Search

During the COVID-19 pandemic, acne was a commonly reported adverse reaction to medical face mask use amongst health care providers (HCP). A cross-sectional, online survey applied to HCP was conducted from December 17th 2020 until February 17th 2021. This study was approved by University's Ethical Committee and conducted according to the principles of the Declaration of Helsinki.

Background Many ingredients used in cosmetics evoke a comedogenic response. The concept of ''acne cosmetica'' was developed to link the use of certain ingredients to comedone formation. Various clinical research methods have been suggested for the effective screening of an ingredient that can worsen acne or acneiform eruption and confirm its clinical relevance as to whether it is used as a non-comedogenic claim. Although comedogenicity assessment has not yet been established, attempts have been made to evaluate the comedogenicity of cosmetic ingredients and find the most appropriate method to evaluate comedogenicity in human skin. Materials and methods Total 6 participants were included in the study. Each participant received patches on the upper back containing cocoa butter. We used reflectance confocal microscopy (RCM) to count the number of microcomedones and follicles induced by cocoa butter. Results The mean value change of microcomedone/follicle by the comedogenic substance was significantly higher than that of the non-applied site for 2 weeks (p = 0.0419). The mean value changes of the microcomedone diameter caused by the comedogenic substance were significantly larger than those found at the non-applied site at 2 and 4 weeks (p = 0.0026 and p = 0.0038, respectively). Conclusions We recommend RCM as a non-invasive real-time method that is useful for evaluating comedogenicity and early detection of a microcomedone.

Epidermal growth factor receptor (EFGR) inhibitors are targeted chemotherapeutic agents that are effective in treating various epithelial cancers. Cutaneous adverse effects, most commonly acneiform/papulopustular eruption, can occur with these medications and limit their tolerability. In severe cases, patients may refuse treatment with EGFR inhibitors because of the significant impact on the quality of life and aesthetic discomfort. We present a 72-year-old-man with a history of EGFR+ non-small-cell lung carcinoma who developed a severe acneiform eruption secondary to afatinib that failed to improve with various traditional treatment modalities. The patient was treated with dapsone and his acneiform eruption resolved within two months of initiating therapy. Patient tolerated dapsone with no reported adverse effects and continues on low dose dapsone, as he will remain on afatinib indefinitely. Dapsone can be an effective therapy for refractory or severe cases of EGFR-induced acneiform eruptions. As in this case, dapsone may improve patient adherence to EGFR inhibitors, thereby allowing for effective therapy of underlying malignancy.

Acne vulgaris is an inflammatory disorder of the pilosebaceous unit typical of adolescent age, even though adulthood onset is not rare in females. Lesions typical of acne include comedones, inflammatory papules, pustules, nodules and cysts. Acneiform eruptions are the main differential diagnosis of acne vulgaris. The evidence of comedones may come in handy to differentiate acne vulgaris from acneiform eruptions as the latter typically do not display such a feature. Rosacea is a benign, inflammatory dermatosis, mainly affecting the central face, characterized by abnormal vasomotor responses, persistent vasodilatation and increased vascular permeability. The dermoscopic hallmark of erythematotelangiectatic rosacea is represented by blurred linear vessels arranged in a reticular pattern. Seborrheic dermatitis (SD) is a frequent inflammatory skin disorder involving areas characterized by high sebum production. Infantile SD typically presents as yellowish, greasy scale on the scalp that is often referred to as “cradle cap”.

Distinguishing between Malassezia folliculitis (Pityrosporum folliculitis [P. folliculitis]) and acneiform eruption, based on clinicopathological features, is challenging for clinicians. In the literature, the histopathological differences between P. folliculitis and acneiform eruption lesions have been poorly described. We aimed to determine the clinicopathologic distinctions between P. folliculitis and acneiform eruption by retrospectively analyzing the histology of hematoxylin and eosin stained tissue sections obtained from 52 patients diagnosed with these lesions. The presence of fungal spores in the follicular lumen was most consistent with a P. folliculitis diagnosis (P < 0.001). However, intrafollicular inflammation (P = 0.009), irregular patterns of keratin plugging (P = 0.008), and nuclear dust in the follicular lumen (P < 0.001) favored an acneiform eruption diagnosis. These intrafollicular characteristics and inflammatory differences are believed to be caused by necrotic keratinocytes that lead to vacuolar changes in the follicular wall (P = 0.013). We did not observe any difference between P. folliculitis and acneiform eruption lesions in terms of perifollicular inflammatory cell infiltration. Our study demonstrated that significant differences exist between P. folliculitis and acneiform eruption lesions relative to the presence of necrotic keratinocytes in the follicular wall, intrafollicular characteristics, and inflammatory cell infiltrations. Necrotic keratinocytes are believed to have a key role in these differences. These findings may contribute to an improved understanding of the pathogenesis and differential diagnosis of P. folliculitis and acneiform eruption.

