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Bettuzzi T, Sanchez-Pena P, Lebrun-Vignes B. Cutaneous adverse drug reactions. Therapie 2024; 79:239-270. [PMID: 37980248 DOI: 10.1016/j.therap.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 11/20/2023]
Abstract
Cutaneous adverse drug reactions (ADRs) represent a heterogeneous field including various clinical patterns without specific features suggesting drug causality. Maculopapular exanthema and urticaria are the most common types of cutaneous ADR. Serious cutaneous ADRs, which may cause permanent sequelae or have fatal outcome, may represent 2% of all cutaneous ADR and must be quickly identified to guide their management. These serious reactions include bullous manifestations (epidermal necrolysis i.e. Stevens-Johnson syndrome and toxic epidermal necrolysis), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). Some risk factors for developing cutaneous ADRs have been identified, including immunosuppression, autoimmunity or genetic variants. All drugs can cause cutaneous ADRs, the most commonly implicated being antibiotics (especially aminopenicillins and sulfonamides), anticonvulsants, allopurinol, antineoplastic drugs, non-steroidal anti-inflammatory drugs and iodinated contrast media. Pathophysiology is related to immediate or delayed "idiosyncratic" immunologic mechanisms, i.e., usually not related to dose, and pharmacologic/toxic mechanisms, commonly dose-dependent and/or time-dependent. If an immuno-allergic mechanism is suspected, allergological explorations (including epicutaneous patch testing and/or intradermal test) are often possible to clarify drug causality, however these have a variable sensitivity according to the drug and to the ADR type. No in vivo or in vitro test can consistently confirm the drug causality. To determine the origin of a rash, a logical approach based on clinical characteristics, chronologic factors and elimination of differential diagnosis (especially infectious etiologies) is required, completed with a literature search. Reporting to pharmacovigilance system is therefore essential both to analyze drug causality at individual level, and to contribute to knowledge of the drug at population level, especially for serious cutaneous ADRs or in cases involving newly marketed drugs.
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Affiliation(s)
- Thomas Bettuzzi
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; EpiDermE, université Paris Est Créteil Val-de-Marne, 94000 Créteil, France
| | - Paola Sanchez-Pena
- Service de pharmacologie médicale, centre régional de pharmacovigilance de Bordeaux, CHU de Bordeaux, 33000 Bordeaux, France; Groupe FISARD de la Société française de dermatologie, France
| | - Bénédicte Lebrun-Vignes
- EpiDermE, université Paris Est Créteil Val-de-Marne, 94000 Créteil, France; Groupe FISARD de la Société française de dermatologie, France; Service de pharmacologie médicale, centre régional de pharmacovigilance Pitié-Saint-Antoine, groupe hospitalier AP-HP-Sorbonne université, 75013 Paris, France.
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Santoro A, Angelico G, Fiorentino V, Zhang Q, Spadola S, Carlino A, Sanchez AM, Franceschini G, Zannoni GF, Mulè A. Melanocyte Colonization and Pigmentation of Breast Carcinoma: Description of Two Pathological Cases and Review of Literature. Diagnostics (Basel) 2021; 11:diagnostics11040709. [PMID: 33921072 PMCID: PMC8071371 DOI: 10.3390/diagnostics11040709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Colonization of breast carcinoma by non-neoplastic melanocytes of epidermal origin was first described by Azzopardi and Eusebi in 1977. We herein report two cases on the exceptional clinical and pathological features of this phenomenon in a 66-year-old and a 51-year-old patients. The pathogenesis is not fully understood, but a disrupted basement membrane and the role of tumoral growth factors are considered essential.
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Affiliation(s)
- Angela Santoro
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (V.F.); (Q.Z.); (S.S.); (A.C.); (A.M.)
| | - Giuseppe Angelico
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (V.F.); (Q.Z.); (S.S.); (A.C.); (A.M.)
| | - Vincenzo Fiorentino
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (V.F.); (Q.Z.); (S.S.); (A.C.); (A.M.)
| | - Qianqian Zhang
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (V.F.); (Q.Z.); (S.S.); (A.C.); (A.M.)
| | - Saveria Spadola
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (V.F.); (Q.Z.); (S.S.); (A.C.); (A.M.)
| | - Angela Carlino
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (V.F.); (Q.Z.); (S.S.); (A.C.); (A.M.)
| | - Alejandro Martin Sanchez
- Department of Woman and Child Health and Public Health, Division of Breast Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy; (A.M.S.); (G.F.)
| | - Gianluca Franceschini
- Department of Woman and Child Health and Public Health, Division of Breast Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy; (A.M.S.); (G.F.)
| | - Gian Franco Zannoni
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (V.F.); (Q.Z.); (S.S.); (A.C.); (A.M.)
