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Albucker SJ, Conway J, Lipner SR. Nails in older adults. Ann Med 2024; 56:2336989. [PMID: 38738374 PMCID: PMC11095289 DOI: 10.1080/07853890.2024.2336989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 03/25/2024] [Indexed: 05/14/2024] Open
Abstract
As the world's population of adults greater than 60 years old continues to increase, it is important to manage nail disorders that may impact their daily lives. Nail disorders may have significant impact on quality of life due to decreased functionality, extreme pain, or social embarrassment. In this review, we discuss nail disorders affecting older patients, including physiologic, traumatic, drug-induced, infectious, environmental, inflammatory, and neoplastic conditions. Diagnosis of these conditions involves a detailed history, physical examination of all 20 nails, and depending on the condition, a nail clipping or biopsy and/or diagnostic imaging. Nails grow even more slowly in older adults compared to younger individuals, and therefore it is important for accurate diagnosis, and avoidance of inappropriate management and delay of treatment. Increased awareness of nail pathologies may help recognition and management of nail conditions in older adults.
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Affiliation(s)
- Samantha Jo Albucker
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jade Conway
- Department of Dermatology, NY Medical College, Valhalla, NY, USA
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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2
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Chighizola CB, Suardi I, Marino A, Gattinara M, Costi S, Cattaneo A, Gerosa M, Caporali R. Belimumab-induced periungual pyogenic granulomas: A case report. Lupus 2024:9612033241260180. [PMID: 38860334 DOI: 10.1177/09612033241260180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Pyogenic granuloma (PG) is a benign vascular neoformation, presenting as a painful red nodule on the skin, mucosa or nail apparatus. It is usually related to local complications such as bleedings and superinfections. The etiology of PG remains still unclear, and several triggers can lead to its formation. In case of multiple lesions, systemic conditions and drugs remain the main causes. Antineoplastic treatments, retinoids, antiretrovirals, hormones and anticonvulsants are frequently implicated in PG formation. In literature, PG has been rarely described in the course of biological treatment due to rheumatological disease. The present case report describes the development of polydactolous PGs in a 21-year-old woman with juvenile systemic lupus erythematosus (jSLE) during treatment with belimumab, a monoclonal antibody directed against BlyS. The clinical presentation, in particular the timing and the multiplicity of the lesions, and the improvement after belimumab discontinuation allowed us to consider PG as drug-induced. This case highlights the importance of considering PG as a potential complication of rheumatologic treatments.
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Affiliation(s)
- Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Ilaria Suardi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Achille Marino
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Maurizio Gattinara
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Stefania Costi
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Angelo Cattaneo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
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3
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Prudkin L, Cedirian S, Santamaria J, Jourdan E, Piraccini BM. Exposome Impact on Nail Health. Skin Appendage Disord 2024; 10:186-198. [PMID: 38835707 PMCID: PMC11147530 DOI: 10.1159/000536573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/25/2024] [Indexed: 06/06/2024] Open
Abstract
Background The nail unit is a complex system with various components, each serving distinct functions. The exposome, encompassing external and internal factors such as UV radiation, air pollution, dietary habits, and cosmetic product usage, substantially influences nail health and can lead to premature nail aging. Summary Internal and external exposomal factors can impact differently on nail health, inducing a variety of different clinical conditions. Effective therapeutic strategies exist, but a comprehensive understanding of how the exposome affects nails is lacking. This article aims to bridge this knowledge gap by exploring the relationship between the exposome and nail health, emphasizing it as a central focus of our analysis. Key Messages (1) The exposome, comprising various external and internal factors, may significantly influence nail health negatively, leading to premature nail aging. (2) Different nail conditions may arise due to the exposomal influence on nails. (3) Understanding the exposome's impact on nail health is crucial for developing solutions to mitigate negative effects and improve overall nail well-being.
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Affiliation(s)
| | - Stephano Cedirian
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Eric Jourdan
- Innovation and Development, ISDIN, Barcelona, Spain
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Nakabayashi A, Tsujii A, Kim D, Tamada T, Yoshimura M, Isoda K, Ohshima S. Ultrasound and magnetic resonance image findings in a patient with a subungual abscess: A case report. Clin Case Rep 2024; 12:e8593. [PMID: 38444921 PMCID: PMC10912096 DOI: 10.1002/ccr3.8593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/04/2023] [Accepted: 01/04/2024] [Indexed: 03/07/2024] Open
Abstract
Subungual abscesses are rare, and information about them through imaging findings is lacking. Carbon dioxide laser drainage and antibiotics are effective treatment strategies for subungual abscesses. We report a case of a 47-year-old male healthcare worker with a subungual abscess that improved after manual drainage alone. Ultrasound and magnetic resonance images showed a tumor (with blood flow) between the nail plate and distal phalanx. Culture tests revealed Staphylococcus aureus. The patient's symptoms resolved quickly and the nail returned to normal after 4 months. This is possibly the first report of a subungual abscess with ultrasound and magnetic resonance imaging findings.
