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Pityrosporum folliculitis (PF) is a fungal acneiform disease of the hair follicles that often presents with pruritic papules and pustules on the upper body and face. This condition is commonly mistaken for acne vulgaris and can be distinguished from bacterial acne by the presence of fungal spores in the follicular lumen. Although studies have been performed to describe PF in cohorts, little work has been done to aggregate these data. Thus, the goal of this review is to describe the clinical characteristics and treatment outcomes of PF in immunocompetent patients. PubMed, Web of Science, and Embase were searched using the terms "Pityrosporum folliculitis" or "Malassezia folliculitis." All cohorts reporting PF characteristics in patients classified as immunocompetent were reviewed. A total of 15 studies were included. Majority of patients were male (64%) with the average age of presentation of 24.26 years. The most common locations of lesions were the chest (70%) and back/shoulders (69.2%). Pruritus was reported by the majority of patients (71.7%). Additionally, 40.5% of patients reported a history of unsuccessful treatment regimens. Treatment was most successful with an oral antifungal (92%), followed by a topical antifungal (81.6%). In conclusion, majority of patients with PF were younger males. Many patients were primarily treated incorrectly, suggesting the importance of proper diagnosis. PF may be distinguishable from acne vulgaris by the presence of pruritus or suggested when a new acneiform eruption develops following antibiotic therapy or immunosuppression. When properly diagnosed, majority of cases of PF achieve complete response with oral or topical antifungals.

Abstract Background Skin disorders are the most common side effect associated with epidermal growth factor receptor‐tyrosine kinase inhibitor (EGFR‐TKI) therapy. It is important to manage skin lesions. Adapalene has been used to treat skin lesions caused by EGFR‐TKIs in some cases. The aim of this study was to investigate the functional mechanism of adapalene in erlotinib‐induced skin disorder. Methods To analyze the effect of adapalene on skin rash, afatinib and adapalene were administered to mice. The relationship between the concentration of adapalene and skin disorders was also examined by analyzing AQP3 expression. A skin lesion model was experimentally established in human skin keratinocytes (HaCaT) by using erlotinib with TNF‐α and IL‐1β. We used qRT–PCR to analyze chemokine‐induced inflammation and western blotting to analyze the effects of adapalene on the NF‐κB signaling pathway. Antimicrobial peptides and adhesion factors were also examined using qRT–PCR. Results Mice administered 0.01% adapalene had less skin inflammation than mice treated with afatinib alone. The expression level of AQP3 decreased in an adapalene concentration‐dependent manner. The mRNA levels of proinflammatory cytokines such as CCL2 and CCL27 in HaCaT cells were significantly reduced by adapalene. The expression of an antimicrobial peptide, hBD3, was upregulated after adapalene treatment. Adhesion factors, such as E‐cadherin, were significantly downregulated by EGFR‐TKI and significantly upregulated by adapalene treatment. Western blot analysis suggested that erlotinib‐induced phosphorylation of p65 was decreased by adapalene. Conclusion We suggest that adapalene may be a possible treatment option for skin disorders induced by EGFR‐TKIs.

As a humanized monoclonal antibody targeting interleukin-17A, ixekizumab is increasingly used for the treatment of psoriasis vulgaris. Here, we present a male patient who developed acneiform eruption after using ixekizumab for psoriasis vulgaris. We described acneiform eruption without comedones on the anterior and posterior trunks of a 35-year-old patient with an estimated psoriasis area and severity index score of 32 at the sixth month of treatment. We successfully treated the patient within 1 month with benzoyl peroxide/clindamycin gel and oral azithromycin. Here, acneiform eruption represents a negative event that does not cause discontinuation of ixekizumab. We felt the need to write this case report to raise awareness of the association of this dermatological side effect, which we accept as a paradoxical reaction, with ixekizumab. [ABSTRACT FROM AUTHOR]