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Roma, Italy
- Correspondence:
| | - Antonino Mulè
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy; (A.S.); (G.A.); (V.F.); (Q.Z.); (S.S.); (A.C.); (A.M.)
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Alizadeh N, Mirpour SH, Darjani A, Rafiei R, Rafiei E, Mohammadhoseini M. Dermatologic adverse effects of breast cancer chemotherapy: a longitudinal prospective observational study with a review of literature. Int J Dermatol 2020; 59:822-828. [PMID: 32406107 DOI: 10.1111/ijd.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/31/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breast cancer patients may experience an increased chance of survival with adjuvant chemotherapy. However dermatologic adverse effects can cause major discomfort due to physical or cosmetic problems. This study aims to describe dermatologic complications in breast cancer patients during chemotherapy. METHODS This longitudinal prospective observational study included data on women with non-metastatic breast cancer whom were treated with AC-T protocol (anthracycline, cyclophosphamide, and taxane) adjuvant chemotherapy and consecutively enrolled during two years. The study was performed in an educational and tertiary referral center. The patients' information including age, body mass index (BMI), past medical history, and different dermatologic complications were collected for all participants. RESULTS Of 190 enrolled women, all patients experienced alopecia, which occurred in 131 patients (68.9%) after the first cycle. Skin, mucosal, and nail involvement were respectively seen in 46 (24.2%), 51 (26.8%), and 86 (45.2%) cases. Cutaneous complications were observed mainly between the third and sixth chemotherapy cycles. Palmoplantar erythema and palmoplantar dysesthesia were the most common cutaneous complications. Dermatologic adverse effects were significantly more frequent in the patients with an underlying disease. CONCLUSION These findings suggest that dermatologic adverse effects of adjuvant chemotherapy are common and could be induced by all components of AC-T regimen. These complications should be skillfully managed to increase patients' comfort.
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Affiliation(s)
- Narges Alizadeh
- Skin Research Center, Department of Dermatology, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyyed Hossein Mirpour
- Department of Hematology and Oncology, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Darjani
- Skin Research Center, Department of Dermatology, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Rana Rafiei
- Skin Research Center, Department of Dermatology, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Elahe Rafiei
- Razi Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Mohammadhoseini
- Skin Research Center, Department of Dermatology, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Abstract
Taxanes (docetaxel and paclitaxel) are among the most commonly prescribed anticancer drugs approved for the treatment of metastatic or locally advanced breast, non-small cell lung, prostate, gastric, head and neck, and ovarian cancers, as well as in the adjuvant setting for operable node-positive breast cancers. Although the true incidence of dermatological adverse events (AEs) in patients receiving taxanes is not known, and has never been prospectively analysed, they clearly represent one of the major AEs associated with these agents. With an increase in the occurrence of cutaneous AEs during treatment with novel targeted and immunological therapies when used in combination with taxanes, a thorough understanding of reactions attributable to this class is imperative. Moreover, identification and management of dermatological AEs is critical for maintaining the quality of life in cancer patients and for minimizing dose modifications of their antineoplastic regimen. This analysis represents a systematic review of the dermatological conditions reported with the use of these drugs, complemented by experience at comprehensive cancer centres. The conditions reported herein include skin, hair, and nail toxicities. Lastly, we describe the dermatological data available for the new, recently FDA-and EMA- approved, solvent-free nab-paclitaxel.
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Lowell DL, Salvo NL, Weily WJ, Swiatek M, Sahli H. Multiple Eccrine Syringofibroadenoma of Mascaro of the Lower Extremity. J Am Podiatr Med Assoc 2016; 106:433-438. [PMID: 28033055 DOI: 10.7547/15-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Eccrine syringofibroadenoma (ESFA) is a rare benign lesion of ductal and secretory differentiation exhibiting multiple cutaneous polymorphic presentations with an unknown etiology. We present a case of ESFA that uniquely exhibited large, thick, verrucous-like hyperplastic growths as well as superficial shiny mosaic plaques and deep ulcerations in three different anatomical locations in the same patient. The diagnosis of ESFA was confirmed histologically after biopsies were performed on all of the affected areas. In addition to a case report and literature review, we also present classification, clinical, and histologic aspects of ESFA.