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Affiliation(s)
- Akihiko Nakabayashi
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Atsuko Tsujii
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Dong‐seop Kim
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Tatsuya Tamada
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Maiko Yoshimura
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Kentaro Isoda
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
- Department of Clinical ResearchNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Shiro Ohshima
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
- Department of Clinical ResearchNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
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5
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Emvalomati A, Oflidou V, Papageorgiou C, Kemanetzi C, Giannouli M, Kalloniati E, Efthymiadis K, Koukoutzeli C, Timotheadou E, Trigoni A, Patsatsi A, Lazaridou E, Apalla Z, Trakatelli M. Narrative Review of Drug-Associated Nail Toxicities in Oncologic Patients. Dermatol Pract Concept 2023; 13:dpc.1301a64. [PMID: 36892360 PMCID: PMC9946059 DOI: 10.5826/dpc.1301a64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Nail toxicity represents one of the most common cutaneous adverse effects of both classic chemotherapeutic agents and new oncologic drugs, including targeted treatments and immunotherapy. OBJECTIVES We aimed to provide a comprehensive literature review of nail toxicities derived from conventional chemotherapeutic agents, targeted therapies (EGFR inhibitors, multikinase inhibitors, BRAF and MEK inhibitors) and immune checkpoint inhibitors (ICIs), including clinical presentation, implicated drugs and approaches for prevention and management. METHODS Retrieved literature from PubMed registry database was reviewed to include all articles published up to May 2021 relevant to the clinical presentation, diagnosis, incidence, prevention, and treatment of oncologic treatment-induced nail toxicity. The internet was searched for relevant studies. RESULTS A wide spectrum of nail toxicities is associated with both, conventional and newer anticancer agents. The frequency of nail involvement, especially with immunotherapy and new targeted agents remains unknown and patients with different cancer types receiving different regimens may develop the same nail disorder, whereas patients with the same type of cancer under the same chemotherapeutic treatment may develop different types of nail alterations. The underlying mechanisms of the varying individual susceptibility and the diverse nail responses to various anticancer treatments need further investigation. CONCLUSION Early recognition and treatment of nail toxicities can minimize their impact, allowing better adherence to conventional and newer oncologic treatments. Dermatologists, oncologists and other implicated physicians should be aware of these burdensome adverse effects in order to guide management and prevent impairment of patients' quality of life.
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Affiliation(s)
- Anastasia Emvalomati
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Valentina Oflidou
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Chryssoula Papageorgiou
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Christina Kemanetzi
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Maria Giannouli
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Evangelia Kalloniati
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Konstantinos Efthymiadis
- Department of Medical Oncology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Chrysanthi Koukoutzeli
- Department of Medical Oncology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Anastasia Trigoni
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Aikaterini Patsatsi
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Elizabeth Lazaridou
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Zoe Apalla
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | - Myrto Trakatelli
- Second Department of Dermatology, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece
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Abstract
Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings. Brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau's lines, onychomadesis and retronychia are common nail disorders seen in clinical practice. These conditions stem from infectious, inflammatory, neoplastic and traumatic aetiologies. Though each nail condition presents with its own distinct characteristics, the clinical findings may overlap between different conditions, resulting in misdiagnosis and treatment delays. Patients can present with nail plate changes (e.g. hyperkeratosis, onycholysis, pitting), discolouration, pain and inflammation. The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units. Dermoscopy, diagnostic imaging and histopathologic and mycological analyses may be necessary for diagnosis. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Nail disease management requires a targeted treatment approach. Treatments include topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important. This article serves to enhance familiarity of the most common nail disorders seen in clinical practice. It will highlight the key clinical manifestations, systematic approaches to diagnosis and treatment options for each nail condition to improve diagnosis and management of nail diseases, as well as patient outcomes.Key messagesNail disease is not only a cosmetic issue, as nail changes can indicate the presence of a serious underlying systemic disease, infection or malignancy.Nail pain and changes associated with NP are physically and emotionally distressing and may contribute to functional impairment and diminished quality of life.LM is a hallmark sign of subungual melanoma and this finding warrants further investigation to rule out malignancy.
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Affiliation(s)
- Debra K Lee
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine New York, NY, USA
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7
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Murillo J, Torres JR, Leal V. Subungual hematomas after mRNA Covid-19 vaccine administration. J Travel Med 2022; 29:6524079. [PMID: 35137161 PMCID: PMC8992200 DOI: 10.1093/jtm/taac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
Large bilateral subungual haemorrhages and hematomas were observed in an adult woman after receiving the second dose of a mRNA COVID-19 vaccine. Improvement was achieved after a course of prednisone. Unusual, rare cutaneous adverse effects are likely to be increasingly noticed as the accelerated massive worldwide COVID-19 vaccination campaign intensifies.
