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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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Park JH, Choi Y, Kim HJ, Oh SJ, Lee DY, Lee JH, Lee JH. Duration of Oral Antibiotics Administration for Cetuximab-Induced Acneiform Eruption. Dermatology 2020; 237:457-463. [PMID: 33302268 DOI: 10.1159/000511623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acneiform eruption is the most common cutaneous adverse event associated with cetuximab. As it can affect quality of life and adversely affect chemotherapy schedule, additional medical care is required. OBJECTIVES To investigate the adherence to and the duration of antibiotic administration to treat cetuximab-induced acneiform eruption. METHODS Medical data of patients who were referred to the Department of Dermatology were reviewed from January 2013 to June 2018. Dermatologists assessed the severity of acneiform eruption and prescribed tetracycline-class antibiotics according to the severity every 2 or 4 weeks. We investigated the duration and amount of oral antibiotic administration and analyzed the factors that may affect the control of acneiform eruption statistically. RESULTS A total of 207 of 267 patients referred to the Department of Dermatology showed acneiform eruption; 124 patients were treated with minocycline, 34 patients with doxycycline, 27 patients with both, and 22 patients with topical agents. The mean duration of oral antibiotic medication was 82.7 days. A statistical analysis of the factors that prolonged the use of antibiotics for more than 90 days showed that male and younger age were risk factors. Shorter time interval from starting cetuximab to starting antibiotics was associated with longer duration of antibiotic use, statistically. CONCLUSIONS Cetuximab-induced acneiform eruption can be well controlled with tetracycline-class antibiotics in about 3 months. It can last longer in male and younger patients. The sooner and the more severe it appears, the longer it can last.
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Affiliation(s)
- Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - YoungHwan Choi
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Je Kim
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Jin Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Heung Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Bharti S, Vadlamudi HC. A strategic review on the involvement of receptors, transcription factors and hormones in acne pathogenesis. J Recept Signal Transduct Res 2020; 41:105-116. [PMID: 32787477 DOI: 10.1080/10799893.2020.1805626] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Acne vulgaris is a very common pilosebaceous inflammatory disease occurring primarily on the face and also rare on the upper arms, trunk, and back, which is caused by Propionibacterium, Staphylococcus, Corynebacterium, and other species. Pathophysiology of acne comprises of irregular keratinocyte proliferation, differentiation, increased sebum output, bacterial antigens and cytokines induced inflammatory response. Treatment of acne requires proper knowledge on the pathophysiology then only the clinician can come out with a proper therapeutic dosage regimen. Understanding the pathophysiology not only includes the mechanism but also involvement of receptors. Thus, this review is framed in such a way that the authors have focused on the disease acne vulgaris, pathophysiology, transcription factors viz. the Forkhead Box O1 (FoxO1) Transcription Factor, hormones like androgens and receptors such as Histamine receptors, Retinoic receptor, Fibroblast growth factor receptors, Toll like receptor, Androgen receptor, Liver X-receptor, Melanocortin receptor, Peroxisome proliferator-activated receptor and epidermal growth factor receptors involvement in the progression of acne vulgaris.