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Affiliation(s)
- Danae L. Lowell
- Department of Surgery, Cleveland VA Medical Center, Cleveland, OH
| | - Nichol L. Salvo
- Young Physicians' Program, American Podiatric Medical Association, Bethesda, MD. Dr. Salvo is now with the Podiatry Section and Podiatry Residency Program, Atlanta VA Medical Center, Decatur, GA
| | | | - Michael Swiatek
- Private practice, Schwein Foot & Ankle Clinic, Mansfield, OH
| | - Hannah Sahli
- Kent State University College of Podiatric Medicine, Independence, OH
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Abstract
Radiation recall dermatitis (RRD) is an uncommon reaction typically triggered by the use of chemotherapeutic agents in the months after treatment with radiation therapy. It usually presents as dermatitis in the irradiated field with prominent intertriginous involvement, and because internal involvement occurs in up to one-third of cases, early recognition is important. RRD has rarely been reported in the pediatric literature. We report the case of a 15-month-old boy with RRD to dactinomycin.
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Affiliation(s)
- Brea Prindaville
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri.
| | - Kimberly A Horii
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Kristi M Canty
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri
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Abstract
The combination of localized radiotherapy and immune checkpoint inhibitors represents a promising therapeutic strategy for various cancers, including metastatic melanoma. Radiation therapy may enhance tumor antigen presentation and cytokine release, which may optimize the systemic antitumor immune response induced by these immunotherapeutic antibodies, with a potential delayed abscopal effect. However, clinical experience of using immune checkpoint inhibitors with concurrent radiotherapy remains scarce. We report here for the first time a case suggestive of acute skin radiosensitization induced by pembrolizumab, with a suggestive time relationship between the completion of ionizing radiation, drug administration, and rapid onset of the skin reaction. This suggests that radiation therapy may also interact rapidly with anti-programmed-death 1 antibodies. Therefore, caution should be exercised when prescribing this combination therapy in advanced cancers.
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Mubki T, Rudnicka L, Olszewska M, Shapiro J. Evaluation and diagnosis of the hair loss patient: part I. History and clinical examination. J Am Acad Dermatol 2015; 71:415.e1-415.e15. [PMID: 25128118 DOI: 10.1016/j.jaad.2014.04.070] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/19/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
Hair loss (alopecia) is a common problem and is often a major source of distress for patients. The differential diagnosis of alopecia includes both scarring and nonscarring alopecias. In addition, many hair shaft disorders can produce hair shaft fragility, resulting in different patterns of alopecia. Therefore, an organized and systematic approach is needed to accurately address patients' complaints to achieve the correct diagnosis. Part 1 of this 2-part continuing medical education article on alopecia describes history taking and the clinical examination of different hair loss disorders. It also provides an algorithmic diagnostic approach based on the most recent knowledge about different types of alopecia.
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Affiliation(s)
- Thamer Mubki
- Al Imam Muhammad Ibn Saud Islamic University, Department of Dermatology, Riyadh, Saudi Arabia
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland; Department of Neuropeptides, Mossakowski Medical Research Centre, Warsaw, Poland
| | | | - Jerry Shapiro
- Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Department of Dermatology, New York University Langone Medical Center, New York, New York.