Background: Skin disorders are the most common side effect associated with epidermal growth factor receptor‐tyrosine kinase inhibitor (EGFR‐TKI) therapy. It is important to manage skin lesions. Adapalene has been used to treat skin lesions caused by EGFR‐TKIs in some cases. The aim of this study was to investigate the functional mechanism of adapalene in erlotinib‐induced skin disorder. Methods: To analyze the effect of adapalene on skin rash, afatinib and adapalene were administered to mice. The relationship between the concentration of adapalene and skin disorders was also examined by analyzing AQP3 expression. A skin lesion model was experimentally established in human skin keratinocytes (HaCaT) by using erlotinib with TNF‐α and IL‐1β. We used qRT–PCR to analyze chemokine‐induced inflammation and western blotting to analyze the effects of adapalene on the NF‐κB signaling pathway. Antimicrobial peptides and adhesion factors were also examined using qRT–PCR. Results: Mice administered 0.01% adapalene had less skin inflammation than mice treated with afatinib alone. The expression level of AQP3 decreased in an adapalene concentration‐dependent manner. The mRNA levels of proinflammatory cytokines such as CCL2 and CCL27 in HaCaT cells were significantly reduced by adapalene. The expression of an antimicrobial peptide, hBD3, was upregulated after adapalene treatment. Adhesion factors, such as E‐cadherin, were significantly downregulated by EGFR‐TKI and significantly upregulated by adapalene treatment. Western blot analysis suggested that erlotinib‐induced phosphorylation of p65 was decreased by adapalene. Conclusion: We suggest that adapalene may be a possible treatment option for skin disorders induced by EGFR‐TKIs. [ABSTRACT FROM AUTHOR]

The document explores the occurrence of acne in patients with atopic dermatitis undergoing treatment with upadacitinib, a Janus kinase inhibitor. Acne-like eruptions were observed in a significant number of patients, with most cases being mild to moderate in severity. The underlying cause of acne in these patients remains unclear, but it is suggested that upadacitinib's impact on CYP3A4 activity may play a role in reducing ATRA signaling, potentially contributing to acne development. Further research is needed to fully understand the relationship between JAK inhibitors and acne in patients with atopic dermatitis. [Extracted from the article]

Acneiform eruptions occur frequently and early in patients on epidermal growth factor receptor inhibitors (EGFRi). Identification of baseline patient risk factors would prompt earlier referral to dermatology to optimize prevention and management. The primary objective of this retrospective study is to determine the association between clinical and demographic characteristics and the development of acneiform eruptions. A retrospective chart review was conducted on patients diagnosed with colon and head and neck cancers who started EGFRi between January 2017 and December 2021. Patients were followed until death or September 2022. Baseline demographic and clinical parameters were documented and patients were followed from the time of diagnosis to most recent visit for the development and management of an acneiform eruption. Regression analyses were performed to determine the association between baseline characteristics and the development of acneiform eruptions. A total of 66 patients were treated with cetuximab or panitumumab between 2017-2021 were included in the analysis. Forty-seven of the sixty-six patients developed an acneiform eruption while on EGFRi therapy (71.2%). Combination cancer therapy with another chemotherapeutic agent was associated with a lower risk of acneiform eruption (OR 0.03, P =.027). No other baseline features were statistically associated with a lower risk of acneiform eruption. Acneiform eruptions are a common cutaneous adverse event of EGFRi therapy. Ongoing research is required to elucidate risk factors for the development of acneiform eruptions, to improve the quality of life of oncology patients. [ABSTRACT FROM AUTHOR]

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.

Background: Various biologic agents targeting specific molecules present new treatment options for various tumors. Acneiform eruption is a very common skin reaction to these agents. Although not life‐threatening, acneiform eruption can affect patients' emotional and social lives. In very exceptional cases, it can lead to cancer therapy interruption. Aims: The aim of this study was to review the incidence rate, clinical characteristics, pathogenesis, and current management of acneiform eruption induced by molecularly targeted agents. Methods: This review was carried out through PubMed, Embase, and Cochrane searching terms 'acneiform eruption', 'papulopustular eruption' or 'acne‐like rash' and 'skin toxicity', 'cutaneous toxicity', 'skin reactions', 'dermatological toxicities', 'target therapy,' or 'drug therapy'. Results: Of the 73 articles matched our search terms, 61 were original articles and 12 were case reports or case series. Acneiform eruption is most commonly observed in patients treated with epidermal growth factor receptor inhibitors and mitogen‐activated protein kinase inhibitors. Typical lesions consist of erythematous papules and pustules without comedones, accompanying with burning, pruritus, or xerosis. The pathogenesis involves inflammation and abnormalities of the follicular epithelium, where a disorder in EGFR signaling plays a key role. The treatment of acneiform eruption depends on the severity of the rash. Conclusions: Early recognition and effective management of this cutaneous adverse reaction can prevent unnecessary reduction and discontinuation of drug use and improve patient survival and quality of life. Close collaboration between oncologists and dermatologists is important to optimize therapy and improve patient survival. [ABSTRACT FROM AUTHOR]

