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Eddy EP, Shet MS, Cataldo M, Grob D, Bhaskar S. Evaluation of dermal toxicity and toxicokinetics of povidone‑iodine in Göttingen minipigs. Toxicol Appl Pharmacol 2024; 482:116783. [PMID: 38061611 DOI: 10.1016/j.taap.2023.116783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Povidone‑iodine (PVP-I) is an effective and commonly used broad-spectrum antiseptic; limited information exists around its long-term safety and impact on endocrine disruption. We assessed the dermal toxicity and toxicokinetics following a once-daily application of 7.5% (w/v) and 10% (w/v) PVP-I in Göttingen Minipigs® for up to 39 weeks. METHODS An in vivo study was conducted in male (n = 27) and female (n = 27) minipigs. Animals were randomized into untreated control, 7.5% and 10% PVP-I, and matching vehicle treatment groups. Animals were assessed for general in-life measurements, including skin irritation and organ weights. Serum samples were analyzed for PVP, total iodine, triiodothyronine [T3], thyroxine [T4], thyroid stimulating hormone [TSH], and toxicokinetic parameters. RESULTS Neither 7.5% nor 10% PVP-I affected general in-life measurements. Increased mean thyroid gland absolute weights were noted with 7.5% and 10% PVP-I. Serum levels of PVP, T3, T4, and TSH in the 7.5% and 10% PVP-I treatment group animals were similar to those in vehicle treatment group animals. Mean total serum iodine concentration was 52- and 13-fold higher with 7.5% and 10% PVP-I, respectively, vs respective vehicle treatments. There was no dose-dependent increase in mean maximum serum concentration and area under the curve from 0 to 24 h for PVP, T3, T4, and TSH, nor accumulation of PVP, T3, T4, or TSH in the study. CONCLUSION Once-daily dermal application of 7.5% and 10% PVP-I for up to 39 weeks was safe and well tolerated in Göttingen Minipigs® and was not associated with skin irritation, thyroid dysfunction, or endocrine disruption. As the anatomy and physiology of the minipig skin closely resembles that of human skin, the findings of this study suggest that 7.5% and 10% PVP-I may be translated into antimicrobial benefits for humans without the risk of endocrine disruption.
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Liu TH, Wu SY, Tsai SL, Wu CW, Hou CC, Lai CY, Tzeng YS. Effective and enduring surgical treatment for targeted therapy-related paronychia: A retrospective study. Medicine (Baltimore) 2022; 101:e31208. [PMID: 36281135 PMCID: PMC9592431 DOI: 10.1097/md.0000000000031208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The development of targeted therapy has improved treatment outcomes for patients with non-small cell lung cancer (NSCLC). However, paronychia, a common adverse effect of targeted therapy, remains burdensome. Although conservative treatments for paronychia have been well reported in the literature, studies on the efficacy of surgical partial matricectomy for paronychia, are scarce. This study aimed to evaluate the effect of surgical partial matricectomy in targeted therapy-induced paronychia in patients with NSCLC. This retrospective cohort study included 11 patients with a total of 18 lesions on the big toes. Data on lung cancer stages, types and duration of targeted therapy, onset of paronychia, pain scale scores, conservative treatments, course of matricectomy, paronychia-free interval after matricectomy, and wound condition were collected from medical records. The Wilcoxon signed-rank test was used for analysis. The mean pain scale score after matricectomy was significantly lower than that after conservative treatments (1.00 ± 0.00 vs 2.94 ± 0.87; P < .001) and before treatment (1.00 ± 0.00 vs 3.06 ± 0.80; P < .001). The mean duration of matricectomy was significantly shorter than that of conservative treatments (3.22 ± 1.00 vs 56.56 ± 52.29 weeks; P < .001). Surgical partial matricectomy is an effective and enduring intervention for targeted therapy-related paronychia. It provides a shorter course of treatment, reduced pain, and improved appearance of the healed wound. Furthermore, surgical partial matricectomy could result in a better quality of life during targeted therapy than that of conservative treatments.
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Affiliation(s)
- Ting-Hsuan Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China
- Department of Surgery, Taichung Armed Forces General Hospital, Taichung City, Taiwan, Republic of China
| | - Shu-Yu Wu
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei City, Taiwan, Republic of China
| | - Sheng-Lin Tsai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China
| | - Chien-Wei Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China
| | - Chih-Chun Hou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China
| | - Chung-Yu Lai
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei City, Taiwan, Republic of China
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China
- * Correspondence: Yuan-Sheng Tzeng, Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China (e-mail: )
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Bromberg H, Chang Y, Portman D, Craig D. Application of Topical Lidocaine for Pain Relief in the Setting of Targeted Therapy-Induced Onycholysis: A Case Report. J Palliat Med 2021; 25:335-336. [PMID: 34551277 DOI: 10.1089/jpm.2021.0197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Selective pan fibroblast growth factor receptor (FGFR) inhibitors have been linked to severe onycholysis, the uncomfortable separation of the nail plate from the nail bed. Recommendations to assist with FGFR inhibitor onycholysis vary based on the severity. We hypothesized that the application of topical lidocaine to mimic a digital nerve block would be beneficial in addition to traditional supportive care interventions and subsequently report its immediate and continued efficacy for targeted therapy-induced onycholysis.