Although epidermal growth factor receptor inhibitors (EGFRIs) are effective in treating advanced carcinomas, they frequently cause acneiform eruption, which could be related to sebaceous gland activity ; however, the mechanism remains largely unknown. Based on the facts that 1) activation of aryl hydrocarbon receptor (AHR) regulates follicular and epidermal keratinocyte differentiation and sebaceous gland activity, 2) EGFR signaling compensates for AHR signaling by sharing p300, and 3) sebum production is increased during EGFRI treatment, we hypothesized that EGFRI-induced activation of AHR may be involved in the development of acneiform eruption. / To demonstrate this, we administered clinically utilized EGFRIs, namely gefitinib and anti-EGFR antibody (Ab), to normal human epidermal keratinocytes (NHEKs) and human sebocyte cell line SEB-1, and examined whether gefitinib and anti-EGFR Ab induced AHR activation. Gefitinib treatment induced up-regulation of CYP1A1 mRNA in NHEKs and SEB-1 cells, which was further enhanced by 6-formylindolo (3,2-b) carbazole (FICZ), an endogenous AHR ligand. Although anti-EGFR antibody treatment alone did not induce up-regulation of CYP1A1 mRNA in NHEKs and SEB-1 cells, it enhanced FICZ-induced up-regulation of CYP1A1 mRNA. In the SEB-1 cells, sebum production was increased by gefitinib treatment, and further enhanced by FICZ. Moreover, knockdown of AHR expression, using siRNA transfection of AHR, inhibited sebum production by gefitinib treatment, thereby indicating that EGFRI-induced AHR activation is involved in the increase of sebum production. / To extend our in-vitro observation, we orally administered gefitinib to C57BL/6 mice and applied FICZ on their abdomen. Gefitinib treatment induced up-regulation of CYP1A1 mRNA in the epidermis, which was enhanced by topical application of FICZ. These data together suggest that AHR activation in keratinocytes and sebocytes, with subsequent sebum production induced by EGFRIs, may play an important role in the development of acneiform eruption., 上皮成長因子受容体阻害薬は進行期の癌に対して有効であるが，しばしば，副作用としてざ瘡様発疹症を生じる．これには脂腺の活動性が増加することが関連することが示唆されているが，その機序はほとんど知られていない．我々は，1）芳香族炭化水素受容体が毛包上皮細胞や表皮細胞の細胞分化を制御し，脂腺の活動性も制御すること，2）上皮成長因子受容体シグナルと芳香族炭化水素受容体シグナルはp300 タンパクを共有しており，お互いに競合しあうこと，3）上皮成長因子受容体阻害薬の投与を開始すると皮脂の分泌が増加すること，という事実に基づき，上皮成長因子受容体阻害薬によって芳香族炭化水素受容体の活性化されることが，ざ瘡様発疹症の発症に関与しているのではないかという仮説を立てた． / この仮説を証明するために，正常ヒト表皮細胞とヒト脂腺細胞のcell line であるSEB-1 細胞に対して，上皮成長因子受容体阻害薬（ゲフィチニブ，抗上皮成長因子受容体抗体）を投与し，芳香族炭化水素受容体が活性化されるかを検討した．ゲフィチニブ，抗上皮成長因子受容体抗体の投与は，CYP1A1 の発現の増加を誘導し，この現象は芳香族炭化水素受容体に対する内因性リガンドであるFICZを投与するとさらに増強した．また，SEB-1 細胞にゲフィチニブを投与したところ，皮脂の分泌が増加し，FICZ を投与するとさらに皮脂の分泌は増加した．さらに，芳香族炭化水素受容体の発現をsiRNA によって低下させた状態では，ゲフィチニブを投与しても皮脂の分泌は増加しなかった． / さらに，in vivo でも同様の結果が得られるか確かめるため，C57BL/6 マウスに対してゲフィチニブを経口投与し，同時に腹部にFICZを外用した．腹部の皮膚を回収し，CYP1A1 の発現について解析したところ，ゲフィチニブを投与すると，CYP1A1 の発現の増加が誘導され，FICZ を外用するとさらにCYP1A1 の発現の増加が増強された． / 以上から，上皮成長因子受容体阻害薬によって生じる芳香族炭化水素受容体の活性化は，ざ瘡様発疹症の発症において重要な役割をしている可能性が示唆された．

In diesem CME-Fortbildungsbeitrag wird ein Uberblick uber das chemische Peeling vermittelt. Die molekularen Grundlagen einiger ausgewahlter Indikationen werden erlautert und die jeweils zutreffenden Grundvoraussetzungen, Vorsichtsmasnahmen sowie mogliche Komplikationen diskutiert. Ferner werden einzelne verfugbare oberflachliche Peelingsubstanzen vorgestellt, und der prinzipielle Ablauf einer chemischen Peelingbehandlung wird umrissen.