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Affiliation(s)
- Jorge Murillo
- South Florida Infectious Disease and Tropical Medicine Center, Miami, FL 33143, USA
| | - Jaime R Torres
- Tropical Medicine Institute, Infectious Diseases Section, Universidad Central de Venezuela, Caracas 1053, Venezuela
| | - Vanessa Leal
- South Florida Infectious Disease and Tropical Medicine Center, Miami, FL 33143, USA
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Abstract
Melanonychia has many causes and can involve one or several fingernails or toenails, and may occur at any age. Dermoscopy is used routinely in the evaluation of a pigmented nail. If pigmentation is caused by melanin produced by nail matrix, identify whether the pigmentation is caused by an activation or proliferation of nail melanocytes. When melanocytic proliferation is suspected, biopsy with histopathologic examination is the gold standard for diagnosis and is recommended when a longitudinal melanonychia occurs in an adult and is localized in a single digit, in the absence of local or systemic causes that may explain its onset.
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Affiliation(s)
- Aurora Alessandrini
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology Alma Mater Studiorum - Università di Bologna, Via Massarenti 1, Bologna 40138, Italy.
| | - Emi Dika
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology Alma Mater Studiorum - Università di Bologna, Via Massarenti 1, Bologna 40138, Italy
| | - Michela Starace
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology Alma Mater Studiorum - Università di Bologna, Via Massarenti 1, Bologna 40138, Italy
| | - Marco Adriano Chessa
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology Alma Mater Studiorum - Università di Bologna, Via Massarenti 1, Bologna 40138, Italy
| | - Bianca Maria Piraccini
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology Alma Mater Studiorum - Università di Bologna, Via Massarenti 1, Bologna 40138, Italy
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9
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Bellet JS. Pediatric Nail Disorders. Dermatol Clin 2021; 39:231-243. [PMID: 33745636 DOI: 10.1016/j.det.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Many pediatric nail findings are normal variants and are no cause for alarm. Others represent congenital abnormalities or genetic syndromes for which there is no cure. Still others are inflammatory or infectious entities that require treatment. Pediatric nail disorders are reviewed, along with management.
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Affiliation(s)
- Jane Sanders Bellet
- Duke University School of Medicine, 5324 McFarland Drive, Suite 410, Durham, NC 27707, USA.
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10
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Lacouture ME, Sibaud V, Gerber PA, van den Hurk C, Fernández-Peñas P, Santini D, Jahn F, Jordan K. Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines ☆. Ann Oncol 2021; 32:157-170. [PMID: 33248228 DOI: 10.1016/j.annonc.2020.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - V Sibaud
- Department of Oncodermatology, Claudius Regaud Institute, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - P A Gerber
- Department of Dermatology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - C van den Hurk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - P Fernández-Peñas
- Department of Dermatology, The University of Sydney, Westmead Hospital, Sydney, Australia
| | - D Santini
- Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy; Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - F Jahn
- Department of Internal Medicine IV, Hematology, Oncology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
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11
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Durão C, Pedrosa F, Dinis-Oliveira RJ. Greenish-blue discoloration of the brain and heart after treatment with methylene blue. Forensic Sci Med Pathol 2020; 17:148-151. [PMID: 32940886 DOI: 10.1007/s12024-020-00316-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
Greenish-blue discoloration of the brain and heart was observed during the autopsy of a 63-year-old woman who had been treated with methylene blue for septic shock following a traffic accident. This "pistachio" or "avatar" discoloration occurs when the colorless metabolite leucomethylene blue is oxidized to methylene blue upon exposure to atmospheric oxygen. Other clinically documented adverse effects of methylene blue include greenish-blue urine and bluish discoloration of the skin and mucosa. In medicine, methylene blue is an inhibitor of nitric oxide synthase and guanylate cyclase with different clinical applications, namely, rapid reversal of circulatory shock that is refractory to fluid administration, inotropic agents, and vasoconstrictors. Postmortem differential diagnosis with putrefaction and hydrogen sulfide poisoning should be made, and forensic pathologists should be aware of methylene blue-related greenish-blue discoloration to avoid unnecessary workup and investigations.
