Hyperkeratotic Skin Adverse Events Induced by Anticancer Treatments: A Comprehensive Review

Psoriasis de novo or exacerbation by PD-1 checkpoint inhibitors

PD-1 (programmed Death-1) immune checkpoint inhibitors have provided significant benefits to tumor patients. However, a considerable proportion of the patients develop immune-related adverse events (irAEs), of which cutaneous irAEs (cirAEs, e.g., psoriasis) occur relatively early. This review provides an overview of the current progress in psoriasis de novo or exacerbation by PD-1 checkpoint inhibitors. It not only describes the relevant influencing factors but also theoretically analyzes the immunological mechanisms that lead to the onset or exacerbation of psoriasis. Finally, the authors present guidelines for the treatment of psoriasis de novo or exacerbation by PD-1 checkpoint inhibitors. The review is intended to assist dermatologists in the early recognition and effective individualized management of such cirAE, which is helpful to continue or adjust the tumor-targeted immunotherapy on the basis of ensuring the quality of life of tumor patients.

Tepotinib-induced hand-foot skin reaction

Tepotinib may cause hand-foot skin reactions with keratotic changes. When such changes are observed in the hands or toes after starting tepotinib treatment, its side effects should be considered, and corticosteroid ointment or withdrawal of tepotinib should be considered if necessary.

Keratosis Pilaris-like Eruption during Treatment of Chronic Myeloid Leukemia with Tyrosine Kinase Inhibitors: Literature Review and Report of a Case Related to Imatinib

The advent of tyrosine kinase inhibitors (TKIs) blocking BCR-ABL activity has revolutionized the therapeutic management of patients with chronic myeloid leukemia (CML). Adverse cutaneous reactions (ACRs) are common nonhematologic adverse events associated with the use of BCR-ABL TKIs. A characteristic pattern of eruption resembling keratosis pilaris (KP) has been described in patients treated with these drugs, especially nilotinib and dasatinib. The pathogenesis of this ACR is still unknown. This type of reaction appears to be uncommon with imatinib. Here, we report the case of an elderly patient with an asymptomatic KP-like eruption, which appeared one month after starting treatment with imatinib for CML. The case presentation is accompanied by a review of similar reactions in patients with CML treated with BCR-ABL inhibitors, attempting to make an excursus on the molecular targets of such drugs and possible mechanisms underlying this ACR.

Assessing Excessive Keratinization in Acral Areas through Dermatoscopy with Cross-Polarization and Parallel-Polarization: A Dermatoscopic Keratinization Scale

Excessive epidermal hyperkeratosis in acral areas is a common occurrence in dermatology practice, with a notable prevalence of approximately 65% in the elderly, especially in plantar lesions. Hyperkeratosis, characterized by thickening of the stratum corneum, can have various causes, including chronic physical or chemical factors, genetic predispositions, immunological disorders, and pharmaceutical compounds. This condition can significantly impact mobility, increase the risk of falls, and reduce the overall quality of life, particularly in older individuals. Management often involves creams containing urea to soften hyperkeratotic areas. Currently, subjective visual evaluation is the gold standard for assessing hyperkeratosis severity, lacking precision and consistency. Therefore, our research group proposes a novel 6-point keratinization scale based on dermatoscopy with cross-polarization and parallel-polarization techniques. This scale provides a structured framework for objective assessment, aiding in treatment selection, duration determination, and monitoring disease progression. Its clinical utility extends to various dermatological conditions involving hyperkeratosis, making it a valuable tool in dermatology practice. This standardized approach enhances communication among healthcare professionals, ultimately improving patient care and research comparability in dermatology.

Cutaneous toxicities from targeted therapies used in oncology: Literature review of clinical presentation and management

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Cutaneous toxicities are frequent with targeted therapies.

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Managing cutaneous toxicities is critical for life-saving treatment continuation.

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Dermatologists can provide a key input in preventing and managing these toxicities.

With the development of molecular targeted therapies, a wide array of dermatologic toxicities is appearing. Their prevention, recognition, and management by dermatologists is critical to ensure antineoplastic treatment continuation. The objective of this study was to provide a literature review of the most common dermatologic toxicities due to targeted therapies in oncologic patients, including their clinical presentation, prevention, and management.

Cutaneous toxicity of FDA-approved small-molecule kinase inhibitors

INTRODUCTION

By 1 January 2021, the FDA has approved a total of 62 small-molecule kinase inhibitors (SMKIs). The increasing clinical use of small-molecule kinase inhibitors has led to some side effects, the most common of which is cutaneous toxicity, as reflected by approximately 90% (57 of 62) of the FDA-approved SMKIs have reported treatment-related cutaneous toxicities. Since these cutaneous toxicities may have a crucial influence on the emotional, physical and psychosocial health of the patients, it is of great importance for doctors, patients, oncologists and interrelated researchers to be aware of the cutaneous side effects of these drugs in order to make the diagnosis accurate and the treatment appropriate.

AREAS COVERED

This review aims to summarize the potential cutaneous toxicities and the frequency of occurrence of FDA-approved 62 SMKIs, and provide a succinct overview of the potential mechanisms of certain cutaneous toxicities. The literature review was performed based on PubMed database and FDA official website.

EXPERT OPINION

It is significant to determine the risk factors for SMKI-induced cutaneous toxicity. The mechanisms underlying SMKI-induced cutaneous toxicities remain unclear at present. Future research should focus on the mechanisms of SMKI-induced cutaneous toxicities to find out mechanistically driven therapies.