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Affiliation(s)
- Sneha Bharti
- Department of Pharmaceutics, Acharya & BM Reddy College of Pharmacy, Bangalore, India
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4
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A technical appraisal of guidelines for the management of skin rash in patients on chemotherapy and targeted therapy. BMC Health Serv Res 2019; 19:704. [PMID: 31619221 PMCID: PMC6794896 DOI: 10.1186/s12913-019-4539-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Skin rash remains one of the most prevalent and troublesome clinical problems experienced by patients on chemotherapy and targeted therapy. To ensure high-quality care, guidelines are seen as the best guidance. Considering the quality of guidelines varies greatly, a systematical appraisal of the methodological quality of guidelines for the management of skin rash in patients on chemotherapeutic drugs and targeted anticancer therapies was undertaken, in order to identify appropriate ones for healthcare professionals. METHODS A systematic search of databases and Internet was conducted to obtain pertinent guidelines. Two reviewers independently assessed the eligibility of guidelines according to the inclusion criteria. Then the guidelines included were appraised by three researchers with the methodological quality of eligible guideline using Appraisal of Guidelines for Research and Evaluation II (AGREEII). RESULTS Totally nineteen guidelines met the inclusion criteria. The quality ranged from good to acceptable in scope and purpose (mean: 78.80%, range: 66.67-94.44%) and clarity of presentation domains (mean: 85.38%, 75.00-91.67%), but not in stakeholder involvement (mean: 50.15%, range: 36.11-75.00%), rigor of development (mean: 23.65%, range: 6.25-70.83%), applicability (mean: 23.96%, range: 4.17-52.08%), and editorial independence domains (mean: 45.18%, range: 0.00-87.50%). Overall, two guidelines were classified as "recommended". CONCLUSIONS Only two guidelines were recommended to manage skin rash in patients on chemotherapy and targeted therapies, most guidelines issued were of low to moderate quality. Thus, more attention should be paid to the methodological quality of guideline development in this field.
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Saraswat N, Sood A, Kumar D, Verma R, Sushil K. Clinical Profile of Cutaneous Adverse Effects of Epidermal Growth Factor Receptor Inhibitors: A Prospective Observational Study of 76 Cases. Indian Dermatol Online J 2019; 10:251-255. [PMID: 31149566 PMCID: PMC6536076 DOI: 10.4103/idoj.idoj_325_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Epidermal growth factor receptor (EGFR) inhibitors are an extensively utilized class of chemotherapeutic agents which form an integral component of treatment in solid organ malignancies such as non-small-cell lung carcinoma, pancreatic carcinoma, colorectal carcinoma, and head and neck carcinoma. It has two subclasses: epidermal growth factor inhibitors (erlotinib) and monoclonal antibody (cetuximab). A wide array of cutaneous adverse effects has been attributed to this class of drugs, such as papulopustular eruptions, paronychia, xerosis, and changes in hair and nails. Materials and Methods: A total of 76 cases of various malignancies on EGFR inhibitors who developed cutaneous side effects while on therapy and reported or referred to us by oncologists from January 2017 to January 2018 were included in the study. All the patients who were on other associated medications or radiotherapy were excluded. Result: In all, 45 (59.2%) were males and 31 (40.7%) were females. Non-small-cell lung carcinoma was the most common carcinoma in 32 (42.1%) patients, and cetuximab was the most common drug in 29 (38.1%) cases. Papulopustular eruptions were seen in 61 (80.2%) patients, xerosis in 31 (40.7%), mucositis in 6 (7.8%), hair growth problems in 4 (5.6%), and paronychia and pyogenic granuloma in 2 (2.6%) patients each. Conclusion: Although most of the skin toxicities associated with EGFR inhibitors can be managed conservatively, a critical analysis of the cases that are significantly affected due to these side effects is required in cohesion with the treating oncologist to improve the therapeutic compliance of the drug.