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Breed WPM, van den Hurk CJG, Peerbooms M. Presentation, impact and prevention of chemotherapy-induced hair loss: scalp cooling potentials and limitations. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.76] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sibaud V, Fricain JC, Baran R, Robert C. Anomalies pigmentaires induites par les traitements anticancéreux. Première partie : les chimiothérapies. Ann Dermatol Venereol 2013; 140:183-96. [DOI: 10.1016/j.annder.2012.12.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/31/2012] [Accepted: 12/05/2012] [Indexed: 02/06/2023]
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de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, Mayer-Steinacker R, Bokemeyer C, Jordan K. Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. ACTA ACUST UNITED AC 2013; 36:127-35. [PMID: 23486002 DOI: 10.1159/000348524] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cytotoxic extravasation is a rare but potentially serious and painful complication of intravenous drug administration in oncology. Literature is anecdotal, and systematic clinical trials are scarce. The German working group for Supportive Care in Cancer (ASORS) has prepared an expert opinion for the diagnosis, prophylaxis and management of cytotoxic extravasation based on an interdisciplinary expert panel. MATERIAL AND METHODS A Pubmed search was conducted for diagnosis, risk factors, symptoms, prophylaxis, and treatment of extravasation by the respective responsible expert. A writing committee compiled the manuscript and proposed the level of recommendation. In a consensus meeting, 13 experts reviewed and discussed the current practice in diagnosis and management of cytotoxic extravasation. In a telephone voting among the experts, the level of recommendation by ASORS was determined. RESULTS Every effort should be made to reduce the risk of extravasation. Staff training, patient education, usage of right materials and infusion techniques have been identified to be mandatory to minimalize the risk of extravasation. Extravasation must be diagnosed as soon as possible, and specific therapy including antidotes dependent on the extravasated drug should be initiated immediately. An extravasation emergency set should be available wherever intravenous cytotoxics are applied. Documentation and post-treatment follow-up are recommended. CONCLUSION We have developed a literature- and expert-based consensus recommendation to avoid cytotoxic extravasation. It also provides practical management instructions which should help to avoid surgery and serious late effects.
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Affiliation(s)
- Maike de Wit
- Klinik für Innere Medizin - Hämatologie und Onkologie, Vivantes Klinikum Neukölln, Berlin, Germany.
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Abstract
Hair loss is a common complaint, both in men and women, and use of prescription medications is widespread. When there is a temporal association between the onset of hair loss and commencement of a medication, the medication is commonly thought to have caused the hair loss. However, hair loss and in particular telogen effluvium may occur in response to a number of triggers including fever, hemorrhage, severe illness, stress, and childbirth, and a thorough exclusion of these potential confounders is necessary before the hair loss can be blamed on the medication. Certain medications are known to cause hair loss by a variety of mechanisms including anagen arrest, telogen effluvium, or accentuation of androgenetic alopecia by androgens.
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Affiliation(s)
- Mansi Patel
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Aikenhead Wing, 41 Victoria Parade, Fitzroy, Melbourne, Victoria 3065, Australia
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Criado PR, Brandt HRC, Moure ERD, Pereira GLS, Sanches Júnior JA. Reações tegumentares adversas relacionadas aos agentes antineoplásicos: parte II. An Bras Dermatol 2010; 85:591-608. [DOI: 10.1590/s0365-05962010000500002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Indexed: 01/16/2023] Open
Abstract
Os eventos e reações envolvendo quimioterapia são frequentes na prática oncológica. Agentes quimioterápicos são uma modalidade de tratamento amplamente utilizada. Efeitos colaterais podem variar de frequência e também ser confundidos com outras manifestações tegumentares do tratamento oncológico. Este artigo objetiva expor as informações sobre reações cutâneas à quimioterapia, em especial, aqueles para os quais o dermatologista é requisitado a emitir parecer e a comentar sobre a segurança e a viabilidade da readministração de uma droga específica. Os autores descrevem os aspectos associados a esses eventos, fazendo uma análise detalhada de cada um deles.
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Tay LK, Lee HY, Thirumoorthy T, Pang SM. Dermatology referrals in an East Asian tertiary hospital: a need for inpatient medical dermatology. Clin Exp Dermatol 2010; 36:129-34. [PMID: 20738321 DOI: 10.1111/j.1365-2230.2010.03923.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Within hospitals, there is a need for dermatological expertise, as hospitalized patients have a wider spectrum of severe and serious dermatological conditions, associated with significant morbidity. AIM To characterize the patient profile and referral pattern of inpatient dermatology consultations, and to evaluate the diagnostic accuracy of non-dermatologists. METHODS This was a retrospective study reviewing all inpatient referrals for dermatology consultations during a 1-year period from July 2005 to June 2006 (inclusive), at the largest multi-disciplinary tertiary hospital in Singapore. RESULTS Of the 731 referrals made for dermatology consultations, 26.9% of patients had ≥ 3 important underlying comorbidities. Eczema/dermatitis (33.1%; n = 242) and cutaneous infections (23.4%; n = 171) accounted for over half of the dermatological consultations, followed by cutaneous adverse drug reactions (12.3%; n = 90). The provisional diagnoses of the referring doctors agreed with the final diagnoses confirmed by dermatologists in only 30.2% of all referrals; incorrect diagnoses were made in 35.2% of cases, and no provisional diagnoses were made in the remaining 34.6% of cases. Most misdiagnosed skin diseases were in fact common dermatoses (such as eczemas, cutaneous infections, drug rash) that required only standard treatment. CONCLUSION Our study reiterates the importance of inpatient medical dermatology in terms of both service and education. There should be continual efforts to ensure that dermatologists have the highest level of training and experience in medical dermatology, to provide collaborative optimum care for hospitalized patients with dermatological diseases.