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Affiliation(s)
- Carlos Durão
- Portuguese National Institute of Legal Medicine and Forensic Sciences, Lisbon, Portugal.,Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Frederico Pedrosa
- Portuguese National Institute of Legal Medicine and Forensic Sciences, Lisbon, Portugal
| | - Ricardo Jorge Dinis-Oliveira
- Department of Sciences, IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116, Gandra, Portugal. .,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal. .,UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
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12
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Kaul S, Kaffenberger BH, Choi JN, Kwatra SG. Cutaneous Adverse Reactions of Anticancer Agents. Dermatol Clin 2019; 37:555-568. [DOI: 10.1016/j.det.2019.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Alessandrini A, Starace M, Cerè G, Brandi N, Piraccini BM. Management and Outcome of Taxane-Induced Nail Side Effects: Experience of 79 Patients from a Single Centre. Skin Appendage Disord 2019; 5:276-282. [PMID: 31559250 DOI: 10.1159/000497824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/09/2019] [Indexed: 12/29/2022] Open
Abstract
Background Nail changes are a common side effect of taxane chemotherapy, although their correct management is poorly standardized. Objective To evaluate incidence, clinical aspects, and response to treatment of taxane-induced nail side effects in patients treated with taxanes for malignancies. Patients and Methods We performed a retrospective clinical study of 79 patients with taxane-induced nail changes from January 2015 to July 2018. Results Paclitaxel was the most responsible drug and both hands and feet were often affected (46.8%). Grade 2 nail toxicity was seen in 63.3% of the patients, including painful subungual hematoma, hemorrhagic onycholysis, and paronychia. Grade 3 nail toxicity was seen only in 2.5% of the patients, including hemorrhagic onycholysis and pyogenic granuloma. Removal of the detached nail plate with application of topical antibiotics and steroids induced regression of symptoms within 2 weeks. Conclusions Nail toxicity develops mostly at the end of therapy, and total drug dosage is the only known factor that predisposes to these side effects. Trauma possibly plays a role as the most severe signs are located on the great toenails. Although it is impossible to prevent taxane-induced nail side effects, a careful patient monitoring permits to immediately recognize and manage the symptoms in order to induce their remission and improvement of the patient's quality of life.
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Affiliation(s)
- Aurora Alessandrini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michela Starace
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giulia Cerè
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Nicolò Brandi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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14
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Capriotti KD, Anadkat M, Choi J, Kaffenberger B, McLellan B, Barone S, Kukoyi O, Goldfarb S, Lacouture M. A randomized phase 2 trial of the efficacy and safety of a novel topical povidone-iodine formulation for Cancer therapy-associated Paronychia. Invest New Drugs 2019; 37:1247-1256. [PMID: 31240513 DOI: 10.1007/s10637-019-00825-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/19/2019] [Indexed: 12/26/2022]
Abstract
Purpose Cancer therapy-associated paronychia (CAP) is a frequent adverse event associated with cytotoxic and targeted therapies that may impact dosing of anticancer therapies and patient quality of life (QoL). There are currently no evidence-based management strategies or approved treatments for CAP. Materials and Methods This was a prospective, multicenter, randomized, double-blind, vehicle-controlled phase 2 study that evaluated the efficacy and safety of 6 to 8 weeks of 1% or 2% povidone-iodine (PVP-I) topical solution versus vehicle-control in adult patients with CAP. Patients were randomized to one of three treatment arms administered twice daily: 1% PVP-I (Cohort A), 2% PVP-I (Cohort B), or vehicle-control (Cohort C). The primary endpoint was a two-grade reduction (or reduction to grade 0 if involved nails were grade 1) on the six-point Paronychia Severity Grading (PSG) scale. Secondary endpoints included safety and the effect on QoL and microbiota. Results A total of 102 patients with cancer were randomized to the study. In Cohort A, 83 of 205 (40.5%, P = 0.6059) affected nails met the primary endpoint versus Cohort C. In Cohort B, 88 of 167 (52.7%, P = 0.0063) affected nails met the primary endpoint versus 64 of 169 (37.9%) in Cohort C. Nineteen of 29 patients (65.5%) in Cohort B reported moderately or very painful nails at baseline that decreased to 15 patients (51.7%) at visit 2 and five patients (17.2%) at visit 3. Conclusions Treatment with twice-daily topical 2% PVP-I was safe and resulted in improvement in CAP compared with control. Clinicaltrials.gov identifier: NCT03207906. https://clinicaltrials.gov/ct2/show/NCT03207906.
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Affiliation(s)
- Kara D Capriotti
- Veloce BioPharma LLC, Fort Lauderdale, FL, USA. .,Bryn Mawr Skin and Cancer Institute, 919 Conestoga Road, Building 2, Suite 106, Rosemont, PA, 19010, USA.
| | - Milan Anadkat
- Department of Medicine, Division of Dermatology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jennifer Choi
- Department of Dermatology, Ohio State University Dermatology, Columbus, OH, USA
| | - Benjamin Kaffenberger
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Beth McLellan
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Oluwaseun Kukoyi
- Department of Medicine, Dermatology Service, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shari Goldfarb
- Department of Medicine, Dermatology Service, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario Lacouture
- Department of Medicine, Dermatology Service, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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McCarthy S, Bourke J. Image Gallery: Minocycline‐induced photo‐onycholysis with pigmentation. Br J Dermatol 2019; 180:e102. [DOI: 10.1111/bjd.17417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S. McCarthy
- Department of Dermatology South Infirmary Victoria University Hospital Cork Ireland
| | - J.F. Bourke
- Department of Dermatology South Infirmary Victoria University Hospital Cork Ireland
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16
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Abstract
Abstract
Melanonychia refers to a brown or black coloration of the nail plate caused by numerous factors. Regarding the arrangement of pigmentation, we can differentiate between total melanonychia, when pigmentation involves the whole nail plate, or transverse or longitudinal melanonychia, when pigmentation involves the nail in a form of transverse or longitudinal band of pigmentation, respectively. Since longitudinal melanonychia can be a sign of numerous benign and malignant lesions, it often poses a diagnostic challenge for a dermatologist. Herein, we report a case of a 13-year-old girl who developed longitudinal melanonychia on multiple nails after receiving a therapy with azithromycin.