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Affiliation(s)
- Neerja Saraswat
- Department of Dermatology, Base Hospital, Delhi Cantt, New Delhi, India
| | - Aradhana Sood
- Department of Dermatology, Base Hospital, Lucknow Cantt, Uttar Pradesh, India
| | - Dharmesh Kumar
- Department of Oncology, Army Hospital R and R, Delhi Cantt, New Delhi, India
| | - Rajesh Verma
- Department of Dermatology, Base Hospital, Delhi Cantt, New Delhi, India
| | - Kumar Sushil
- Department of Dermatology, MLN Medical College Allahabad, Uttar Pradesh, India
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6
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Anzengruber F, Meier B, Maul JT, Kerl K, French LE, Navarini AA. Extreme Phenotype of Epidermal Growth Factor Receptor Inhibitor-induced Destructive Folliculitis. Int J Trichology 2016; 8:176-179. [PMID: 28442875 PMCID: PMC5387879 DOI: 10.4103/0974-7753.203174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Due to the increasingly widespread use and side effect profile of epidermal growth factor receptor inhibitors (EGFRIs), cutaneous side effects of these drugs are frequently encountered. The EGFR is expressed on keratinocytes and fibroblasts. Inhibition of EGFR can produce a range of cutaneous adverse effects, the most frequent being a characteristic acneiform skin eruption. As the latter is associated with good anti-neoplastic responses, the onset of EGFRI-induced acneiform skin eruption is typically viewed as a positive sign by patients and physicians. It can usually be treated well with standard acne drugs, but in rare cases, the skin eruption can be so severe that systemic therapy and/or interruption of EGFRI treatment are required. One of the severest forms of EGFRI-induced skin eruption occurring on the head and neck area resembles folliculitis decalvans. Here, we discuss the management of such a case seen in our department. In addition, we present an analysis of tumor necrosis factor-α, interleukin-1β (IL-1β), and IL-17A expression based on immunohistochemical stains and qPCR.
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Affiliation(s)
- Florian Anzengruber
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Barbara Meier
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Katrin Kerl
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Lars E French
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
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7
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Herausforderungen zielgerichteter Substanzen an die onkologische Supportivtherapie. ONKOLOGE 2015. [DOI: 10.1007/s00761-014-2795-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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8
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Abstract
Erlotinib is a reversible epidermal growth factor receptor tyrosine kinase inhibitor used to treat advanced non-small cell lung carcinoma patients who have shown progression on at least 1 prior chemotherapy regimen. Most of the patients on erlotinib show cutaneous adverse effects. We report the 18F-FDG PET/CT findings in a case of metastatic non-small cell lung carcinoma on erlotinib chemotherapy with developed skin toxicity.
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9
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Kim HK, Yeo IK, Li K, Kim BJ, Kim MN, Hong CK. Topical epidermal growth factor for the improvement of acne lesions: a randomized, double-blinded, placebo-controlled, split-face trial. Int J Dermatol 2014; 53:1031-6. [DOI: 10.1111/ijd.12488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hyun Kyu Kim
- Department of Dermatology; Chung-Ang University College of Medicine; Seoul Korea
| | - In Kwon Yeo
- Department of Dermatology; Chung-Ang University College of Medicine; Seoul Korea
| | - Kapsok Li
- Department of Dermatology; Chung-Ang University College of Medicine; Seoul Korea
| | - Beom Joon Kim
- Department of Dermatology; Chung-Ang University College of Medicine; Seoul Korea
| | - Myeung Nam Kim
- Department of Dermatology; Chung-Ang University College of Medicine; Seoul Korea
| | - Chang Kwun Hong
- Department of Dermatology; Chung-Ang University College of Medicine; Seoul Korea
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10
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Potthoff K, Habl G, Bruckner T, Suppan C, Hassel J, Jäger D, Indorf M, Debus J. Randomized controlled trial to evaluate the effects of ethyl-2-cyanoacrylate on pain intensity and quality of life in head and neck cancer patients suffering from cetuximab-induced rhagades during radioimmunotherapy: the support trial. BMC Cancer 2014; 14:270. [PMID: 24742019 PMCID: PMC4051406 DOI: 10.1186/1471-2407-14-270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 03/19/2014] [Indexed: 11/17/2022] Open
Abstract