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Affiliation(s)
- L K Tay
- Department of Dermatology, Singapore General Hospital, Singapore City, Singapore.
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Sanches Junior JA, Brandt HRC, Moure ERD, Pereira GLS, Criado PR. Reações tegumentares adversas relacionadas aos agentes antineoplásicos: parte I. An Bras Dermatol 2010; 85:425-37. [DOI: 10.1590/s0365-05962010000400003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Indexed: 11/22/2022] Open
Abstract
O tratamento local e sistêmico das neoplasias pode causar alterações na pele, membranas mucosas, cabelos e unhas. O diagnóstico preciso e o tratamento adequado destes efeitos colaterais requerem conhecimento dos padrões das reações adversas mais comuns para as medicações que o paciente está utilizando. O dermatologista deve estar familiarizado com as manifestações tegumentares das neoplasias, bem como com os efeitos adversos mucocutâneos dos tratamentos antineoplásicos.
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Rosman IS, Lloyd BM, Hayashi RJ, Bayliss SJ. Cutaneous effects of thiotepa in pediatric patients receiving high-dose chemotherapy with autologous stem cell transplantation. J Am Acad Dermatol 2008; 58:575-8. [DOI: 10.1016/j.jaad.2007.12.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 12/19/2007] [Accepted: 12/27/2007] [Indexed: 12/12/2022]
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Cutaneous Reactions to Chemotherapy: Commonly Seen, Less Described, Little Understood. Dermatol Clin 2008; 26:103-19, ix. [DOI: 10.1016/j.det.2007.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Bodó E, Tobin DJ, Kamenisch Y, Bíró T, Berneburg M, Funk W, Paus R. Dissecting the impact of chemotherapy on the human hair follicle: a pragmatic in vitro assay for studying the pathogenesis and potential management of hair follicle dystrophy. THE AMERICAN JOURNAL OF PATHOLOGY 2007; 171:1153-67. [PMID: 17823286 PMCID: PMC1988866 DOI: 10.2353/ajpath.2007.061164] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chemotherapy-induced alopecia represents one of the major unresolved problems of clinical oncology. The underlying molecular pathogenesis in humans is virtually unknown because of the lack of adequate research models. Therefore, we have explored whether microdissected, organ-cultured, human scalp hair follicles (HFs) in anagen VI can be exploited for dissecting and manipulating the impact of chemotherapy on human HFs. Here, we show that these organ-cultured HFs respond to a key cyclophosphamide metabolite, 4-hydroperoxycyclophosphamide (4-HC), in a manner that resembles chemotherapy-induced HF dystrophy as it occurs in vivo: namely, 4-HC induced melanin clumping and melanin incontinence, down-regulated keratinocyte proliferation, massively up-regulated apoptosis of hair matrix keratinocytes, prematurely induced catagen, and up-regulated p53. In addition, 4-HC induced DNA oxidation and the mitochondrial DNA common deletion. The organ culture system facilitated the identification of new molecular targets for chemotherapy-induced HF damage by microarray technology (eg, interleukin-8, fibroblast growth factor-18, and glypican 6). It was also used to explore candidate chemotherapy protectants, for which we used the cytoprotective cytokine keratinocyte growth factor as exemplary pilot agent. Thus, this novel system serves as a powerful yet pragmatic tool for dissecting and manipulating the impact of chemotherapy on the human HF.
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Affiliation(s)
- Eniko Bodó
- Department of Dermatology, University Hospital Schleswig-Holstein, University of Lübeck, D-23538 Lübeck, Ratzeburger Allee 160, Germany.