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Affiliation(s)
- Hannah Bromberg
- Department of Supportive Care, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Young Chang
- Department of Supportive Care, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Diane Portman
- Department of Supportive Care, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - David Craig
- Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Gupta MK, Lipner SR. Review of chemotherapy-associated paronychia. Int J Dermatol 2021; 61:410-415. [PMID: 34242408 DOI: 10.1111/ijd.15740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/18/2021] [Accepted: 05/28/2021] [Indexed: 12/01/2022]
Abstract
Chemotherapy-associated paronychia (CAP) is an inflammation of the nail folds in response to various chemotherapeutic medications. Altered proliferation of keratinocytes or nail matrix stem cells is thought to be a major causative factor. Prophylactic tetracyclines, topical povidone-iodine, and general irritation avoidance measures are among some of the recommended interventions for CAP. Appropriate recognition and treatment of CAP are important for prevention of chemotherapy dose reduction or medication discontinuation.
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Affiliation(s)
- Mohit K Gupta
- College of Medicine, State University of New York Downstate, Brooklyn, New York, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York City, New York, USA
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Langer MF, Grünert JG, Spies CK, Ueberberg J, Oeckenpöhler S, Wieskötter B. [Paronychia and Felons - Surgical Treatment]. HANDCHIR MIKROCHIR P 2021; 53:245-258. [PMID: 34134157 DOI: 10.1055/a-1472-1933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Infections of the distal phalanx are the most common of all hand infections. There are dorsal localised infections, which develop in the area of the nail and are called paronychia, and palmar infections, which affect the fingertip and are the typical felons. The acute paronychia must be specifically opened depending on the site of infection. This requires precise anatomical knowledge of nail structure. Chronic paronychia usually have other causes and treatment is much more difficult. Felons are often extremely painful. There is a complex system of fibrous septa and swelling is limited. If the septa are destroyed a spread into the bones or the flexor tendon sheath is possible.
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Affiliation(s)
- Martin F Langer
- Universitätsklinikum Münster; Klinik für Unfall-, Handund Wiederherstellungschirurgie
| | - Jörg G Grünert
- Kantonsspital St. Gallen, Klinik für Plastische Chirurgie und Handchirurgie
| | | | - Johanna Ueberberg
- Universitätsklinikum Münster; Klinik für Unfall-, Handund Wiederherstellungschirurgie
| | - Simon Oeckenpöhler
- Universitätsklinikum Münster; Klinik für Unfall-, Handund Wiederherstellungschirurgie
| | - Britta Wieskötter
- Universitätsklinikum Münster; Klinik für Unfall-, Handund Wiederherstellungschirurgie
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Langer MF, Grünert JG. [Diagnostic and therapeutic Problems in Paronychia and Felons]. HANDCHIR MIKROCHIR P 2021; 53:259-266. [PMID: 34134158 DOI: 10.1055/a-1472-2030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The infections of the terminal phalanx are always special. Diseases, tumors or virus infections can look very similar and can show similar symptoms. Many require a radiological, dermatological, histological or general physical clarification, some need no surgery and in some surgery is contraindicated. If surgery is necessary, the exact incision is particularly important. A surgical approach set only a few millimeters wrong, can have catastrophic consequences at the fingertip. Differential diagnoses and the consequences of wrong incisions are shown.
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Affiliation(s)
- Martin F Langer
- Universitätsklinikum Münster, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie
| | - Jörg G Grünert
- Kantonsspital St. Gallen, Klinik für Plastische Chirurgie und Handchirurgie
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Hoang TPN, Ghori MU, Conway BR. Topical Antiseptic Formulations for Skin and Soft Tissue Infections. Pharmaceutics 2021; 13:558. [PMID: 33921124 PMCID: PMC8071503 DOI: 10.3390/pharmaceutics13040558] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/06/2021] [Accepted: 04/10/2021] [Indexed: 01/22/2023] Open
Abstract
Skin and soft tissue infections (SSTIs) are usually acute conditions of inflammatory microbial occupation of the skin layers and underlying soft tissues. SSTIs are one of the most frequent types of infection, typically requiring medical intervention and contribute to morbidity and mortality in both primary care and hospitalised patients. Due to the dramatic rise of antibiotic resistance, antiseptic agents can be potential alternatives for the prevention and treatment of SSTIs. Notably, they are commonly recommended in many global practical guidelines for use in per- and post- operative procedures. A range of antiseptics, including chlorhexidine, triclosan, alcohol, and povidone-iodine, are used and are mainly formulated as traditional, simple dosage forms such as solutions and semi-solids. However, in recent years, there have been studies reporting the potential for nanotechnology in the delivery of antiseptics. In this review, we have collated the scientific literature that focuses on topical antiseptic formulations for prevention and treatment of SSTIs, and have divided findings into traditional and advanced formulations. We conclude that although nanotechnological formulations have demonstrated potential advantages for delivering drugs; nevertheless, there is still scope for traditional formulations and further development of optimised topical formulations to address the rise of antimicrobial resistance.