Background Cetuximab is a chimeric monoclonal antibody against the epidermal growth factor receptor (EGFR). Skin reactions are the most common side effects of cetuximab. Rhagades of the tips of the fingers and toes, the heels and especially the interphalangeal joints are one of the most frightening and painful dermatological side effects that may develop from EGFR-inhibitor therapy. Rhagades are characterized by pain, severe tenderness and poor healing response. They are challenging to treat. Thus, rhagades often poses the most significant threat to the quality of life (QoL) for these patients. Ethyl-2-cyanoacrylate (ECA), an ethyl ester of the 2-cyano-2-propenoic acid, is often used as adhesive in a variety of different work settings in industry, i.e. as a component in nail-care products such as nail glue. In addition, ECA is used for various medical indications, such as for liquid bandages and for suture-less surgery. Wound healing can be accelerated with ECA. The purpose of the SUPPORT trial is to investigate the efficacy of ECA for the treatment of cetuximab-induced rhagades and to assess the clinical usefulness of the SUPO score, a new classification system for rhagades induced by EGFR-inhibitor therapy. Methods/Design The SUPPORT trial is an open-label, prospective, randomized, national multicenter intervention study to evaluate the effectiveness of ECA versus the standard treatment of each institution on the pain intensity and QoL in patients with locally advanced head and neck cancer suffering from painful cetuximab-induced rhagades during radioimmunotherapy. Primary endpoint is the assessment of the pain intensity 24 hours after application of ECA or the standard treatment quantified by the visual analogue scale (VAS). Secondary endpoints are the evaluation of QoL assessed by the EORTC-QoL-C30 questionnaire and the Dermatological Life Quality Index (DLQI). Discussion During treatment with EGFR inhibitors it is necessary to recognize and manage side effects promptly to assure better patient QoL. The SUPPORT trial is the first randomized clinical trial evaluating a new treatment option for painful cetuximab-induced rhagades. Furthermore, the new SUPO score will be prospectively assessed in terms of clinical usefulness for classification of EGFR inhibitor-induced rhagades. Trial registration Current Controlled Trials
NCT01693159.
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Affiliation(s)
- Karin Potthoff
- Department of Radiation Oncology, National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany.
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11
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Rolfo C, Bronte G, Passiglia F, Papadimitriou K, Russo A, Peeters M. Management of Toxicity Induced by Anti-EGFR Therapy in Metastatic Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0174-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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12
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Lee SL, Tan BS, Chan LC. Paronychia induced by the epidermal growth factor receptor inhibitor cetuximab. J Oncol Pharm Pract 2012; 19:273-8. [PMID: 23161875 DOI: 10.1177/1078155212461289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While the development of epidermal growth factor receptor inhibitors has been hailed as a remarkable triumph in the field of oncology, it has inherited with it a host of cutaneous side-effects that have been increasingly observed in a substantial number of patients in the recent years. One cutaneous manifestation that may inflict significant pain and affect activities of daily living among some of the patients receiving epidermal growth factor receptor inhibitors is paronychia. A case of paronychia associated with the use of cetuximab in the management of KRAS wild-type midrectal adenocarcinoma along with its management has been described.
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Affiliation(s)
- Soo Lin Lee
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia.
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13
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Gerber PA, Meller S, Eames T, Buhren BA, Schrumpf H, Hetzer S, Ehmann LM, Budach W, Bölke E, Matuschek C, Wollenberg A, Homey B. Management of EGFR-inhibitor associated rash: a retrospective study in 49 patients. Eur J Med Res 2012; 17:4. [PMID: 22472354 PMCID: PMC3351712 DOI: 10.1186/2047-783x-17-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/23/2012] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In recent years inhibitors directed against the epidermal growth factor receptor (EGFR) have evolved as effective targeting cancer drugs. Characteristic papulopustular exanthemas, often described as acneiform rashes, are the most frequent adverse effect associated with this class of novel cancer drugs and develop in > 90% of patients. Notably, the rash may significantly compromise the patients' quality of life, thereby potentially leading to incompliance as well as dose reduction or even termination of the anti-EGFR therapy. Yet, an effective dermatologic management of cutaneous adverse effects can be achieved. Whereas various case reports, case series or expert opinions on the management of EGFR-inhibitor (EGFRI) induced rashes have been published, data on systematic management studies are sparse. METHODS Here, we present a retrospective, uncontrolled, comparative study in 49 patients on three established regimens for the management of EGFRI-associated rashes. RESULTS Strikingly, patients' rash severity improved significantly over three weeks of treatment with topical mometason furoate cream, topical prednicarbate cream plus nadifloxacin cream, as well as topical prednicarbate cream plus nadifloxacin cream plus systemic isotretinoin. CONCLUSIONS In summary our results demonstrate that EGFRI-associated rashes can be effectively managed by specific dermatologic interventions. Whereas mild to moderate rashes should be treated with basic measures in combination with topical glucocorticosteroids or combined regiments using glucocorticosteroids and antiseptics/antibiotics, more severe or therapy-resistant rashes are likely to respond with the addition of systemic retinoids.
