Systemic Drug-induced Chronic Paronychia and Periungual Pyogenic Granuloma

Belimumab-induced periungual pyogenic granulomas: A case report

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.

Surgery for benign nail tumor

The vast majority of tumors in the nail apparatus have a different clinical presentation and course from their equivalents on the skin. Some, such as onychomatricoma and onychopapilloma, are unique to the nail and others, such as superficial acral fibromyxoma, have a tropism for the nail apparatus. As a rule, benign lesions respect the general architecture of the nail apparatus, whereas malignant tumors are destructive. Treatment is always surgical and good knowledge of the anatomy and the procedures is mandatory in order not to induce postoperative nail dystrophy.

Deep Seated Lobular Capillary Hemangioma (Pyogenic Granuloma) of the Colon: A Rare Case Requiring Surgery beyond Endoscopic Management

Background. Lobular capillary hemangiomas typically present as skin or oral mucosa lesions and have rarely been described in unusual sites, including the gastrointestinal tract. Most colonic lobular capillary hemangiomas, either asymptomatic or associated with GI bleeding, have been amenable to endoscopic treatment in literatures. Case Presentation. A 41-year-old woman presented with an incidental colonic mass during a systemic workup after adjuvant chemotherapy for HER2-positive breast cancer. Abdominal computed tomography revealed a deep seated colonic mass in the splenic flexure. An endoscopic strip biopsy was attempted for differential diagnosis of this lesion, but uncontrolled bleeding occurred, and an emergency surgery was eventually performed. Microscopic examination showed lobular capillary hemangioma involving full thickness of the colonic wall with mucosal ulceration. Conclusions. Colonic lobular capillary hemangioma is a benign vascular proliferation but is a candidate in differential diagnosis of benign or malignant tumors. Furthermore, the exceptional case may be deep seated and require more invasive surgery, unlike most cases of colonic lobular capillary hemangioma that can be treated with endoscopic modality.

Acute and chronic paronychia revisited: A narrative review

Paronychia refers to the inflammation of the tissue which immediately surrounds the nail and it can be acute (<6 weeks duration) or chronic (>6 weeks duration). Disruption of the protective barrier between the nail plate and the adjacent nail fold preceded by infectious or noninfectious etiologies results in the development of paronychia. A combination of general protective measures, and medical and/or surgical interventions are required for management. This review explores the pathogenesis, clinical features, differential diagnosis, medical, and surgical management of paronychia. For the purpose of this review, we searched the PubMed, Cochrane, and Scopus databases using the following keywords, titles, and medical subject headings (MeSH): acute paronychia, chronic paronychia, and paronychial surgeries. Relevant review articles, original articles, and case reports/series published till February 2020 were included in this study.

Osimertinib and Ramucirumab Induced Pyogenic Granulomas: A Possible Synergistic Effect of Dual Oncologic Therapy

Pyogenic granulomas represent benign vascular tumors that can present on the skin and mucous membranes. Multiple etiologic agents have been implicated in the pathogenesis including several systemic medications. Two notable oncologic therapies, epidermal growth factor receptor inhibitors and vascular endothelial growth factor receptor inhibitors, have each been associated with drug-induced pyogenic granulomas. We report a novel case report of dual therapy, medication-induced pyogenic granulomas. This likely represents a synergistic relationship between an epidermal growth factor receptor inhibitor, osimertinib, and a vascular endothelial growth factor receptor inhibitor, ramucirumab.

Treatment of pyogenic granuloma with copper vapor laser radiation

Background. Pyogenic granuloma (PG) or lobular capillary hemangioma, ICD10 code: L98.0. appears as a single bright red or violet papule up to 20 mm in size, on the face, fingers, skull surface, arms, and intergluteal fold, as well as on the oral mucous membranes. Surgical removal of facial PG is not always possible due to insufficient thickness of the dermis. Treatment of PG with a pulsed dye laser (PDL) or neodymium laser (Nd:YAG) can achieve a noticeable elimination of the lesion but is reported to be accompanied by such side effects as purpura or scarring. It determines the feasibility of introducing into clinical practice the methods of laser treatment of PG using the radiation of a copper vapor laser (CVL) with a wavelength of 578 nm, which effectively absorbed by the blood. Aim. The assessment of the clinical efficacy and safety of the CVL treating PG. Methods. 26 adult patients with PG in various parts of the face, including the lips, limbs, and trunk, were included in this study. PG treatment was carried out in one session with CVL (Yakhroma-Med, FIAN) at an average power of 0.71.0 W, at a wavelength of 578 nm, exposure time 0.20.3 s. The diameter of the light spot is 1 mm. Results. Immediately after the single laser treatment, the PG involved area became grey. In 710 days, the irradiated area was utterly similar to the adjacent intact skin. No postoperative bleeding or infection was noted. Side effects included mild skin atrophy. During the follow-up observation for five years, no side effects were found. Conclusion. The high efficiency of PG elimination using CVL in the absence of pronounced side effects allows suggesting this method for introducing into dermatologists and cosmetologists' clinical practice as a highly effective and inexpensive method of treatment.

Paronychia and Periungual Granulation as a Novel Side Effect of Ibrutinib: A Case Report

Ibrutinib is an oral covalent inhibitor of the Bruton's tyrosine kinase pathway and is approved for the treatment of B-cell malignancies including chronic lymphocytic leukaemia, mantle cell lymphoma, and Waldenström's macroglobulinaemia. It is generally a drug of choice for high-risk patients with indolent lymphomas. The safety profile of ibrutinib appears to be tolerable, with well-known side effects such as infections and haematologic complications. Additionally, dermatological adverse reactions with ibrutinib therapy have been reported to encompass maculopapular rash and hair/nail abnormalities. Here, we present a case of ibrutinib-induced paronychia and periungual granulation in a 40-year-old woman. To the best of our knowledge, this is the third description of ibrutinib-induced paronychia and periungual granulation.