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17
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A Practical Guide to Curing Onychomycosis: How to Maximize Cure at the Patient, Organism, Treatment, and Environmental Level. Am J Clin Dermatol 2019; 20:123-133. [PMID: 30456537 DOI: 10.1007/s40257-018-0403-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Onychomycosis is a fungal nail infection caused by dermatophytes, non-dermatophyte molds, and yeasts. Treatment of this infection can be difficult, with relapse likely to occur within 2.5 years of cure. The objective of this article is to review factors that can impact cure and to suggest practical techniques that physicians can use to maximize cure rates. Co-morbidities, as well as disease severity and duration, are among the many patient factors that could influence the efficacy of antifungal therapies. Furthermore, organism, treatment, and environmental factors that may hinder cure include point mutations, biofilms, affinity for non-target enzymes, and exposure to fungal reservoirs. To address patient-related factors, physicians are encouraged to conduct confirmatory testing and treat co-morbidities such as tinea pedis early and completely. To combat organism-focused factors, it is recommended that disruption of biofilms is considered, and drugs with multiple routes of delivery and unique mechanisms of action are prescribed when traditional agents are not effective. Extending follow-up periods, using combination treatments, and considering pulse regimens may also be of benefit. Through these practical techniques, physicians can maximize cure and limit the risk of relapse and re-infection.
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18
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19
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Damiani G, Manganoni A, Cazzaniga S, Naldi L. Survey of cutaneous adverse reactions to targeted cancer therapies: value of dermatological advice. GIORN ITAL DERMAT V 2018; 155:658-661. [PMID: 29756421 DOI: 10.23736/s0392-0488.18.06033-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Target-therapy offers a better efficacy for several cancers, with less toxic adverse effects, if compared with traditional chemotherapy. However cutaneous complications are increased in number and complexity. The severity of these reactions positively correlates with efficacy, and the management of these reactions is challenging. METHODS This was a multicenter cross-sectional study on a consecutive series of adult patients with incident cutaneous reactions linked to targeted cancer therapies observed in five referral centers for cancer treatment in the province of Bergamo and Brescia in northern Italy. Each center was asked to collect data on the first 5 consecutive cases of severe adverse cutaneous events observed during a one-week surveillance period. RESULTS From June to October 2012, 25 patients with cutaneous adverse reactions linked to targeted therapies were included in the study. The main prescribed drugs were cetuximab (52%) and erlotinib (20%) and the most common reactions were folliculitis/pustules (40%) and rash/erythema (40%). Hand-foot reaction syndrome was present in 8% of patients. A total of 30% of patients treated for a cutaneous reaction underwent a consultation by a dermatologist. In these patients the rate of oncologic therapy continuation without regimen modifications was higher (100%), while it was progressively lower in patients treated by oncologists (71%) or without any specific treatment (60%). CONCLUSIONS Adverse reaction should be recognized by both dermatologists and oncologists and a multidisciplinary approach is mandatory.
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Affiliation(s)
- Giovanni Damiani
- Young Dermatologists Italian Network (YDIN), Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy - .,Unit of Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopedic Institute, University of Milan, Milan, Italy - .,Unit of Dermatology, ASST Spedali Civili of Brescia, Brescia, Italy -
| | | | - Simone Cazzaniga
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Inselspital University Hospital, Bern, Switzerland
| | - Luigi Naldi
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, AULSS8, San Bortolo Hospital, Vicenza, Italy
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20
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Thomas R, Williams M, Cauchi M, Berkovitz S, Smith SA. A double-blind, randomised trial of a polyphenolic-rich nail bed balm for chemotherapy-induced onycholysis: the UK polybalm study. Breast Cancer Res Treat 2018; 171:103-110. [DOI: 10.1007/s10549-018-4788-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
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21
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Hiperpigmentación de la mucosa oral y discromía ungueal inducida por cloroquina. ACTA ACUST UNITED AC 2018; 14:177-178. [DOI: 10.1016/j.reuma.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 11/19/2022]
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22
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Masatkar V, Nagure A, Gupta LK. Unusual and Interesting Adverse Cutaneous Drug Reactions. Indian J Dermatol 2018; 63:107-116. [PMID: 29692451 PMCID: PMC5903039 DOI: 10.4103/ijd.ijd_584_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Any drug can cause any rash! Cutaneous adverse drug reactions (CADRs) are great mimickers and can be included in the differential diagnosis of any inflammatory dermatoses. Several drugs can cause rash of similar morphology and the same drug can cause rash of different morphology. While some common and specific drug reaction patterns are recognized easily by the clinicians, many a times unusual and interesting patterns can be induced by drug(s), thus leading to erroneous diagnosis and mistreatment. This review aims to familiarize clinicians with some rare, yet interesting patterns of CADR.