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Affiliation(s)
- Thi Phuong Nga Hoang
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (T.P.N.H.); (M.U.G.)
| | - Muhammad Usman Ghori
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (T.P.N.H.); (M.U.G.)
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (T.P.N.H.); (M.U.G.)
- Institute of Skin Integrity and Infections Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK
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Lacouture ME, Sibaud V, Anadkat MJ, Kaffenberger B, Leventhal J, Guindon K, Abou‐Alfa G. Dermatologic Adverse Events Associated with Selective Fibroblast Growth Factor Receptor Inhibitors: Overview, Prevention, and Management Guidelines. Oncologist 2021; 26:e316-e326. [PMID: 33021006 PMCID: PMC7873330 DOI: 10.1002/onco.13552] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022] Open
Abstract
Fibroblast growth factor receptor (FGFR) tyrosine kinases, which are expressed on the cell membrane, are involved in a wide range of biological functions such as cell proliferation, survival, migration, and differentiation. The identification of FGFR fusions and other alterations in a wide range of solid tumors, including cholangiocarcinoma and bladder cancer, has resulted in the development of several selective FGFR inhibitors for use in these indications, for example, infigratinib, erdafitinib, derazantinib, pemigatinib, and futibatinib. In addition to the typical adverse events associated with tyrosine kinases, the FGFR inhibitors appear to give rise to a number of adverse events affecting the skin. Here we describe these skin events, which include the more common nail adverse events (e.g., onycholysis), palmar-plantar erythrodysesthesia syndrome, and stomatitis, as well as less common reactions such as calciphylaxis. This review aims to provide oncologists with an understanding of these dermatologic events and proposes guidelines for the management of treatment-emergent dermatologic adverse events. Awareness of possible adverse events associated with specific drugs should allow physicians to educate patients as to what to expect and implement effective management plans at the earliest possible opportunity, thereby preventing premature discontinuation while maintaining patient quality of life. IMPLICATIONS FOR PRACTICE: Identification of fibroblast growth factor receptor (FGFR) aberrations in cholangiocarcinoma and bladder cancer led to development of selective FGFR inhibitors for these indications, based on clinical benefit and safety profiles. The most frequent adverse events (AEs) include those affecting skin, hair, and nails, a unique class effect of these agents. These are usually mild to moderate in severity. This work reviewed skin AEs reported with FGFR inhibitors and provides management guidelines for physicians, aiming to increase awareness of skin events and provide effective treatment strategies. Early intervention and effective management may improve treatment adherence, optimize outcomes, and improve quality of life.
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Affiliation(s)
| | - Vincent Sibaud
- Department of Oncodermatology, Institut Universitaire du Cancer Toulouse OncopoleToulouseFrance
| | - Milan J. Anadkat
- Division of Dermatology, Department of Medicine, Washington University School of MedicineSaint LouisMissouriUSA
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Ferreira MN, Ramseier JY, Leventhal JS. Dermatologic conditions in women receiving systemic cancer therapy. Int J Womens Dermatol 2019; 5:285-307. [PMID: 31909148 PMCID: PMC6938835 DOI: 10.1016/j.ijwd.2019.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/12/2019] [Accepted: 10/13/2019] [Indexed: 12/24/2022] Open
Abstract
As advances in cancer therapies have improved cancer-related survival, novel therapeutics have also introduced a variety of dermatologic toxicities, and an increased number of patients are living with these sequalae. Women with cancer in particular experience a spectrum of dermatologic conditions that affect their skin, hair, nail, and mucosal surfaces. Studies have shown that these toxic effects can significantly affect quality of life and alter a woman's self-image, cultural identity, femininity, sexuality, and mental health. In severe instances, dermatologic toxicities may even disrupt cancer therapy and can therefore affect overall survival and treatment response. In this article, we review the dermatologic adverse effects from traditional chemotherapy, targeted therapy, immune checkpoint inhibitors, and endocrine therapy that disproportionately affect women. The timely diagnosis and management of these dermatologic conditions is crucial in the multidisciplinary care of women with cancer.
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