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. 2021 Mar;9(5):434. doi: 10.21037/atm-20-3719

Table 1. Environmental triggers of DM.

Herbal supplements
   Spirulina platensis (2-4)
   Aphanizomenon flos-aquae
   Chlorella
   Echinacea (2)
   Alfalfa (5)
Drugs
   Hydroxyurea (6-10)
   TNF-α inhibitors (6,11-18)
   PD-1 inhibitors (19-25)
   CTLA-4 inhibitors (19,26,27)
   Penicillamine (6,28-31)
   Hydroxymethylglutaryl Co-A reductase inhibitors (32,33)
   Lacosamide (34)
   Additional drugs: Phenylbutazone, Cyclophosphamide, Etoposide, Imatinib mesylate, Interferon-α2b, Omeprazole, Phenytoin, Tegaflur, Alfuzason, Etancercept, Gemfibrozil (6)
Vaccinations
   Smallpox, diptheria and tetanus, Bacillus-Calmette-Guerin (BCG), diptheria, inactivated polio, oral cold vaccine, influenza (35-45)
Infections
   Viral
    Parvovirus (46)
    Coxsackie B virus (47-49)
    Polyomavirus (50,51)
    Epstein-Barr virus (52,53)
    Hepatitis B and C virus (54-57)
    Human immunodeficiency virus (58)
   Bacterial
    Streptococcus pyogenes (59)
    Mycobacterium tuberculosis (60)
    Borrelia burgdorferi (61)
Ultraviolet radiation (62-70)
Environmental pollution
   Silica (71-73)
   Dust (biological, mineral, gases/fumes) (74)
   Particulate matter (vehicle/industrial emissions) (75-78)
   Cigarette smoking (79,80)
   Maternal exposure (associated with JDM): Chalk dust, gasoline vapor, maternal smoking, carbon monoxide (81)
Miscellaneous
   Seasonal variation (82-86)
   Pregnancy (87-93)
   Liquid silicone filler rhinoplasty (94)
   Silicone breast implants (95)