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Affiliation(s)
- Peter Arne Gerber
- Department of Dermatology, University of Duesseldorf, Medical Faculty, Moorenstrasse 5, D-40225 Duesseldorf, Germany.
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14
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Gutzmer R, Wollenberg A, Ugurel S, Homey B, Ganser A, Kapp A. Cutaneous side effects of new antitumor drugs: clinical features and management. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:133-40. [PMID: 22419954 PMCID: PMC3301977 DOI: 10.3238/arztebl.2012.0133] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 09/21/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Many new antitumor drugs have been approved in recent years. Their side-effect profiles are distinct from those of older drugs, and their adverse effects are sometimes highly specific, particularly with respect to the skin. METHODS This article is based on articles retrieved by a selective search in Medline and the database of the American Society of Clinical Oncology (ASCO), as well as on the authors' personal experience. RESULTS Cutaneous adverse effects are among the more common adverse effects of new antitumor drugs: they occur in up to 34% of patients receiving multikinase inhibitors, up to 90% of those receiving selective tyrosine kinase inhibitors (such as EGFR or mutant BRAF inhibitors), and up to 68% of those receiving immunotherapeutic agents (such as CTLA4 inhibitors). These adverse effects can be correlated with therapeutic benefit, but they can also be treatment-limiting because of their severity or visibility. CONCLUSION The recognition and proper management of cutaneous adverse effects is an important part of treatment with new antitumor drugs.
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Affiliation(s)
- Ralf Gutzmer
- Department of Dermatology and Allergy, Hannover Skin Cancer Center, Hannover Medical School
| | - Andreas Wollenberg
- Clinic and Policlinic for Dermatology and Allergology, Ludwig Maximilian University of Munich
| | - Selma Ugurel
- Department of Dermatology and Venereology, Medical University of Graz
| | - Bernhard Homey
- Department of Dermatology, Heinrich-Heine University of Düsseldorf
| | - Arnold Ganser
- Department of Hematology, Hemostaseology, Oncology and Stem Cell Transplantation, Hannover Medical School
| | - Alexander Kapp
- Department of Dermatology and Allergy, Hannover Skin Cancer Center, Hannover Medical School
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15
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Gobbo M, Ottaviani G, Mustacchi G, Di Lenarda R, Biasotto M. Acneiform rash due to epidermal growth factor receptor inhibitors: high-level laser therapy as an innovative approach. Lasers Med Sci 2011; 27:1085-90. [PMID: 22120470 DOI: 10.1007/s10103-011-1029-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 11/03/2011] [Indexed: 12/27/2022]
Abstract
Acneiform rash associated with epidermal growth factor receptor inhibitors frequently presents facial manifestations. The treatment modality for such lesions still needs to be elucidated. The aim of this original report was to evaluate the effectiveness of high-level laser therapy in reducing the severity of facial acneiform rash induced by cetuximab, an epidermal growth factor receptor inhibitors. Four patients with metastatic colorectal cancer and two patients with head and neck cancer showing cetuximab-induced facial rash were treated by high-level laser therapy in two 8-min-long consecutive sessions/day over a 4-day treatment. Patients wore protective glasses to prevent eye damage related to laser light. Subsequently, patients were seen once a week for up to 21 days and after 180 days. During each day of treatment and each follow-up recall, patients were asked to complete a questionnaire about the onset and progression of their acneiform rash (for a total of eight sessions). Cetuximab-related toxicity and general discomfort visual analogue scales were also recorded in each of these eight sessions in the treated and control areas in each patient. After the fourth session of high-level laser therapy, the patients showed a noteworthy decrease in both cetuximab-related toxicity and visual analogue scales, up to a complete regression of the lesions at the end of the follow-up in all treated areas. The high-level laser therapy was effective in the healing of acneiform rash associated with epidermal growth factor receptor inhibitors with no side effects.