Aim: To assess the patterns of dermatological adverse drug reactions (ADRs) and drugs responsible to formulate a strategy for prevention and treatment using a new app. Materials and Methods: In the present study, 870 patients in dermatology outpatient department were screened, out of which sixty cutaneous ADRs were included in the study. The ADRs were categorized and assessed by Causality Assessment Scale and Preventability Scale using an innovative mobile software application named “Pharmvigill©-ADR analyzer App. ”Results: It was observed that rashes and acneiform eruption (25% and 16.7%, respectively) were the most common cutaneous ADRs. Nonsteroidal anti-inflammatory drugs (25%) were the most common group of drugs causing cutaneous ADRs followed by antimicrobial drugs (23.3%) and steroids (20%). Similarly, betamethasone, paracetamol, and phenytoin were the most common drugs causing ADRs. In the causality assessment, almost 81% fell into the category of “probable, ”whereas 58.8% of the ADRs were “probably preventable ”and almost 40% were “not preventable. ”There was no statistically significant difference (P > 0.05) between scores in manual assessment and software-based assessment. Conclusion: Cutaneous ADRs are caused by some of the very commonly prescribed medicines. A high degree of suspicion is required to identify the “preventable ”type of ADR. The ADR analysis app “Pharmvigill ”is accurate and can decrease the analysis time of the ADRs in a dynamic clinical scenario.

Epidermal growth factor plays a critical role in tumor growth and progression, including cell proliferation, inhibition of apoptosis, angiogenesis, invasion, and metastasis. Cetuximab is the first monoclonal antibody that effects by binding to epidermal growth factors in the treatment of metastatic colorectal cancer. Because of the increasingly frequent use of epidermal growth factors inhibitors such as cetuximab in oncology services, perhaps more patients with the dermatologic complaints may require evaluation by dermatologists. Here, we report a case of severe acneiform eruption, hypertrichosis, telangiectasia, paronychia, ingrown toenails, pyogenic granuloma-like lesions, and digital fissures due to cetuximab in a 53-year-old female patient with colorectal cancer with metastases.

Thalidomide has become the gold standard for the treatment of erythema nodosum leprosum (ENL) within a few decades of its serendipitous discovery for this condition. It has also demonstrated efficacy in dermatoses such as recalcitrant oral aphthae, prurigo nodularis, and pyoderma gangrenosum. Despite a good safety profile, thalidomide is known to cause side effects such as sedation, constipation, peripheral neuropathy, and thromboembolism. Although rare and anecdotal, adverse cutaneous drug reactions (ACDRs) have been reported. Both thalidomide and its newer analogs have been implicated for maculopapular, urticaria-angioedema, Steven–Johnson-like, toxic epidermal necrolysis, and acneiform eruptions. Only a few cases of leukocytoclastic vasculitis (LCV) occurring in patients of multiple myeloma on this drug have been described till date. However, this unusual presentation of ACDR due to thalidomide in leprosy has not been hitherto documented. Herein, we describe a patient of lepromatous leprosy with ENL who developed thalidomide-induced LCV and discuss myriad aspects such as immunopathogenesis with emphasis on the possible role of various cytokines such as interleukin (IL)-2, IL-6, IL-12, and tumor necrosis factor-alpha.

Background: Targeted chemotherapeutic drugs have led to a remarkable improvement in the survival of cancer patients but also have resulted in the increased incidence of uncommon but specific muco-cutaneous adverse effects. Aims: This study aimed to highlight the spectrum of such cutaneous adverse drug reactions and to derive a causal association. Materials and Methods: A hospital-based, descriptive study was carried out in the dermatology outpatient department between August 2016 and July 2018, on patients referred from the state cancer institute, who developed muco-cutaneous lesions after the initiation of targeted chemotherapeutic drugs. Results: A total of 80 patients, 59 (74%) males and 21 (26%) females of mean age 45.83 ± 16.37 years (range 4–70 years) developed one or more uncommon albeit specific muco-cutaneous adverse effects. Among them, papulopustular and acneiform eruptions were found in 21 patients (26.25%), and PRIDE complex was seen in 3 patients. Sixteen patients (20.00%) developed palmar-plantar erythrodysesthesia, 8 patients (10%) developed lichenoid drug eruption, and 5 patients (6.25%) developed flagellate dermatitis. Twenty-two (27.5%) patients showed nail changes, the most common, being melanonychia. Conclusion: There has been a paradigm shift in the management of both hematopoietic and solid cancers with the advent of targeted chemotherapeutic drugs leading to an increase in uncommon and specific drug reactions. Early recognition of these decreases morbidity, improves quality of life, and allows continuation of the life saving chemotherapy.