Today, the cornerstone of modem oncology is the discovery cf targeted therapies. Although with fewer toxicities compared to conventional chemotherapy, the cutaneous adverse effects can determine the limitation of doses or even the interruption cf treatment. EGFR inhibitors produce numerous adverse skin reactions. Currently, EGFR inhibitors play an essential role in the oncological therapeutic arsenal, being used in the treatment of the following cancers: head and neck, lung, colon, prostate, breast, ovary, pancreas. Thus, recognizing the clinical signs, understanding the mechanism by which these adverse skin reactions occur, and most important knowing how to manage them is cf great importance for all dermatologists. [ABSTRACT FROM AUTHOR]

A 47-year-old, north african, male patient, has recently been diagnosed with pernicious anemia, treated with weekly intramuscular hydroxocobalamin. 6 weeks after its initiation, the patient presented a sudden, extensive and monomorphic eruption of inflammatory papulo-pustules and nodules, affecting the face, and the trunk. The eruption was pruritic, and comedones were also present, on the chest. The patient was diagnosed with vitamin B12-induced acneiform eruption. Levels of vitamin B12 were normalized. Hydroxocobalamin was therefore stopped and lymecycline was started, allowing a complete resolution of the lesions within 3 months. Drug intake, sudden and uncommon age of onset, pruritus, a monomorphic pattern and an involvement of extra-seborrheic areas are features that distinguish acneiform eruptions from acne vulgaris.

Introduction: Cutaneous adverse drug reactions (CADRs) are the most common adverse reactions attributed to drugs in which any type of skin reaction can be mimicked, induced, or aggravated. Aim and Objectives: To study the morphological patterns of various types of CADRs. Materials and Methods: It was a descriptive cross-sectional study carried out from November 2017 to September 2019, where medical records of diagnosed cases of CADRs were analyzed in a predesigned proforma with respect to demographic data, clinical features, treatment history (topical and oral), offending drug, temporal association with a skin eruption, investigations, and treatment outcome. Statistical analysis was done using mean, median, and proportion. Results: A total of 180 patients with CADRs were enrolled. There was a male preponderance with the mean age being 32.9 ± 2.9 years. The most common CADR reported was fixed drug eruption (n = 77). Steven Johnson syndrome was the most common (n = 7) severe cutaneous adverse reaction. The mean duration of latency was 6.2 (±8.61 days). Antimicrobial drugs accounted for most of the benign as well as severe CADRs (41.4%). Among all cases, 43.9% of patients had mild CADR and 16.7% had severe CADR. Causality assessment using the Naranjo adverse drug reaction probability scale, 70% had a possible association, 18.3% probable and 11.7% had a doubtful association. Conclusion: Early identification of CADR is important to reduce morbidity and mortality. Patient education is required to avoid self-administration of drugs and re-administration of the same offending drugs to prevent further morbidity. Immediate withdrawal of the culprit drug/drugs with adequate management can be lifesaving. [ABSTRACT FROM AUTHOR]

