Sticky palms--an unusual side-effect of etretinate therapy

Non-medication Acquired Sticky Skin: Case Report of Idiopathic Acquired Cutaneous Adherence and Review of Medication-Induced Sticky Skin

Sticky skin is a dermatologic phenomenon in which the skin may cause objects to adhere to it on contact or adhere to itself or both. The entire skin can be affected in patients with sticky skin. Alternatively, just acral sites, such as the hand, can be involved. The acquisition of sticky skin has been described in patients treated with certain medications. These drugs include retinoids, proton pump inhibitors, and antifungals; they also include combination therapy utilizing an antineoplastic agent and an antifungal drug in patients with hormone-resistant prostate cancer.

The pathogenesis of acquired cutaneous adherence in patients with androgen-independent prostate cancer was postulated to be the result of therapy-induced elevation of endogenous retinoids. Retinoids have multiple biological effects on epidermal differentiation that may contribute to the pathogenesis of acquired cutaneous adherence. These include the induction of fine, granular, mucus-like deposits within and between the keratinocytes in the upper stratum spinosum and stratum corneum, modulation of lipid composition in keratinocytes, prevention of cross-linked, cornified envelope formation in keratinocytes by the inhibition of epidermal transglutaminase, and altered and decreased content of keratin within the epidermis. We describe an older man who developed non-medication acquired sticky skin (NoMasts). His acquired cutaneous adherence was considered to be idiopathic. We postulate that aging may be associated with elevated endogenous retinoid levels in older individuals and may have resulted in his sticky skin. Further investigation into these retinoid-induced effects and to what extent they promote acquired cutaneous adherence is still needed.

Seborrheic dermatitis-like eruption in patients taking isotretinoin therapy for acne: retrospective study of five patients

BACKGROUND

Isotretinoin therapy for acne is often associated with mucocutaneous reactions that are usually dose dependent.

OBJECTIVE

To describe the characteristics of five patients who presented with a peculiar facial rash that developed during or after a successful course of isotretinoin therapy for acne.

METHODS

In this retrospective study, five patients who were treated with isotretinoin and who developed, during or following treatment, a peculiar facial eruption that has not previously been reported, are described. The clinical characteristics, laboratory findings, therapy, and course of the eruption are presented.

RESULTS

The rash was characterized by small, yellow, adherent, greasy scales, either flat-topped or spiky, mostly on the cheeks, that resembled seborrheic dermatitis. Cultures obtained in one case grew Staphylococcus coagulase-negative, Acinetobacter, and Pityrosporum ovale organisms. In another patient, microscopic study showed hyperkeratotic scales with many spores and Gram-negative coccobacilli. Topical administration of ointments containing chloramphenicol 3% for 2-3 weeks was curative.

CONCLUSION

Seborrheic dermatitis-like eruption may be another adverse cutaneous effect of isotretinoin treatment. Its pathogenesis probably involves a minimal toxic retinoid effect on epidermal differentiation with overgrowth of commensal microorganisms in susceptible individuals.

Acquired cutaneous adherence in patients with androgen-independent prostate cancer receiving ketoconazole and doxorubicin: medication-induced sticky skin

BACKGROUND

The phenomenon of sticky skin has been reported in patients with psoriasis who are receiving retinoids.

OBJECTIVE

We describe therapy-induced sticky skin in eight patients receiving ketoconazole and doxorubicin for androgen-independent prostate cancer.

METHODS

Patients were treated with oral daily ketoconazole (400 mg every 8 hours) and intravenous doxorubicin weekly (20 mg/m2 continuously for 24 hours). Thirty-nine patients were entered into the study; retrospective information regarding sticky skin was obtainable from 28 patients or their spouses. Prostate specific antigen (PSA) values were compared in patients with and without therapy-induced sticky skin.

RESULTS

Eight patients (29%) described sticky skin. Six of these patients (75%) had a PSA response. Of the 20 patients without sticky skin a PSA response occurred in 12 (60%).

CONCLUSION

Sticky skin occurred in patients with androgen-independent prostate cancer who were simultaneously receiving ketoconazole and doxorubicin. To our knowledge this unique skin manifestation of acquired cutaneous adherence has not been previously described in association with chemotherapeutic or antifungal agents. The pathogenesis of acquired cutaneous adherence in these patients might relate to therapy-induced elevation of endogenous retinoids. The similar PSA response rate in patients with or without sticky skin suggests that retinoids may not play an essential role in the mechanism of antitumor activity of ketoconazole and doxorubicin.