Background & objectives: Tyrosine kinase inhibitors (TKIs) targeting the epidermal growth factor receptor (EGFR) have been evaluated in patients with advanced non-small cell lung cancer (NSCLC). Erlotinib and gefitinib are the first-generation EGFR-TKIs for patients with NSCLC. However, there is a paucity of studies comparing the effectiveness of these two drugs. Hence, this study was aimed to compare the effectiveness and safety of erlotinib and gefitinib in NSCLC patients. Methods: This study included 71 NSCLC patients who received EGFR-TKIs between 2013 and 2016. Adverse drug reaction of both erlotinib (n=37) and gefitinib (n=34) was determined and graded according to Common Terminology Criteria for Adverse Events grading system. Effectiveness was measured using response evaluation criteria in solid tumours and progression-free survival (PFS). Pharmacoeconomic analysis was performed by cost-effective analysis. Results: When comparing safety profile, both the drugs had similar adverse events except for dermal side effects such as acneiform eruption (51.4%), rash (54.05%) and mucositis (59.5%) for erlotinib and 20.6, 26.5 and 29.4 per cent for gefitinib, respectively. The PFS of the two drugs was compared to differentiate the effectiveness of erlotinib and gefitinib. There was no significant difference between the effectiveness of the two drugs. The pharmacoeconomic analysis showed that gefitinib was more cost-effective than erlotinib. Interpretation & conclusions: This study showed that erlotinib and gefitinib had similar effectiveness but gefitinib had a better safety profile compared to erlotinib. Therefore, gefitinib could be considered a better option for NSCLC patients compared to erlotinib. However, further studies need to be done with a large sample to confirm these findings.

Introduction: Cutaneous adverse drug reactions (CADRs) are the most common adverse drug reactions reported in the literature. CADRs have resulted in disabling infirmities during hospitalization and complications following outdoor drug therapy. The pattern of CADRs and the responsible drugs usually changes with the introduction of newer drugs and evolving clinical practices. Moreover, several international studies showed variable prevalence, emphasizing the need for local data in light of different socioeconomic and demographic practices. Therefore, the purpose of this study is to evaluate the prevalence of adverse cutaneous drug reactions and identify the clinical spectrum and any potential risk factors. Methodology: The current study is a descriptive cross-sectional study conducted at Aga Khan University Hospital, Pakistan. One hundred ninety-three patients who met the study inclusion criteria were included. Data were collected from patients on a proforma after taking informed consent. Quantitative data were presented as simple descriptive statistics giving mean and standard deviation, while qualitative variables were presented as frequency and percentages. Effect modifiers were controlled through stratification to highlight the effect of these on the outcome variable. The post-stratification chi-square test was applied and the p-value of ≤0.05 was statistically significant. Results: A total of 193 patients who had cutaneous adverse drug reactions were included in the study. The mean age in this study was 47.78±8.33 years. One hundred eight (56%) were male and 85 (44%) were female. Out of 193 patients, 135 (69.9%), 50 (25.9%), 24 (12.4%), 12 (6.2%), 20 (10.4%), 11 (5.7%) and six (3.1%) had maculopapular rash, acneiform eruptions, Stevens-Johnson syndrome, erythema multiform, urticaria, fixed drug eruptions and toxic epidermal necrolysis, respectively. Conclusion: CADRs are a common clinical presentation and awareness and knowledge about their diagnosis and prevention is important. It can be assumed that in our local setup, the clinical trends and medications causing ADRs are strikingly similar to those found in other countries. Physicians commonly come across these cases and they should be well aware of the clinical spectrum of skin reactions to enable early diagnosis and management.

Two adolescent boys presented with acute acneiform eruptions in the setting of recent dupilumab administration. Subsequent investigation via direct scraping of pustules revealed live Demodex mite colonization of the face. These adolescent patients represent a population not commonly associated with Demodex folliculitis, and we theorize their baseline commensal Demodex mite population may have increased as a consequence of dupilumab-induced, focused immunomodulation. We recommend that pediatricians consider Demodex potentially etiologic in patients presenting with new onset acneiform or rosacea-like dermatoses in patients treated with dupilumab.

BACKGROUND AND OBJECTIVES To evaluate the efficacy and safety of fractional 1064 nm Nd:YAG picosecond laser combined with intense pulsed light (IPL) in the treatment of atrophic acne scar with post-inflammatory erythema (PIE). © 2021 Wiley Periodicals LLC. STUDY DESIGN/MATERIALS AND METHODS Seventeen patients received five sessions of treatment at weeks 0, 4, 8, 12, 16 and were followed up at week 28. One half of the face was randomly treated by fractional 1064 nm Nd:YAG picosecond laser combined with IPL (FxPico + IPL), and the other by IPL alone as a control. RESULTS For the 15 patients who completed the study, the FxPico + IPL side demonstrated significant median Echelle D'evaluation clinique des cicatrices D'acne (ECCA) score improvement (P