Introduction: Epidermal growth factor receptor (EGFR) inhibitors are established therapies for advanced lung, colorectal, and head and neck cancers. They commonly cause acneiform eruptions that affect patient quality of life and may lead to discontinuation of therapy. Methods: A systematic review and meta‐analysis was undertaken to assess strategies for the prevention and reactive management of acneiform rash associated with EGFR inhibitor therapy for advanced lung, colorectal, and head and neck cancers. A systematic Medline, Embase, and EBM Reviews database search was conducted on the 2nd of January 2021. The Preferred Reporting Items for Systematic Reviews and Meta‐analyses statement was followed and the studies were critically appraised. Studies were selected if they focused on preventing or treating acneiform eruptions in adults being treated for advanced lung cancer, colorectal cancer, and head and neck cancers with EGFR inhibitors. Results: Oral antibiotics had the greatest efficacy in preventing grade 2 or higher acneiform eruptions with a relative risk reduction of 40% (RR =.6, 95% CI.46–.79, p <.01). Other treatment modalities did not have statistically significant results. Topical antibiotics had a total relative risk reduction of 19% (RR =.81, 95% CI.45–1.48, p =.5). Vitamin K1 cream did not reduce the relative risk (RR = 1.08, 95% CI.45–1.48, p =.50). Sunscreen had a total relative risk reduction of 25% (RR =.75, 95% CI.49–1.14, p =.18). Conclusions: The results of this meta‐analysis reinforce the fact that oral tetracycline antibiotics are the most efficacious prophylactic option for acneiform eruptions in EGFR inhibitors. They should be offered to suitable patients commencing treatment and used with a general skin‐care routine involving emollients and avoidance of irritants. [ABSTRACT FROM AUTHOR]

Vemurafenib, a kinase inhibitor that targets tumors with the BRAF V600E mutation, is a promising option for unresectable or metastatic melanoma. Cutaneous side-effects have been reported including alopecia, photosensitivity, squamous cell carcinoma, keratoacanthomas, keratosis pilaris-like eruption, and palmoplantar hyperkeratosis. Acneiform eruptions have been reported in 3%-6% of the patients treated with BRAF inhibitors,and 5 cases are described in the literature. Although they responded well to topical therapies, oral antibiotics, or observation, one case required oral etretinate and the withdrawal of vemurafenib because the adverse event reached grade 3. We report one case of a severe acneiform eruption associated with vemurafenib with a good response to isotretinoin allowing continuation of the BRAF inhibitor.

The development of new biological drugs for the treatment of advanced oncological processes or severe inflammatory diseases brings with it the appearance of new adverse effects. Vedolizumab, an α4β7 integrin inhibitor antibody, is approved for induction and maintenance therapy in both Crohn disease and ulcerative colitis. We report a case of severe acneiform eruption induced by vedolizumab in a 17-year-old woman with ulcerative colitis.

We report the case of a patient with chronic granulomatous disease and acne treated with isotretinoin, who developed a diffuse staphylococcal skin infection during the therapy. Chronic granulomatous disease is a rare genetic disorder characterized by an altered innate immunity with an increased risk of potentially lethal bacterial and fungal infections. Although chronic granulomatous disease is rare, acne is a common manifestation in these patients, but there are no data about the gold standard therapy.

Purpose: Epidermal growth factor receptor inhibitors (EGFRI) can be used with pathway inhibitors, including mitogen-activated protein kinase kinase inhibitors (MEKIs), BRAF inhibitors (BRAFIs), and checkpoint inhibitors such as programmed death-ligand 1 (PD-L1) and programmed cell death protein 1 (PD-1) to treat colorectal cancer. These can precipitate treatment-resistant acneiform eruptions, prompting dose modification or discontinuation. Predicting the likelihood of severe rash development and crafting effective treatments may promote adherence to life-saving chemotherapy.Methods: An Institutional Review Board-approved retrospective chart review of patients with colorectal cancer treated with EGFRI or MEKI in combination with HER2, BRAF, PI3K, or checkpoint inhibitors between January 1, 2016, and January 1, 2020, was performed. Surrogates for rash severity were investigated, including lower extremity involvement, utilization of oral steroids or retinoids, dose modification, and incidence of superinfection.Results: Of 122 patients treated with combination therapy, 105 developed a rash, and 87 developed an acneiform eruption. Common combinations included MEKI/PD-LI, EGFRI/MEKI, and MEKI/PD-1I. Patients treated with EGFRI/MEKI developed the most severe rashes (p = 0.02). Lower extremity involvement was more frequent with EGFRI/MEKI compared to alternative combinations (p = 0.05). Drug holiday correlated with all rash severity surrogates, including rash grade, lower extremity involvement, oral steroid or retinoid use, and incidence of superinfection. Use of oral steroids or retinoids was associated with development of superinfection (p = 0.002). Prophylactic tetracycline use did not impact rash severity or rash incidence.Conclusion: This is the first descriptive analysis to characterize acneiform eruptions for patients with colorectal cancer on combination cancer therapy. Approximately 85% of patients developed a cutaneous toxicity with what appears to be synergistic effects of EGFRI and MEKI combination therapy causing the most severe eruptions. Superinfection rate correlated to systemic therapy use beyond oral tetracyclines. Further investigation into the utility of prophylactic oral tetracyclines in this population is needed. [ABSTRACT FROM AUTHOR]