Identification of Beilschmiedia tsangii Root Extract as a Liver Cancer Cell-Normal Keratinocyte Dual-Selective NRF2 Regulator

Transcription factor nuclear factor erythroid 2-related factor 2 (NRF2) plays a crucial role in regulating the expression of genes participating in cellular defense mechanisms against oxidative or xenobiotic insults. However, there is increasing evidence showing that hyperactivation of NRF2 is associated with chemoresistance in several cancers, including hepatocellular carcinoma (HCC), thus making NRF2 an attractive target for cancer therapy. Another important issue in cancer medication is the adverse effects of these substances on normal cells. Here, we attempted to identify a dual-selective NRF2 regulator that exerts opposite effects on NRF2-hyperactivated HCC cells and normal keratinocytes. An antioxidant response element driven luciferase reporter assay was established in Huh7 and HaCaT cells as high-throughput screening platforms. Screening of 3,000 crude extracts from the Taiwanese Indigenous Plant Extract Library resulted in the identification of Beilschmiedia tsangii (BT) root extract as a dual-selective NRF2 regulator. Multiple compounds were found to contribute to the dual-selective effects of BT extract on NRF2 signaling in two cell lines. BT extract reduced NRF2 protein level and target gene expression levels in Huh7 cells but increased them in HaCaT cells. Furthermore, notable combinatory cytotoxic effects of BT extract and sorafenib on Huh7 cells were observed. On the contrary, sorafenib-induced inflammatory reactions in HaCaT cells were reduced by BT extract. In conclusion, our results suggest that the combination of a selective NRF2 activator and inhibitor could be a practical strategy for fine-tuning NRF2 activity for better cancer treatment and that plant extracts or partially purified fractions could be a promising source for the discovery of dual-selective NRF2 regulators.

Influence of keratolytics on cutaneous pharmacokinetics of glucocorticoids

BACKGROUND

Keratolytics are often used to accelerate and improve the therapeutic response of hyperkeratotic dermatoses. Keratolytics are a chemically inhomogeneous group of substances and substance mixtures that clinically lead to a decrease in symptoms of a cornification disorder, but mediate different effects. Thus, keratolytic, keratoplastic, keratoemulsifying and keratodiluting effects are distinguished. The physicochemical effects or pharmacological efficacy of the respective keratolytics result in different mechanism as well as risks with regard to local or systemic compatibility. Until now, only little attention has been paid upon selection of keratolytics to the immediate consequences regarding diffusion conditions and pharmacokinetics of sequentially applied topicals, in particular of glucocorticoids.

PATIENTS AND METHODS

This paper deals with the influence of keratolytics on the penetration-time profile of betamethasone dipropionate in sequential application. For this purpose, cutaneous bioavailability was investigated with the Franz chamber test using a tritium-labeled drug depending on the previous application of a keratolytic agent. Comparative data analyses were performed.

RESULTS

It was shown that keratoplastic substances significantly promote diffusion of the glucocorticoid. Keratoemulsifying substance mixtures exert no relevant effects in this regard, while keratodiluting substance mixtures inhibit penetration.

CONCLUSIONS

The targeted selection of a keratolytic can optimize the therapeutic effect and influence the bioavailability of sequentially applied topicals.

Agnucastoside C, isolated from Moringa oleifera ameliorates thyrotoxicosis and liver abnormalities in female mice

Background

In the present investigation an attempt was made to evaluate the potential of agnucastoside C (ACC), isolated from the leaves of Moringa oleifera in ameliorating thyrotoxicosis, hepatic lipid peroxidation (LPO) and hyperglycemia in female mice.

Methods

L-thyroxine (L-T4) at 0.5 mg/kg/d was administered through intra-peritoneal route for 15 consecutive days to induce thyrotoxicosis and then the effects of three different doses (10, 20 and 30 mg/kg body weight) of the isolated ACC for 21 days were investigated on the changes in serum thyroid hormones, insulin, glucose, different lipids; hepatic lipid peroxidation, enzymatic antioxidants such as superoxide dismutase, catalase and glutathione peroxidase, advanced oxidation protein products, reduced glutathione and in lipid peroxides.

Results

Following the administration of L-T4, serum T3, T4, insulin, glucose levels and the tissue LPO were increased with a decrease in serum thyroid stimulating hormone and antioxidative enzymes. However, administration of the test compound to hyperthyroid animals significantly decreased the levels of thyroid hormones, glucose and lipid peroxidation and normalized the concentration of insulin and tissue antioxidants, suggesting its antithyroid, antihyperglycemic and antiperoxidative potential. The T4-induced adverse effects on liver histology were also abolished. These findings suggest the possible use of the test compound in ameliorating thyrotoxicosis.

Conclusion

ACC exhibited antithyroidic, antihypoglycemic, antioxidative and insulin normalizing activities.

Balancing Cancer Immunotherapy Efficacy and Toxicity

Anti-programmed cell death-1 receptor/programmed cell death-1 receptor ligand-directed therapies are transforming cancer care, with durable antitumor responses observed in multiple cancer types. Toxicities arising from therapy are autoimmune in nature and may affect essentially any organ system. The immunologic basis of such toxities is complex, with contributions from T-cell activation and autoantibody generation. Although less recognized, hypersensitivity reactions are also possible. Although most toxicities resolve with systemic corticosteroids, some require second-line immunosuppression. Furthermore, the safety of drug rechallenge is not well characterized, with variable rates of toxicity flares arising with re-exposure. Herein, we review toxicities of immune checkpoint inhibitor therapies, particularly focusing on issues that allergists/immunologists may clinically encounter, including interstitial nephritis, skin toxicity, and risks associated with immunotherapy rechallenge.