamyalızade, P. and Özkayalar, H. (2017) Drug Induced Sweet’s Syndrome – Case Presentation. Romanian Journal of Clinical and Experimental Dermatology, Mar;1(4):38-40 (online).

Carpentier, O., Piette, F. and Delaporte, E. (2002) Sweet’s syndrome after BCG vaccination. Acta Dermato-Venereologica;82(3):221 (PubMed).

Cohen, P. (2015) Proton pump inhibitor-induced Sweet’s syndrome: report of acute febrile neutrophilic dermatosis in a woman with recurrent breast cancer. Dermatology Practical & Conceptual, April; 5(2):113–119 (online).

Cohen, P. (2007) Sweet’s syndrome – a comprehensive review of an acute febrile neutrophilic dermatosis (online).

Cruz-Velásquez, G., Pac Sha, J., Simal Gil, E. and Gazulla, J. (2016). Aseptic meningitis and anti-β2-glycoprotein 1 antibodies in Sweet syndrome. Neurologia (Barcelona, Spain), Jul 21 (online). Article in Spanish, use translate.

Culla, T., Amayuelas, R., Diez-Canseco, M., Fernandez-Figueras, M., Giralt, C. and Vazquez, M. (2014) Neutrophilic dermatosis (Sweet’s syndrome-like) induced by paracetamol. Clinical and Translational Allergy, Jul; 4(Suppl 3): P83 (online).

Gormley, R., Wanat, K., Elenitsas, R., Giles, J., McGettingan, S., Schucher, L. and Takeshita, J. (2014) Ipilimumab-associated Sweet syndrome in a melanoma patient. Journal of the American Academy of Dermatology, Nov;71(5):e211-3 (online).

Gosheger, G., Hillman, A., Ozaki, T., Buerger, H. and Winklemann, W. (2002) Sweet’s Syndrome Associated With Pigmented Villonodular Synovitis. Acta Orthopædica Belgica, Feb;68(1):68-71 (PubMed).

Gupta, S., Bajpai, M. and Uraiya, D. (2015) Diclofenac-induced sweet’s syndrome. Indian Journal of Dermatology;60:424 (online).

Hali, F., Sbai, M., Benchikhi, H., Ouakadi, A. and Zamiati, S. (2010) [Sweet’s syndrome after H1N1 influenza vaccination]. Annales de Dermatologie et de Venereologie,  Nov;137(11):740-1 (PubMed).

Ikram, S. and Veerappan, V. (2016) Ticagrelor-induced Sweet Syndrome: an unusual dermatologic complication after percutaneous coronary intervention. Cardiovascular Intervention and Therapeutics, May 4th (PubMed).

Jovanovic, M., Poljacki, M., Vujanovic, L. and Duran, V. (2005) Acute febrile neutrophilic dermatosis (Sweet’s syndrome) after influenza vaccination. Journal of the American Academy of Dermatology, Feb;52(2):367-9 (PubMed).

Kasirye, Y., Danhof, R., Epperla, N. and Garcia-Montilla, R. (2011) Sweet’s Syndrome: One Disease, Multiple Faces. Clinical Medicine & Research, Nov;9(3-4):134-136 (online).

Korman, S., Hastings, J. and Byrd, J. (2016) Sweet-Like Eruption Associated With Obinutuzumab Therapy for Chronic Lymphocytic Leukemia. JAMA Dermatology, Nov 23 (online).

Llamas-Velasco, M., Concha-Garcon, M., Fraga, J. and Arageus, M. (2015) Histiocytoid sweet syndrome related to bortezomib: A mimicker of cutaneous infiltration by myeloma. Indian Journal of Dermatology, Venereology and Leprology, May;81:305-6 (online).

Oh, E., Shin, J., Hong, J., Kim, J., Ro, Y. and Ko, J. (2016) Drug-induced bullous Sweet’s syndrome by celecoxib. The Journal of Dermatology, Apr 6 (PubMed).

Pedrosa, A., Morais, P., Nogueira, A., Pardal, J. and Azevedo, F. (2013) Sweet’s syndrome triggered by pneumococcal vaccination. Cutaneous and Ocular Toxicology, Sep;32(3):260-1 (PubMed).

Polimeni. G., Cardillo, R., Garaffo, E., Giardina, C., Macrì, R., Sirna, V.,  Guarneri, C. and Arcoraci, V. (2015) Allopurinol-induced Sweet’s syndrome. International Journal of Immunopathology and Pharmacology, Dec 18th (PubMed).

Romdhane, H., Mokni, S., Fathallah, N., Ghariani, N., Sriha, B. and Salem, B. (2016) Sulfasalazine-induced Sweet’s syndrome. Therapie, Jun;71(3):345-347 (PubMed).

Salem, C., Larif, S., Fathallah, N., Slim, R., Aounallah, A. and Hmouda, J. (2015) A rare case of azathioprine-induced Sweet’s syndrome in a patient with Crohn’s disease. Current Drug Safety, July (PubMed online).

Tam, C. and Ingraffea, A. (2015) Case Letter: Sweet Syndrome Presenting With an Unusual Morphology. Cutis, Aug;96(2):E9-E10 (online).

Tan, A., Tan. H., and Lim, P. (2006) Bullous Sweet’s syndrome following influenza vaccination in a HIV-infected patient. International Journal of Dermatology, Oct;45(10):1254-5 (PubMed). 

Volpe, M. (2016) Sweet Syndrome Associated with Upper Respiratory Infection and Amoxicillin Use. Cureus, Apr; 8(4): e568 (online).

Wolf, R., Barzilai, A. and Davidovici, B. (2009) Neutrophilic dermatosis of the hands after influenza vaccination. International Journal of Dermatology, Jan;48(1):66-8 (PubMed).

Xenophontos, E., Ioannou, A., Constantinides, T. and Papanicolaou. E. (2016) Sweet syndrome on a patient with autoimmune hepatitis on azathioprine and CMV infection. Oxford Medical Case Reports, Feb; (2): 24–27 (online).

Other information.

Cetin, G., Sayarlioglu, H., Erhan, C., Kahraman, H., Ciralik, H. and Sayarlioglu, M. (2014) A case of neutrophilic dermatosis who develop palpable purpura during the use of montelukast. European Journal of Dermatology,  Dec; 1(4): 170–171 (online).

Oakley, A. (2015) Erythema Multiforme. DermNet NZ (online). Updated by Dr. Delwyn Dyall-Smith, 2009. Further updated by Dr. Amanda Oakley, October 2015. Accessed 5/06/17.

Sánchez-Borges, M., Caballero-Fonseca, F., Capriles-Hulet, A. and González-Aveledo, L. (2010) Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs: An Update. Pharmaceuticals, Jan; 3(1): 10-18 (online).

© 2012-2017 Sweet’s Syndrome UK