We report the case of a patient with chronic granulomatous disease and acne treated with isotretinoin, who developed a diffuse staphylococcal skin infection during the therapy. Chronic granulomatous disease is a rare genetic disorder characterized by an altered innate immunity with an increased risk of potentially lethal bacterial and fungal infections. Although chronic granulomatous disease is rare, acne is a common manifestation in these patients, but there are no data about the gold standard therapy. [ABSTRACT FROM AUTHOR]

Epidermal growth factor receptor inhibitors (EGFRi) are now standard of care in patients with EGFR mutations in non‐small cell lung cancer (NSCLC) and are increasingly being used in other EGFR mutated cancers, including gastrointestinal, and head and neck. However, EGFRi are well known to cause acneiform eruptions, which are shown to positively correlate with tumor response to treatment, but may be severe enough to cause interruption of their treatment. Although most guidelines call for the use of tetracyclines to treat these acneiform eruptions, there is mounting evidence for the use of systemic retinoids instead. The objective of this review is to summarize available data on the use of systemic retinoids for management of acneiform eruptions on EGFRi. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. MEDLINE and EMBASE were searched from database inception until December 10th, 2021. All articles were screened and relevant data extracted independently in duplicate by two reviewers. In total, 16 case reports, case series and retrospective reviews were included. Forty‐three patients were treated with retinoids for their acneiform eruption due to EGFRi. The majority (77%) noted moderate to significant improvement after treatment initiation with minimal adverse events (16%). The findings of this systematic review suggest that systemic retinoids are a safe and effective therapy for the management of acneiform eruptions induced by EGFRi. [ABSTRACT FROM AUTHOR]

Background: Although pre-emptive therapy with oral tetracycline, moisturizer, sunscreen, and topical corticosteroid is useful for preventing acneiform eruption (AfE) due to epidermal growth factor receptor (EGFR) inhibitors, no studies have examined the efficacy of topical corticosteroids themselves, or investigated the optimal potency of corticosteroid for treating facial AfE (FAfE).Patients and Methods: Screened patients with RAS wild-type colorectal cancer started pre-emptive therapy with oral minocycline and moisturizer on initiation of cetuximab or panitumumab therapy. Patients who developed grade 1 or 2 FAfE were randomly allocated to two groups: a ranking-down (RD) group that started with a very strong corticosteroid and serially ranked down every 2 weeks unless FAfE exacerbated; and a ranking-up (RU) group that started with a weak corticosteroid and serially ranked up at exacerbation. FAfE grade, patient quality of life, and adverse events (AEs) with topical corticosteroid were evaluated every 2 weeks. The primary endpoint was the total number of times grade 2 or higher FAfE was identified in the central review of the 8-week treatment period.Results: No significant differences in total numbers of grade 2 or higher FAfE or in AEs caused by topical corticosteroids were observed between groups during the 8 weeks. Incidence of grade 2 or higher FAfE tended to be lower in the RD group during the first 2 weeks.Conclusion: Considering the long-term care of FAfE, the RU regimen appears suitable and should be considered the standard treatment for FAfE due to EGFR inhibitor therapy.Trial Registration: UMIN Clinical Trials Registry (UMIN000024113). [ABSTRACT FROM AUTHOR]

Extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, is an Epstein–Barr virus (EBV)-associated aggressive form of lymphoma that primarily involves areas outside the nasal cavity. Skin is also commonly involved resulting in a variety of skin manifestations. Here, we report an ENKTL, nasal type, in a 29-year-old male with a previously undescribed acneiform presentation. Skin biopsy revealed an angiodestructive, perivascular lymphocytic infiltration, which stained positive for CD3, CD56, and TIA-1 in various proportions. Scattered EBV-infected cells were demonstrated by in situ hybridization. The patient received chemotherapy with almost complete resolution of the skin lesions initially but later experienced flare-ups.