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Affiliation(s)
- Vaishali Masatkar
- Department of Dermatology, Ananta Institute of Medical Sciences and Research Centre, Rajsamand, India
| | - Ashok Nagure
- Department of Dermatology, Bidar Institute of Medical Sciences, Bidar, Karnataka, India
| | - Lalit Kumar Gupta
- Department of Dermatology, RNT Medical College, Udaipur, Rajasthan, India
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23
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Paurobally D, Andre J, Richert B. Nail Pyogenic Granuloma following Treatment with Blinatumomab. Skin Appendage Disord 2018; 4:96-97. [PMID: 29765967 DOI: 10.1159/000479575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/17/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Josette Andre
- Department of Dermatology, Brugmann - St Pierre and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Bertrand Richert
- Department of Dermatology, Brugmann - St Pierre and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
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24
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Wollina U, Nenoff P, Haroske G, Haenssle HA. The Diagnosis and Treatment of Nail Disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:509-18. [PMID: 27545710 DOI: 10.3238/arztebl.2016.0509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nail disorders can arise at any age. About half of all nail disorders are of infectious origin, 15% are due to inflammatory or metabolic conditions, and 5% are due to malignancies and pigment disturbances. The differential diagnosis of nail disorders is often an area of uncertainty. METHODS This review is based on publications and guidelines retrieved by a selective search in PubMed, including Cochrane reviews, meta-analyses, and AWMF guidelines. RESULTS Nail disorders are a common reason for derma - tologic consultation. They are assessed by clinical inspection, dermatoscopy, diagnostic imaging, microbiological (including mycological) testing, and histopathological examination. Some 10% of the overall population suffers from onychomycosis, with a point prevalence of around 15%. Bacterial infections of the nails are rarer than fungal colonization. High-risk groups for nail disorders include diabetics, dialysis patients, transplant recipients, and cancer patients. Malignant tumors of the nails are often not correctly diagnosed at first. For subungual melanoma, the mean time from the initial symptom to the correct diagnosis is approximately 2 years; this delay is partly responsible for the low 10-year survival rate of only 43%. CONCLUSION Evaluation of the nail organ is an important diagnostic instrument. Aside from onychomycosis, which is a common nail disorder, important differential diagnoses such as malignant diseases, drug side effects, and bacterial infections must be considered.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Dresden-Friedrichstadt Hospital, Academic Teaching Hospital of the Technical University of Dresden, Laboratory for Medical Microbiology, Mölbis, Georg Schmorl Institute of Pathology, Dresden-Friedrichstadt Hospital, Academic Teaching Hospital of the Technical University of Dresden, Department of Dermatology, Heidelberg University Hospital
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25
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Criado PR, Cosenza FD, Junior WB, Ferreira PS. Longitudinal melanonychia due to voriconazole therapy during treatment of chromoblastomycosis. Clin Exp Dermatol 2017; 43:75-76. [DOI: 10.1111/ced.13279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- P. R. Criado
- Department of Dermatology, Division of Dermatology of Hospital das Clínicas; São Paulo University, School of Medicine; Sao Paulo Brazil
| | - F. D. Cosenza
- Department of Dermatology, Division of Dermatology of Hospital das Clínicas; São Paulo University, School of Medicine; Sao Paulo Brazil
| | - W. B. Junior
- Department of Dermatology, Division of Dermatology of Hospital das Clínicas; São Paulo University, School of Medicine; Sao Paulo Brazil
| | - P. S. Ferreira
- Department of Dermatology, Division of Dermatology of Hospital das Clínicas; São Paulo University, School of Medicine; Sao Paulo Brazil
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26
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Capriotti K, Capriotti J, Pelletier J, Stewart K. Chemotherapy-associated paronychia treated with 2% povidone-iodine: a series of cases. Cancer Manag Res 2017; 9:225-228. [PMID: 28721095 PMCID: PMC5500570 DOI: 10.2147/cmar.s139301] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Nail changes are known to occur during the use of chemotherapy for a variety of malignancies, particularly those treated with taxanes and EGFR inhibitors. There are currently no actively recruiting prospective clinical trials investigating potential treatments. There are also no US Food and Drug Administration-approved medical treatments for chemotherapy-associated paronychia and no consensus on the best way to treat these common chemotherapy-induced events. Methods A retrospective review of all cases presenting to a single dermatology private practice from June 2016 to January 2017 identified nine patients with chemotherapy-associated paronychia seeking treatment. Each patient was prescribed a topical solution comprised of 2% povidone–iodine in a dimethylsulfoxide vehicle that was prepared by a licensed compounding pharmacy. Patients were seen at 3 week and 6 week follow-up visits. Results All 9/9 patients demonstrated complete or partial resolution. The number of nails involved for each patient ranged from 4–12. There were a total of 58 nails affected in the case series, and 44/58 (76%) resolved overall. The treatment was well tolerated. Conclusion The topical povidone–iodine/dimethylsufoxide solution described is very effective in alleviating the signs and symptoms of paronychia associated with chemotherapy. This novel combination warrants further investigation in randomized, controlled trials to further elucidate its clinical utility.