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Affiliation(s)
- M Gobbo
- Division of Oral Pathology, Dental Science Department, University of Trieste, Ospedale Maggiore, Piazza dell'Ospitale 2, 34100, Trieste, Italy
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16
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Ehmann LM, Heinemann V, Wollenberg A. [New tyrosine kinase and EGFR inhibitors in cancer therapy. Cardiac and skin toxicity as relevant side effects. Part B: Skin]. Internist (Berl) 2011; 52:1359-64. [PMID: 21796420 DOI: 10.1007/s00108-011-2896-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recently, inhibitors of the epidermal growth factor receptor (EGFR) and multikinase inhibitors have been successfully established in the therapy of various solid tumors. EGFR inhibitors and multikinase inhibitors are specific and selective agents that intervene with the dysfunctional regulatory processes of malignant cells. This results in a favorable safety profile and range of side effects, especially in comparison to conventional chemotherapy. The various cutaneous adverse drug reactions are considered substance class effects and are the most frequent side effects of these targeted therapies. Therapy with EGFR inhibitors is associated with acneiform rash, painful paronychia, xerosis cutis, acral fissures, hair changes, and pruritus. Treatment with tyrosin kinase inhibitors may cause hand-foot syndrome, various types of drug rash, hair loss, xerosis cutis, and pruritus. These side effects may be stigmatizing and place a huge burden on the patient's quality of life. Treatment is a challenge and best performed in interdisciplinary cooperation of dermatologists and oncologists.
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Affiliation(s)
- L M Ehmann
- Klinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Frauenlobstraße 9-11, 80337, München
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17
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Lacouture ME, Anadkat MJ, Bensadoun RJ, Bryce J, Chan A, Epstein JB, Eaby-Sandy B, Murphy BA. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer 2011; 19:1079-95. [PMID: 21630130 PMCID: PMC3128700 DOI: 10.1007/s00520-011-1197-6] [Citation(s) in RCA: 286] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 05/17/2011] [Indexed: 11/26/2022]
Abstract
Background Epidermal growth factor receptor inhibitors (EGFRI) produce various dermatologic side effects in the majority of patients, and guidelines are crucial for the prevention and treatment of these untoward events. The purpose of this panel was to develop evidence-based recommendations for EGFRI-associated dermatologic toxicities. Methods A multinational, interdisciplinary panel of experts in supportive care in cancer reviewed pertinent studies using established criteria in order to develop first-generation recommendations for EGFRI-associated dermatologic toxicities. Results Prophylactic and reactive recommendations for papulopustular (acneiform) rash, hair changes, radiation dermatitis, pruritus, mucositis, xerosis/fissures, and paronychia are presented, as well as general dermatologic recommendations when possible. Conclusion Prevention and management of EGFRI-related dermatologic toxicities is critical to maintain patients’ health-related quality of life and dose intensity of antineoplastic regimens. More rigorous investigation of these toxicities is warranted to improve preventive and treatment strategies. Electronic supplementary material The online version of this article (doi:10.1007/s00520-011-1197-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Rockefeller Outpatient Pavilion Suite 228, 160 East 53rd Street, New York, NY 10022, USA.