Background: Renal transplant recipients tend to have a variety of skin diseases due to multiple immunosuppressive medications, accompanying co-morbidities and prolonged survival with the transplantation procedure. The aim of this cross-sectional study is to present dermatological findings and the contributing factors in renal transplant recipients. Materials and Methods: Forty-one renal transplant recipients were examined by dermatologists between February and May 2021. The etiology of the chronic renal failure, the age at the time of the transplantation, time after transplantation, current medications, donor features, socio-demographic features of the patients, history of dialysis and accompanying co-morbidities were questioned. Results: Average age of patients (27 male, 14 female) was 49.9±11.2 years. Average time after renal transplantation was 12.8±6.6 years. 87.8% of the patients were taking mycophenolate mofetil; 78% systemic steroids, 68.3% tacrolimus, 22% cyclosporin-A and 12.2% azathioprine. Skin signs due to immunosuppressive medications were more frequent in younger patients (p=0.031). Xerosis of the skin due to immunosuppressive medications was found in 41.5% and acneiform eruption in 34.1% of the patients. For skin infections, superficial fungal infections were the most frequent (73.2%), 56.1% of them being onychomycosis. Warts (22%) were the most frequent viral skin disease (31.7%). Viral and fungal skin infections were significantly more common in patients who are taking tacrolimus (p=0.024 and p=0.002, respectively). Fungal skin infections were more common in patients with prolonged and high-dose mycophenolate mofetil treatment (p=0.021 and p=0.005, respectively). Kaposi sarcoma was found in one of the patients and in situ squamous cell carcinoma was found in another patient. The most common oral lesion was gingival hyperplasia (29.3%). Conclusion: Fungal and viral skin infections, skin cancers, acneiform eruptions, xerosis of the skin and gingival hyperplasia are commonly seen in renal transplant recipients. Therefore, proper dermatologic follow-up examinations are crucial. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Acneiform eruption is the recognized dermatological side effect of sirolimus, an inhibitor of the mammalian target of rapamycin, although the pathophysiological mechanisms and dose dependency of this side effect remain unclear. This case report describes a case of a 40-year-old Japanese woman treated with systemic sirolimus who developed acneiform eruptions following the administration of clarithromycin. The acneiform eruption resolved after discontinuation of sirolimus and relapsed with the resumption. Since sirolimus and clarithromycin have a potential drug-drug interaction mediated by cytochrome P450 3A (CYP3A), this case suggests that the acneiform eruption developed in association with elevated blood levels of sirolimus. We conclude that clinicians should be aware of the possibility of developing acneiform eruption during sirolimus treatment, especially when administered with medications that inhibit CYP3A., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kataoka et al.)

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. [ABSTRACT FROM AUTHOR]

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.

Acneiform is used to describe eruptions that resemble acne vulgaris, but are not aetiologically similar. A number of drugs that can be responsible for acneiform eruptions exist. Vortioxetine is a multimodal antidepressant molecule that shows an antagonistic effect to the 5HT1D, 5HT3, and 5HT7 receptors, a partial agonistic effect to the 5HT1B receptor and a fully agonistic effect to the 5HT1A receptor, and also is an inhibitor to the serotonin transporter (SERT). In this article, we report a female patient who developed acneiform eruption during vortioxetine treatment.