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Fluhr JW, Miteva M, Primavera G, Ziemer M, Elsner P, Berardesca E. Functional Assessment of a Skin Care System in Patients on Chemotherapy. Skin Pharmacol Physiol 2007; 20:253-9. [PMID: 17587889 DOI: 10.1159/000104423] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 04/27/2007] [Indexed: 12/19/2022]
Abstract
BACKGROUND/PURPOSE Cancer patients undergoing chemotherapy frequently experience skin problems such as xerosis. The aim of this study was to verify whether a concomitant treatment with an acidic washing and an acidic emollient (both pH 5.5) can significantly improve the quality of the skin in such patients. METHODS 30 adult patients on chemotherapy experiencing dry and sensitive skin were included in a controlled, monocentric, 3-week treatment trial. One forearm served as a test site, the other one remained untreated. Noninvasive biophysical measurements were performed at baseline, on days 7, 14 and 21, along with clinical evaluation of the skin symptoms. RESULTS After a 3-week treatment, a significant increase in stratum corneum hydration was recorded in the treated site (p < 0.001). Reduced transepidermal water loss values, consistent with a restored barrier function, were obtained (p < 0.001). Casual sebum levels as measured by sebumetry showed a significant increase (p < 0.03). All skin symptoms investigated revealed a considerable improvement over 3 weeks. CONCLUSION Controlled and regular use of a skin care system, especially an acidic one, improved skin physiology in patients undergoing chemotherapy.
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Affiliation(s)
- J W Fluhr
- Skin Physiology Laboratory, Friedrich-Schiller University, Jena, Germany.
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Yun SJ, Kim SJ. Hair Loss Pattern due to Chemotherapy-Induced Anagen Effluvium: A Cross-Sectional Observation. Dermatology 2007; 215:36-40. [PMID: 17587837 DOI: 10.1159/000102031] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 02/15/2007] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Anagen effluvium is a common side effect of chemotherapy, but few studies have examined its clinical characteristics. OBJECTIVE This study was aimed at evaluating the hair loss caused by chemotherapeutic agents. METHODS Sixty-four patients with anagen effluvium were evaluated in the study. Chemotherapeutic agents were classified into 5 different groups. The pattern of hair loss was analyzed when specific involvement of the hairline was obvious. RESULTS Forty-six (71.9%) of the 64 total patients maintained hairs along their hairline. Hairs were maintained with a total hairline in 20 (31.3%), frontal hairline in 13 (20.3%) and occipital hairline in 12 (18.8%) patients. Among the 20 males with patterned hair loss, the following hairlines were preserved: occipital in 10 (50%), total in 7 (35%) and frontal in 3 (15%). Among the 25 females with patterned hair loss, hairlines were preserved as total in 13 (52%), frontal in 10 (40%) and occipital in 2 (8%). However, no significant differences were detected in hair loss patterns according to age, associated symptoms, chemotherapeutic agent group or combination of chemotherapeutic agents. CONCLUSION Our results suggest that anagen effluvium induced by chemotherapeutic agents represents patterned hair loss.
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Affiliation(s)
- Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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Affiliation(s)
- Philip R Cohen
- Dermatologic Surgery Center of Houston, Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USA.
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Abstract
Skin changes in cancer patients have many causes and are difficult to categorize. Chemotherapy-associated cutaneous side effects are usually toxic and often show a characteristic reaction pattern, offering diagnostic clues to the consulting dermatologist. Severe chemotherapy-associated reactions which require dose reduction, change or discontinuation of the cytostatic agents are rare. Most problems are reversible and self-limiting disease. The most common chemotherapy reactions are reviewed.
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Affiliation(s)
- A L Branzan
- Klinik und Poliklinik für Dermatologie, Klinikum der Universität Regensburg
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25
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Anand A, Chan SY. The use of topotecan for relapsed ovarian cancer in accordance with the National Institute for Clinical Excellence Guidance 2001: the Nottingham experience. Clin Oncol (R Coll Radiol) 2005; 16:543-8. [PMID: 15630848 DOI: 10.1016/j.clon.2004.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The topoisomerase-1 inhibitor, topotecan, is an established chemotherapy agent for the treatment of relapsed ovarian cancer after the failure of platinum-based chemotherapy, and is an established treatment choice at first relapse. In line with National Institute for Clinical Excellence (NICE) guidance, topotecan has been used at Nottingham City Hospital for the last 2 years. MATERIALS AND METHODS A retrospective audit, over the period September 2001 to September 2002, was carried out to assess response rates and side-effects for patients with relapsed ovarian cancer who were treated with topotecan. Twenty-five patients received topotecan as a 30-min intravenous infusion for 5 consecutive days, every 21 days. The starting dose was either 1.5 mg/m2/day (n = 22) or 1.25 mg/m2/day (n = 3). Patient response was monitored by physical examination and serological CA125 tumour marker level. Radiological assessment was by computed tomography. RESULTS Eighteen (72%) patients had their previous platinum-based treatment less than 6 months before topotecan therapy. Thirteen patients received topotecan therapy as second-line, seven as third-line and five as > or = fourth-line treatment. Twenty-two (88%) patients who received more than one cycle of chemotherapy were evaluable for response. A clinical benefit was observed in 11 (44%) patients (two [8%] partial response and nine [36%] stable disease). Seven patients achieving clinical benefit received topotecan as second-line treatment. Dose was reduced from 1.5 to 1.25 mg/m2/day in six patients after the first cycle of topotecan. Twelve (48%) patients had dose delay of at least 1 week. Grade 3/4 neutropenia, observed in nine (36%) patients, was the main dose-limiting toxicity. One patient died as a result of treatment. CONCLUSION The Nottingham experience with topotecan in platinum-resistant ovarian cancer has been encouraging, even in such a heavily pre-treated patient population. There is a better chance of response if the patients receive topotecan at first relapse. The haematological toxicity is significant but manageable with dose reduction and dose delay.