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Affiliation(s)
- Kara Capriotti
- Veloce BioPharma LLC, Fort Lauderdale, FL.,Bryn Mawr Skin and Cancer Institute, Rosemont, PA
| | - Joseph Capriotti
- Veloce BioPharma LLC, Fort Lauderdale, FL.,Plessen Ophthalmology Consultants, Christiansted, VI, USA
| | - Jesse Pelletier
- Veloce BioPharma LLC, Fort Lauderdale, FL.,Plessen Ophthalmology Consultants, Christiansted, VI, USA
| | - Kevin Stewart
- Veloce BioPharma LLC, Fort Lauderdale, FL.,Plessen Ophthalmology Consultants, Christiansted, VI, USA
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27
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Gupta AK, Versteeg SG, Shear NH. Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment. J Cutan Med Surg 2017. [PMID: 28639462 DOI: 10.1177/1203475417716362] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. Diabetes, human immunodeficiency virus, immunosuppression, obesity, smoking, and advancing age are predisposing factors of this fungal infection. Potassium hydroxide and culture are considered the current standard for diagnosing onychomycosis, revealing both fungal viability and species identification. Other diagnostic tests currently available include periodic acid-Schiff staining, polymerase chain reaction techniques, and fluorescent staining. Across 6 recently published epidemiology studies, the global prevalence of onychomycosis was estimated to be 5.5%, falling within the range of previously reported estimates (2%-8%). Newly approved onychomycosis treatments include efinaconazole, tavaborole, and laser therapy with lasers only approved to temporarily increase the amount of clear nail. Additional onychomycosis treatments being investigated include iontophoresis and photodynamic therapy with small open-label studies reported thus far. Preventative strategies, to help decrease recurrence and reinfection rates, include sanitisation of footwear and prophylactic topical antifungal agents.
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Affiliation(s)
- Aditya K Gupta
- 1 Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.,2 Mediprobe Research, Inc, London, Ontario, Canada
| | | | - Neil H Shear
- 3 Department of Medicine (Dermatology, Clinical Pharmacology and Toxicology) and Department of Pharmacology, Sunnybrook and Women's College Health Science Centre and the University of Toronto, Toronto, Ontario, Canada
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28
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Hair and Nail Manifestations of Systemic Disease. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Pugliese SB, Neal JW, Kwong BY. Management of Dermatologic Complications of Lung Cancer Therapies. Curr Treat Options Oncol 2016; 16:50. [PMID: 26338208 DOI: 10.1007/s11864-015-0368-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OPINION STATEMENT In recent years, oncogene-directed targeted agents and immunotherapies have expanded the treatment armamentarium for advanced lung cancer and, in particular, non-small cell lung cancer (NSCLC). Along with extended survival, these agents are accompanied by a host of cutaneous complications that affect the skin, hair, and nails. These skin complications range from the well-characterized papulopustular (acneiform) eruption of the epidermal growth factor receptor (EGFR) inhibitors to the emerging characterization of lichenoid skin eruptions seen during treatment with antibodies targeting the programmed cell death protein 1 (PD-1) and programmed cell death protein 1 ligand (PD-L1). When promptly recognized and accurately diagnosed, most cutaneous adverse events can be managed with supportive treatments, avoiding the need to interrupt antitumor therapy. Furthermore, preemptive management of skin problems can lead to significantly decreased severity of many cutaneous complications of these therapies. We encourage close collaboration between dermatologists and oncologists to better characterize cutaneous toxicity, select appropriate management, and avoid unnecessary dose reduction or discontinuation while simultaneously improving patient quality of life.
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30
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Abstract
Adverse drug reactions (ADRs) are a common cause of dermatologic consultation, involving 2 to 3 per 100 medical inpatients in the United States. Female patients are 1.3 to 1.5 times more likely to develop ADRs, except in children less than 3 years of age, among whom boys are more often affected. Certain drugs are more frequent causes, including aminopenicillins, trimethoprim-sulfamethoxazole, and nonsteroidal antiinflammatory drugs. Chemotherapeutic agents commonly cause adverse reactions to the skin and nails, with certain agents causing particular patterns of reactions. ADRs can involve any area of the skin; the appendages, including hair and nails; as well as mucosa.