The COVID-19 pandemic has led to more stringent infection control practice within hospitals, with the added requirement of personal protective equipment (PPE). Consequentially, the incidence of PPE-related dermatoses in healthcare workers is increasing. Analysis of staff members seen in a dermatology self-referral service during the first COVID-19 peak revealed a wide range of healthcare professionals being affected, with irritant hand dermatitis and acneiform eruptions being the commonest diagnoses. These PPE-related dermatoses had significant effects on staff members' work and wellbeing, which improved following assessment and treatment by dermatology. Given the change to our behaviour wearing PPE daily, which is likely to continue for the foreseeable future, the consequences will inevitably affect both healthcare workers and the general public, with these common dermatoses presenting in both primary and secondary care. It is therefore imperative to recognise both the physical and emotional impact that COVID-19 PPE has, and initiate prompt treatment to improve wellbeing.

The most common adverse event of epidermal growth factor receptor inhibitors, used to treat colorectal, non-small cell lung, and head and neck cancers, is acneiform eruption, with a profound effect on treatment continuation. Prolonged acneiform eruptions treated with topical corticosteroids, a standard management, may be associated with secondary bacterial infections, thus there is a need for new treatments. We conducted a multicenter, phase II trial to evaluate the efficacy and safety of topical benzoyl peroxide for epidermal growth factor receptor inhibitor-induced prolonged acneiform eruptions. Patients with colorectal, non-small lung cell, and head and neck cancers who received epidermal growth factor receptor inhibitors for >10 weeks and had persistent acneiform eruptions were eligible. Topical benzoyl peroxide was applied to the affected area of the face once daily for 8 weeks; a clinical evaluation was performed every 2 weeks. The primary endpoint was a change in acneiform eruption severity evaluated between disease onset and end of the treatment period. The quality of life of patients was assessed using the Dermatology Life Quality Index. Of the 14 enrolled patients, 11 completed the trial. The protocol-specified grade of acneiform eruptions from baseline to week 8 improved from 2.0 to 1.0 (P < 0.01). The dermatology life quality index score from baseline to week 8 improved from 3.0 to 1.0 point (P < 0.01). No patient experienced severe adverse events. Overall, topical benzoyl peroxide may be effective for treating and managing prolonged acneiform eruptions induced by epidermal growth factor receptor inhibitors.

Drug-induced facial diseases are numerous. Clinical presentations can be various, from acneiform eruptions to photosensitivity. As a result, management is a challenge. This chapter presents the most frequent facial complications related to systemic or topical administration of drugs.

Acne is a common disease, and its diagnosis is usually easy. In this chapter, not only unusual or special types of acne but also acne-like diseases that are clinically and etiologically different from acne vulgaris are discussed. The former category includes neonatal acne, acne conglobata, acne fulminans, cosmetic acne, acne excoriee, steroid acne, chloracne, hormonal acne including polycystic ovary syndrome, drug-induced acne, SAPHO syndrome, and so on. The other category is represented by rosacea, perioral dermatitis, folliculitis including Malassezia folliculitis and demodicosis, sycosis barbae, eosinophilic folliculitis, acneiform eruption due to anti-EGFR drugs or other anti-cancer drugs, and other non-follicular diseases such as lupus miliaris disseminatus faciei.

Solid organ transplant recipients (SOTRs) are susceptible to various cutaneous side effects as a consequence of long-term immunosuppressive therapy. Skin cancers and infections are well-studied complications that can cause death and/or allograft rejection. Other cutaneous drug reactions, such as inflammatory manifestations, have a high prevalence but are rarely studied. We analyzed these manifestations' prevalence and their association with immunosuppressants in transplant recipients from a Brazilian tertiary center. Among 532 SOTRs followed at our dermatology clinic, 60 (11.3%) developed some cutaneous adverse reactions to the immunosuppressants, with a median age at transplantation of 50.5 years and a median life span posttransplantation of seven years. Acneiform eruption was the most common drug reaction found (21 patients, 30.4%), followed by diffuse non-scarring alopecia (16 patients, 23.1%), lymphedema (10 patients, 14.5%), gingival hyperplasia (7 patients, 10.1%), hypertrichosis (6 patients, 8.7%) and sebaceous hyperplasia (9 patients, 13.1%). Adequate immunosuppression is an essential prerequisite for successful organ transplantation. In the immediate post-transplant period, significant immunosuppression is needed, but after that, the complications of excessive immunosuppression outweigh the risk of organ rejection. SORTs may present with a broad spectrum of inflammatory and cosmetic findings due to immunosuppressants that can impair life quality.