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Affiliation(s)
- A Anand
- Department of Clinical Oncology, Nottingham City Hospital, Hucknall Road, Nottingham, UK
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26
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Lawenda BD, Gagne HM, Gierga DP, Niemierko A, Wong WM, Tarbell NJ, Chen GTY, Hochberg FH, Loeffler JS. Permanent alopecia after cranial irradiation: Dose–response relationship. Int J Radiat Oncol Biol Phys 2004; 60:879-87. [PMID: 15465206 DOI: 10.1016/j.ijrobp.2004.04.031] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Revised: 01/26/2004] [Accepted: 04/12/2004] [Indexed: 11/29/2022]
Abstract
PURPOSE To develop a dose-response relationship for the occurrence of permanent alopecia after cranial irradiation and to analyze potential confounding variables that may contribute to this unwanted and often unavoidable complication of treatment. METHODS AND MATERIALS Twenty-six patients were enrolled in this study. Three reviewers independently assessed 61 scalp regions and assigned a score for the degree of alopecia in each region using a 4-point scale. Patient and treatment data were collected using a patient questionnaire and outpatient medical chart review. The hair follicle dose was calculated for each scalp region and correlated with the alopecia score for that region. A dose-response relationship was established using the data from these correlations. RESULTS Permanent alopecia correlated significantly with the follicle dose only (p < 0.001). A personal history of alopecia and the use of chemotherapy correlated with permanent alopecia with borderline statistical significance (p = 0.059 and p = 0.068, respectively). Patient age, family history of baldness, gender, tobacco use, diabetes, and beam energy did not correlate with alopecia. CONCLUSION We report the first human dose-response relationship describing the effect of the follicle dose on the subsequent development of permanent scalp alopecia after cranial irradiation. This information will assist the radiation oncologist, physicist, and dosimetrist in designing a treatment plan that might minimize the risk of this untoward side effect of cranial irradiation.
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Affiliation(s)
- Brian D Lawenda
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom Street, Boston, MA 02114, USA
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Baysse L, Boralevi F, Lepreux S, Boyer A, Morel C, Léauté-Labrèze C, Taïeb A. [Eccrine squamous syringometaplasia and cytomegalovirus infection]. Rev Med Interne 2003; 24:394-8. [PMID: 12814829 DOI: 10.1016/s0248-8663(03)00112-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Eccrine squamous syringometaplasia has been reported in some cases as an Herpeviridae complication. We report a case of eccrine squamous syringometaplasia associated with a severe cytomegalovirus infection in an immunocompromised patient, and we discuss about potential viral or drug triggering factors. METHODS A 22 years-old man was hospitalized in an intensive care unit for rejection of a renal graft associated with a disseminated cytomegalovirus infection. A papular and papulopustular eruption appeared on the trunk and the limbs. RESULTS Histological examination of a skin sample showed eccrine squamous syringometaplasia, with evidence of cytomegalovirus genomic sequences using PCR. Two weeks later, the patient developed toxic epidermal necrolysis, with fatal issue. CONCLUSIONS Eccrine squamous syringometaplasia is a rare condition, without specific clinical features. Numerous local affections have been reported to induce eccrine syringometaplasia (ulcer, scar, pyoderma gangrenosum, drug injection.), drugs (cytotoxic agents, non steroidal anti inflammatory therapies) and in cases of infection due to cytomegalovirus or herpes simplex virus. The potential implication of cytomegalovirus or foscarnet as triggering factors in our case is discussed. This observation and other similar reported cases lead to the conclusion that eccrine squamous syringometaplasia may be an underestimated complication of cytomegalovirus infections in immunocompromised patients.