We present the first detailed report of acneiform eruptions in patients on CTLA-4 inhibitor therapy. Acneiform eruptions commonly occur (up to 75-100%) as a cutaneous adverse event associated with EGFR inhibition; however, acneiform eruptions have not been highly reported as a cutaneous adverse event associated with CTLA-4 inhibitor therapy. We conducted a retrospective chart review of our institution's database to assess cutaneous adverse events associated with ipilimumab and tremelimumab, identifying 12 patients with acneiform eruptions (2 on tremelimumab and 10 on ipilimumab). The median time to onset of rash was 3 weeks after starting CTLA-4 inhibitor therapy, ranging from 0.7-45 weeks. Median time to cutaneous resolution was 6 weeks, ranging from 2 to 282 weeks. Treatment included oral and topical antibiotics, antihistamines, and oral or topical corticosteroids with four patients receiving no treatment. Acneiform eruptions are seen less commonly with CTLA-4 inhibitors than other cancer therapies, but awareness that it does occur is important for clinical practice. Better description is a necessary help to aid in early diagnosis and intervention. While EGFR inhibitor-associated acneiform eruptions are associated with clinical benefit, our sample size is too small to determine whether CTLA-4 inhibitor associated acneiform eruptions display the same correlation. [ABSTRACT FROM AUTHOR]

Extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, is an Epstein–Barr virus (EBV)-associated aggressive form of lymphoma that primarily involves areas outside the nasal cavity. Skin is also commonly involved resulting in a variety of skin manifestations. Here, we report an ENKTL, nasal type, in a 29-year-old male with a previously undescribed acneiform presentation. Skin biopsy revealed an angiodestructive, perivascular lymphocytic infiltration, which stained positive for CD3, CD56, and TIA-1 in various proportions. Scattered EBV-infected cells were demonstrated by in situ hybridization. The patient received chemotherapy with almost complete resolution of the skin lesions initially but later experienced flare-ups. [ABSTRACT FROM AUTHOR]

Purpose: Cutaneous toxicities from novel anticancer treatments are an emerging problem in dermato-oncology. However, the prevalence of those toxicities and necessity of skin consultations are currently unknown. The purpose of our study was to perform an epidemiologic analysis of cutaneous toxicities that were referred to our cutaneous toxicity clinic in Athens, Greece.Methods: All patients examined at the oncodermatology department over a 42-month period were included. Gender, age, type of cancer, type of antineoplastic treatment, and type of toxicity were recorded and analyzed.Results: Four hundred fifty-nine patients (182 males, 277 females) with mean age (SD) 60.6 years (13.05) were included in the analysis. Six hundred seventy-two cutaneous toxicities were recorded. Chemotherapy-induced toxicities were the most commonly recorded incidents, with taxanes being the most commonly involved agent. Immune-related adverse events (IRAEs) have steadily increased over the past 3 years. Treatment modifications due to skin toxicities were more common in patients treated with targeted agents and immune checkpoint inhibitors than in those treated with chemotherapy. The toxicities that led to the most treatment modifications were acneiform eruptions and perionychias. The most common IRAEs recorded were psoriasis in 11 patients, followed by pruritus, macular rash, and lichenoid-type eruptions. In addition, 4 interesting cases of IRAEs are discussed.Conclusion: Antineoplastic treatments can lead to a wide range of cutaneous toxicities. Our study underlines the need for a multidisciplinary approach in oncologic patients. The dermatologists' role is crucial in effectively managing those reactions and preventing antineoplastic drug dose adjustments or discontinuation of treatment. [ABSTRACT FROM AUTHOR]

Use of a facial mask is a necessity during the current pandemic. The associated occlusion with extended daily use can lead to physiological changes in the skin with resultant irritation, itching, and infections. This can lead to exacerbation of pre-existing dermatoses or induction of irritant dermatitis or bacterial folliculitis. We observed several patients with previously controlled acne vulgaris who developed a flare. Also, in those without a history of pre-existing acne, an acneiform eruption was noted. The majority of patients were women who had pre-existing acne and needed to wear a N95 respirator or a surgical mask for several hours a day, every day. A few suggested simple preventative measures provided herein might help this vulnerable population. [ABSTRACT FROM AUTHOR]

Paroxetine is an antidepressant included in the group of selective serotonin reuptake inhibitors (SSRI) with antidepressant and anxiolytic properties. A rarely seen adverse effect of paroxetine is dermatological reactions. Commonly seen reactions to paroxetine are eczematous reactions and benign skin lesions in general, while some clinical pictures such as life-threatening Stevens–Johnson syndrome and toxic epidermal necrolysis can also be seen. A case of a female patient who developed urticaria during paroxetine use is discussed in this paper.