Epidermal growth factor receptor inhibitors (EGFRs) are chemotherapeutic agents used in multiple solid organ malignity. These medications have common dermatological side effects, particularly papulopustular (PPL) lesions. The management of the diagnosis and treatment processes for such side effects may facilitate the continuation of chemotherapy and enhance the patient's quality of life.The objective of this study is to report the cutaneous side effects of EGFR inhibitors and to share treatment methods for such side effects.In this prospective study, 59 patients using EGFR due to breast and colorectal carcinoma at the oncology unit of Haseki Training and Research Hospital were assessed. The patients for whom EGFR was initiated were examined at the beginning of the treatment at weeks 1 and 2, their demographic characteristics were recorded, and the patients who developed a skin rash were followed up from the onset of the lesion. The PPL side effects that developed in the patients and other dermatological findings were recorded. The PPL side effects were graded, and the treatment plans were reported. The study was conducted between February 2016 and February 2018 under the approval of the local ethical committee.The mean age of the 59 patients (47 females, 12 males) taking EGFR inhibitors was 52.4 ± 12.0 (range: 29-84). Forty-five patients had early stage and 14 patients had advanced stage carcinoma. Fourteen patients had colorectal carcinoma, three patients had renal cancer, and 42 patients had breast cancer. Forty-two patients were using trastuzumab (single therapy in 29 patients and combined therapy in 13 patients), five patients were using cetuximab, three patients were using sunitinib, eight patients were using panitumumab, and six patients were using pertuzumab. In 22 patients, PPL side effects were observed in the skin; it was G1 in 19 patients and G2 in three patients. In seven patients who developed acneiform side effects, systemic doxycycline was used, and in others, topical tetracycline and clindamycin were used. Except for one patient using trastuzumab, all patients has lesions on the face, upper trunk, and back. One patient exhibited an atypical rash, which was diagnosed as a granulomatous follicular reaction. Xerosis was present in two cases, and paronychia, pyogenic granuloma, trichomegaly, and madarosis were observed in one patient each. The patients who developed an acneiform rash were treated with topical and systemic antibiotics, light keratolytics, and emollients. The skin side effects of all patients were mild to moderate, and all patients completed the chemotherapy process. An acneiform skin rash and other dermatological side effects are common with EGFR inhibitors. To treat these side effects, emollients, topical steroids, and local, systemic antibiotics are recommended. Clindamycin may be preferred as a topical treatment, and doxycycline may be preferred as a systematic treatment.

Background: Epidermal growth factor receptor (EGFR) inhibitors are routinely used in advanced non-small-cell lung cancer (NSCLC) harboring EGFR mutations. However, their use is associated with gastrointestinal and cutaneous toxicities, including acneiform eruptions, pruritus, xerosis, nail and hair changes. Aside from reducing patients’ quality of life, such cutaneous reactions have a considerable impact on the oncologic treatment given that dose reduction or even drug discontinuation may be necessary, especially for the severe forms. Objectives: To assess the incidence, impact on treatment and management of EGFR inhibitor-related cutaneous reactions in patients with NSCLC. Methods: We conducted a prospective observational study on 87 consecutive patients with advanced NSCLC treated with EGFR-tyrosine kinase inhibitors from January to December 2019. Patients who developed mucocutaneous reactions were evaluated and treated by both oncologists and dermatologists, and underwent dermatologic follow-up until resolution of the cutaneous reaction. Demographic and clinical data were collected for each patient, and the severity of the cutaneous reaction was graded using the Common Terminology Criteria for Adverse Events. Results: Seventy-one patients (81.6%) developed cutaneous reactions. The number of cutaneous reactions per patient was 1 in 37%, 2 in 41% and 3 or more in 22%. The most common cutaneous reactions included acneiform eruptions (56.3%), xerosis ± asteatotic eczema (48.3%), nail changes (39.1%), mucositis (29.9%), pruritus (24.1%) and hair changes (12.6%). Afatinib was associated with a higher rate of nail changes and mucositis (p < 0.01 and p < 0.005, respectively) compared to other agents, while no patient-related predictive factors were identified. Dose reduction was performed in 18% of patients. Multidisciplinary management involving dermatologists allowed to resume the drug in all patients who had discontinued it due to the cutaneous reactions. Conclusions: A multidisciplinary approach to EGFR inhibitor-related cutaneous reactions is advantageous and can reduce the need to discontinue oncologic treatment.

Background Treatment with BRAF inhibitors (BRAFI) and MEK inhibitors (MEKI) causes cutaneous reactions in children, limiting dosing or resulting in treatment cessation. The spectrum and severity of these reactions is not defined. Objective To determine the frequency and spectrum of cutaneous reactions in children receiving BRAFI and MEKI and their effects on continued therapy. Methods A multicenter, retrospective study was conducted at 11 clinical sites in the United States and Canada enrolling 99 children treated with BRAFI and/or MEKI for any indication from January 1, 2012, to January 1, 2018. Results All children in this study had a cutaneous reaction; most had multiple, with a mean per patient of 3.5 reactions on BRAFI, 3.7 on MEKI, and 3.4 on combination BRAFI/MEKI. Three patients discontinued treatment because of a cutaneous reaction. Treatment was altered in 27% of patients on BRAFI, 39.5% on MEKI, and 33% on combination therapy. The cutaneous reactions most likely to alter treatment were dermatitis, panniculitis, and keratosis pilaris–like reactions for BRAFI and dermatitis, acneiform eruptions, and paronychia for MEKI. Conclusions Cutaneous reactions are common in children receiving BRAFI and MEKI, and many result in alterations or interruptions in oncologic therapy. Implementing preventative strategies at the start of therapy may minimize cutaneous reactions.