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Affiliation(s)
- L Baysse
- Service de dermatologie, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 cedex, Bordeaux, France
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Sharov AA, Li GZ, Palkina TN, Sharova TY, Gilchrest BA, Botchkarev VA. Fas and c-kit are involved in the control of hair follicle melanocyte apoptosis and migration in chemotherapy-induced hair loss. J Invest Dermatol 2003; 120:27-35. [PMID: 12535195 DOI: 10.1046/j.1523-1747.2003.12022.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chemotherapy alters the structure and function of hair follicle melanocytes. Molecular mechanisms controlling melanocyte responses during chemotherapy-induced hair loss, however, remain largely unknown. Using immunohistology and multicolor confocal microscopy, we show here that cyclophosphamide administration to C57BL/6 mice alters the activity and fate of hair follicle melanocytes. After 24-48 h, hair bulb melanocytes expressing Fas undergo apoptosis. The number of apoptotic follicular melanocytes is significantly reduced (p<0.01) in cyclophosphamide-treated Fas knockout mice compared to wild-type controls, suggesting that Fas signaling contributes to chemotherapy-induced melanocyte death. After 3-5 d, surviving hair bulb melanocytes express c-kit receptor, proliferate, and appear to migrate up the outer root sheath. Tyrosinase-positive and melanogenically active cells then appear in the epidermis. By Western blotting and immunohistochemistry, expression levels of the c-kit ligand, stem cell factor, in skin and epidermis are strongly increased after cyclophosphamide treatment. Cyclophosphamide-induced migration of the hair follicle melanocytes into epidermis is completely abrogated by administration of c-kit neutralizing antibody. These data suggest that chemotherapy induces a complex response in the hair follicle melanocytes, which includes apoptosis, proliferation, and migration. Pharmacologic manipulation of Fas and c-kit signaling pathways might be useful for the correction of skin hyperpigmentation as a side-effect of chemotherapy.
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Affiliation(s)
- Andrei A Sharov
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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de Jonge ME, Mathôt RAA, Dalesio O, Huitema ADR, Rodenhuis S, Beijnen JH. Relationship between irreversible alopecia and exposure to cyclophosphamide, thiotepa and carboplatin (CTC) in high-dose chemotherapy. Bone Marrow Transplant 2002; 30:593-7. [PMID: 12407434 DOI: 10.1038/sj.bmt.1703695] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2002] [Accepted: 06/26/2002] [Indexed: 11/10/2022]
Abstract
Reversible alopecia is a commonly observed, important and distressing complication of chemotherapy. Permanent alopecia, however, is rare after standard-dose therapy, but has occasionally been observed after high-dose chemotherapy with cyclophosphamide, thiotepa and carboplatin (CTC). We evaluated the relationships between total exposure to these three compounds and their different metabolites in the high-dose CTC regimen, and the subsequent development of irreversible alopecia. Twenty-four patients received two or three courses of high-dose CTC, each followed by peripheral blood progenitor cell transplantation. Plasma levels of cyclophosphamide, its active metabolite 4-hydroxycyclophosphamide, thiotepa, its active metabolite tepa, and carboplatin were determined, and the area-under-the-plasma concentration-versus-time curves (AUC) of the compounds were calculated. Eight of the 24 patients included in the study developed permanent alopecia, while seven had normal hair regrowth and nine patients developed incomplete and/or thin hair regrowth. The carboplatin AUC and the summed AUC of thiotepa and tepa were both significantly associated with increasing irreversibility of hair loss. These results suggest that high exposure to carboplatin and the sum of the thiotepa and tepa exposure may lead to the development of permanent alopecia. This knowledge could guide therapeutic drug monitoring in order to prevent the occurrence of permanent alopecia and thereby improve the patients' quality of life.
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Affiliation(s)
- M E de Jonge
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute/Slotervaart Hospital, Amsterdam, The Netherlands
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30
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Affiliation(s)
- Susan Newton
- Medical Oncology Hematology Associates, Inc., Dayton, OH, USA.
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31
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2001; 10:561-76. [PMID: 11828841 DOI: 10.1002/pds.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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