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31
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Comparaison de différents vernis à ongles en matière d’efficacité photoprotectrice. Étude de l’intérêt de leur recours en soins de support en oncologie. Bull Cancer 2016; 103:612-21. [DOI: 10.1016/j.bulcan.2016.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 11/19/2022]
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32
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Yorulmaz A, Dogan M, Artuz F, Zengin N. Comparison of pigmentary side effects of taxanes and anthracyclines: an onychoscopic evaluation. Cutan Ocul Toxicol 2016; 36:135-139. [DOI: 10.3109/15569527.2016.1173698] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Mutlu Dogan
- Department of Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | | | - Nurullah Zengin
- Department of Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
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33
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Beau lines, onychomadesis, and retronychia: A unifying hypothesis. J Am Acad Dermatol 2015; 73:849-55. [DOI: 10.1016/j.jaad.2015.08.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/01/2015] [Accepted: 08/05/2015] [Indexed: 11/22/2022]
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34
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Robert C, Sibaud V, Mateus C, Verschoore M, Charles C, Lanoy E, Baran R. Nail toxicities induced by systemic anticancer treatments. Lancet Oncol 2015; 16:e181-9. [PMID: 25846098 DOI: 10.1016/s1470-2045(14)71133-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients treated with systemic anticancer drugs often show changes to their nails, which are usually well tolerated and disappear on cessation of treatment. However, some nail toxicities can cause pain and functional impairment and thus substantially affect a patient's quality of life, especially if they are given taxanes or EGFR inhibitors. These nail toxicities can affect both the nail plate and bed, and might present as melanonychia, leukonychia, onycholysis, onychomadesis, Beau's lines, or onychorrhexis, as frequently noted with conventional chemotherapies. Additionally, the periungual area (perionychium) of the nail might be affected by paronychia or pyogenic granuloma, especially in patients treated with drugs targeting EGFR or MEK. We review the nail changes induced by conventional chemotherapies and those associated with the use of targeted anticancer drugs and discuss preventive or curative options.
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Affiliation(s)
- Caroline Robert
- Gustave Roussy, Département de Médicine Oncologique, Service de Dermatologie, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin Bicetre, France.
| | - Vincent Sibaud
- Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse Oncopole, France
| | - Christina Mateus
- Gustave Roussy, Département de Médicine Oncologique, Service de Dermatologie, Villejuif, France
| | | | - Cécile Charles
- Département Interdisciplinaire de Soins de Support en Oncologie, Villejuif, France
| | - Emilie Lanoy
- Département de Biostatistiques, Villejuif, France
| | - Robert Baran
- Gustave Roussy, Département de Médicine Oncologique, Service de Dermatologie, Villejuif, France
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35
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Abstract
Cutaneous drug reactions are common adverse effects that occur in about 2-3% of the hospitalized patients. They have both immunologic and non-immunologic underlying mechanisms. These reactions are clinically and histologically similar to dermatoses. Their significant clinical indicators include: history of drug intake, atypical clinical features and improvement after cessation of the offending drugs. Their diagnostic histological clues include the presence of mixed histological patterns, apoptotic keratinocytes, eosinophils (dermis and epidermis), papillary dermal edema and extravasations of erythrocytes. However, no single clinical or histological feature is specific of drug eruptions. This work attempts to classify the histomorphologic reactions to various drugs in defined categories for assistance in morphologic diagnosis.
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36
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Gupta AK, Daigle D, Foley KA. The prevalence of culture-confirmed toenail onychomycosis in at-risk patient populations. J Eur Acad Dermatol Venereol 2014; 29:1039-44. [PMID: 25413984 DOI: 10.1111/jdv.12873] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/22/2014] [Indexed: 11/30/2022]
Abstract
Onychomycosis is a fungal infection of the nail and is the most common nail affliction in the general population. Certain patient populations are at greater risk of infection and the prevalence of onychomycosis reported in the literature has yet to be summarized across these at-risk groups. We performed a systematic review of the literature and calculated pooled prevalence estimates of onychomycosis in at-risk patient populations. The prevalence of dermatophyte toenail onychomycosis was as follows: general population 3.22% (3.07, 3.38), children 0.14% (0.11, 0.18), the elderly 10.28% (8.63, 12.18), diabetic patients 8.75% (7.48, 10.21), psoriatic patients 10.22% (8.61, 12.09), HIV positive patients 10.40% (8.02, 13.38), dialysis patients 11.93% (7.11, 19.35) and renal transplant patients 5.17% (1.77, 14.14). Dialysis patients had the highest prevalence of onychomycosis caused by dermatophytes, elderly individuals had the highest prevalence of onychomycosis caused by yeasts (6.07%; 95% CI = 3.58, 10.11) and psoriatic patients had the highest prevalence of onychomycosis caused by non-dermatophyte moulds (2.49%; 95% CI = 1.74, 3.55). An increased prevalence of onychomycosis in certain patient populations may be attributed to impaired immunity, reduced peripheral circulation and alterations to the nail plate which render these patients more susceptible to infection.
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Affiliation(s)
- A K Gupta
- University of Toronto, Toronto, ON, Canada.,Mediprobe Research Inc., London, ON, Canada
| | - D Daigle
- Mediprobe Research Inc., London, ON, Canada
| | - K A Foley
- Mediprobe Research Inc., London, ON, Canada
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