Cutaneous manifestations due to drugs used in the treatment of gastrointestinal disorders are multiple and common. Adequate diagnosis is of great importance, bearing in mind that the therapeutic regimen depends on its diagnosis. In this review, we provided an overview of the most common drug-induced skin lesions with a detailed explanation of the disease course, presentation and treatment, having in mind that in recent years, novel therapeutic modalities have been introduced in the treatment of various gastrointestinal disorders, and that incidence of cutaneous adverse reactions has been on the rise.

Cutaneous toxicities associated with EGFR inhibitors (EGFRIs) have a significant impact on patient treatment continuation, quality of life and healthcare resource utilization. This paper reviews the current prophylaxis and management of EGFRI-induced cutaneous toxicities in patients with colorectal cancer, and combines these findings with the authors’ clinical expertise to define a novel algorithm for healthcare professionals managing patients receiving EGFRIs. This tool includes a grading system based on the location, severity and psychological impact, and provides a standard prescription pack, advice on prophylaxis/self-management of cutaneous symptoms for patients initiating EGFRIs, and essential guidance on subsequent review and treatment escalation. It aims to optimize treatment of metastatic colorectal cancer by minimizing cutaneous toxicities to maintain dose intensity and efficacy of EGFRI-based chemotherapy.

Background Patients treated with vemurafenib for metastatic melanoma often develop skin lesions similar to those observed after exposure to dioxin-like compounds. We previously called these lesions MADISH (metabolizing acquired dioxin-induced skin hamartoma) when analysing a case of acute dioxin poisoning. Objective We performed a clinical trial aimed at comparing the skin lesions observed under vemurafenib treatment with MADISH in order to bring to light a possible crosstalk between vemurafenib and dioxin pathways. Methods In this case series study, we explored the histological aspect of skin lesions in 10 cases treated with vemurafenib for malignant melanoma. We also analysed the ability of vemurafenib and tyrosine kinase inhibitors to induce dioxin-AhR pathway. Results All patients had skin lesions diagnosed as 'non-inflammatory acneiform eruption' by dermatologists. These were predominantly facial with notable retroauricular involvement and clinically compatible with chloracne/MADISH when assessed by dioxin expert. Histological analysis showed mostly comedone-like lesions and dermal cysts containing epithelial wall with basal or lateral epithelial projections and lamellar keratinization and alterations of remaining sebaceous glands. The expression of CYP1A1, a gene highly induced following dioxin exposure, was not observed in these lesions. Vemurafenib and the tyrosine kinase inhibitors erlotinib and gefitinib did not induce CYP1A1 activity. Discussion Although the skin lesions under vemurafenib treatment were morphologically similar to MADISH, the absence of CYP1A1 expression in dermal cysts of patients and the absence of CYP1A1 activation by vemurafenib led us consider that these skin lesions were different from true MADISH and not mediated by a crosstalk of AhR signalling, but rather to a hyperactivation of PI3K-Akt pathway as a consequence of vemurafenib treatment. A strong expression of CYP1A1 in the epithelial wall of dermal cysts must be required, parallel to the morphology of the lesions, to make the diagnosis of MADISH, the hallmark of an exposure to dioxin-like/chloracnegen compounds.

Behcet’s disease (BD) is a systemic inflammatory disorder and involvement of the bowel leads to a poor prognosis due to perforation of intestinal ulcers and penetration of ulceration into surrounding organs. We describe the clinical features of 4 Japanese BD patients (1 male) with intestinal lesions detected by colonoscopy, and the 4 patients had no abdominal complaints at their first admission to our hospital from 2003 to 2005. Case 1 was a 74-year-old woman, Case 2 was a 25-year-old woman, Case 3 was a 32-year-old woman, and Case 4 was a 32-year-old man. The characteristics of BD which they all had in common were recurrent oral aphthous ulcers, erythema nodosum, acneiform eruption, genital ulcers, polyarthritis and gastrointestinal lesions without abdominal complaints. None of these patients were positive for HLA-B*51, but all of them had HLA-A*26. Our findings suggest that screening colonoscopy is important for diagnosing intestinal BD in order to achieve a good prognosis.

Introduction:Panitumumab (VECTIBIX®) is a monoclonal antibody used alone or in combination with a chemotherapy for management of metastatic colorectal cancer.Observation:A patient treated with this protocol manifested skin lesions; the etiological diagnosis was difficult. The lesions, namely a papulopustular rash at the lower third of the face, and the medical history allowed to diagnose an acute skin toxicity case due to this monoclonal antibody.Commentary:Many side effects are related to the panitumumab, among which dermatologic adverse events having already been the subject of some publications. Nevertheless, several studies conclude that the therapeutic benefit of this epidermal growth factor receptor inhibitor makes acceptable these complications.Conclusion:Stop treatment and corticosteroids allowed a whole and quick disappearance of skin lesions. Alongside dermatologists and infectious diseases specialists, the opinion of an oral surgeon was useful to provide an answer to these symptoms.

Follicular mucinosis (FM) can present as an acneiform eruption, and is usually a benign variant of primary FM unrelated to cutaneous T-cell lymphoma (CTCL). We report two cases of women in their twenties who presented with an acneiform rash on the face, arms and back. In both cases, pathological evaluation of the facial papules revealed predominantly mucinous degeneration of the follicular epithelium, with insufficient lymphocytic infiltration or atypia to diagnose mycosis fungoides. These cases are similar to previous reports of acneiform FM. As none of the reported cases progressed to CTCL, we consider that overdiagnosis and overtreatment should be avoided in acneiform FM, but recommend long-term follow-up.

BACKGROUND Tularaemia is a zoonotic infectious disease caused by Francisella tularensis, an aerobic, uncapsulated, gram-negative coccobacillus. Several case reports have appeared on the dermatological manifestations of tularaemia, but relatively few longer-term studies are available. AIM To identify skin features of tularaemia that aid in its diagnosis. METHODS In total, 168 patients (68 male, 100 female) diagnosed with tularaemia were retrospectively examined. All dermatological data for these patients were evaluated. RESULTS Of the 168 patients, 149 (88.69%) had tularaemia of the oropharyngeal type, 12 (7.73%) had the ulceroglandular type, 5 (2.9%) had the oculoglandular type and 2 (0.59%) had the pulmonary type. Secondary skin manifestations were found in 26 patients (15.47%). Sweet syndrome (SS) was found in 11 patients (6.54%), most of whom presented with the oropharyngeal form, while erythema nodosum (EN) was found in 7 patients (4.16%), dermatitis in 2 (1.19%), urticaria in 2 (1.19%), acneiform eruptions in 1 (0.59%), vasculitis-like eruptions in 1 (0.59%) and SS + EN in 1 (0.59%). Patients with the oropharyngeal form had a statistically significant (P < 0.001) higher number of skin findings than patients with the other forms. CONCLUSIONS In clinical practice, tularaemia may present with various cutaneous manifestations, and dermatologists who work in endemic regions must be aware of the possibility of this disease.

Introduction: Steroid induced dermatoses on face are one of the common presentations in Dermatological practice. Objectives: 1) Understand the clinical patterns of adverse effects of long term abuse of topical steroid on face and 2) Assess the factor which promotes its abuse. Materials and Methods: This was a descriptive exploratory cross-sectional study carried out from December, 2013 through November, 2014. A total of 39 patients fulfilling the inclusion criteria were enrolled into the study. All the study variables were recorded using preformed structured questionnaire and analyzed. Results: The following effects of steroid abuse on face were seen: pruritus (38.5%), burning (15.4%), eythema (74.4%), telangiectasias (66.7%), acneiform eruptions (59%), comedones (35.9%), xerosis (55.1%), photosensitivity (51.3%), rebound phenomenon (38.5%) and others (38.5%). Most of them used steroids on recommendation of their friends (38.5%) and pharmacists (20.5%). All of them used steroid for different dermatoses on their face. Limitations : This is a hospital-based small-scale study and might not be true picture of problem in the community. Conclusion : Long term use of steroid on face results in different clinical presentations. Most of the patients used steroid on recommendation of their friends facilitated by easy availability of the drug over- the -counter.

Disorders involving follicular occlusion, such as hidradenitis suppurativa, folliculitis, acneiform eruptions, and pilonidal cysts, have shown an increased prevalence in the Down syndrome (DS) population, but there are limited published data examining this association. We conducted a retrospective chart review of 243 DS patients presenting to a pediatric dermatology clinic to further examine the prevalence of disorders of follicular occlusion in DS patients. Our study showed high rates of disorders of follicular occlusion in DS patients, with prevalent disorders including folliculitis (21.0%), keratosis pilaris (17.3%), acne vulgaris (11.1%), hidradenitis suppurativa (7.0%), and furunculosis (4.5%), and overall prevalence of 44.9%. These findings add to a limited but growing body of evidence that documents an increased rate of disorders of follicular occlusion in pediatric DS patients.