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18
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Gerber PA, Buhren BA, Kürle S, Homey B. [Therapy with epidermal growth factor receptor inhibitors. Clinical spectrum of cutaneous adverse effects]. Hautarzt 2011; 61:654-61. [PMID: 20628713 DOI: 10.1007/s00105-010-1943-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recently, inhibitors of the epidermal growth factor receptor (EGFR), such as erlotinib, gefitinib, cetuximab or panitumumab, have been successfully established in the therapy of a variety of solid tumors. Cutaneous adverse effects are the most frequent side-effects of these so-called targeted cancer drugs and occur in 45-100% of patients. In addition to a characteristic papulo-pustular rash, adverse effects include painful paronychia, xerosis cutis, pruritus, alopecia or alterations of the hair structure. These often stigmatizing side-effects represent a serious threat to the patients' quality of life and compliance and may lead to dose-reduction or even cessation of the antineoplastic therapy. Considering the steadily growing numbers of patients who receive EGFR-targeting therapy, these medicament-associated cutaneous adverse effects are becoming increasingly more important in the routine clinical practice of dermatologists and oncologists.
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Affiliation(s)
- P A Gerber
- Hautklinik, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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Gutzmer R, Becker JC, Enk A, Garbe C, Hauschild A, Leverkus M, Reimer G, Treudler R, Tsianakas A, Ulrich C, Wollenberg A, Homey B. Management of cutaneous side effects of EGFR inhibitors: recommendations from a German expert panel for the primary treating physician. J Dtsch Dermatol Ges 2010; 9:195-203. [PMID: 21059173 DOI: 10.1111/j.1610-0387.2010.07561.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Inhibitors of the epidermal growth factor receptor (EGFR) are increasingly used in the treatment of various entities of malignant tumors. Patients treated with EGFR inhibitors very likely develop cutaneous side effects. The development of a papulopustular, follicular exanthema during the first weeks of therapy correlates with therapeutic benefit. However, this exanthema and other cutaneous side effects can impair the quality of life of the patient and might limit the therapy with the EGFR inhibitor. For an optimal therapeutic benefit and quality of life an adequate management of cutaneous side effects is necessary. A panel of German dermatologists developed on the basis of personal experience and current literature consensus recommendations for the management of cutaneous side effects of EGFR inhibitors.
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Affiliation(s)
- Ralf Gutzmer
- Department of Dermatology, Allergy and Venereology, Skin Cancer Center, Hannover Medical School, Germany.
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Potthoff K, Hofheinz R, Hassel JC, Volkenandt M, Lordick F, Hartmann JT, Karthaus M, Riess H, Lipp HP, Hauschild A, Trarbach T, Wollenberg A. Interdisciplinary management of EGFR-inhibitor-induced skin reactions: a German expert opinion. Ann Oncol 2010; 22:524-535. [PMID: 20709812 DOI: 10.1093/annonc/mdq387] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Anti-epidermal growth factor receptor treatment strategies, i.e. monoclonal antibodies such as cetuximab and panitumumab, or epidermal growth factor receptor (EGFR) small molecule tyrosine kinase inhibitors, such as erlotinib and gefitinib, have expanded the treatment options for different tumor types. Dermatologic toxic effects are the most common side-effects of EGFR inhibitor therapy. They can profoundly affect the patient's quality of life. PURPOSE The aim of this study was to provide interdisciplinary expert recommendations on how to treat patients with skin reactions undergoing anti-EGFR treatment. MATERIAL AND METHODS An expert panel from Germany with expertise in medical oncology, dermatology or clinical pharmacology was convened to develop expert recommendations based on published peer-reviewed literature. RESULTS The expert recommendations for the state-of-the-art treatment of skin reactions induced by EGFR inhibitor therapy include recommendations for diagnostics and grading as well as grade-specific and stage-adapted treatment approaches and preventive measures. It was concluded that EGFR-inhibitor-related dermatologic reactions should always be treated combining basic care of the skin and a specific therapy adapted to stage and grade of skin reaction. For grade 2 and above, specific treatment recommendations for early- and later-stage skin reactions induced by EGFR-inhibitor therapy were proposed. CONCLUSION This paper presents a German national expert opinion for the treatment of skin reactions in patients receiving EGFR inhibitor therapy.
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Affiliation(s)
- K Potthoff
- Department of Radiation Oncology, University of Heidelberg, Heidelberg.
| | - R Hofheinz
- Department of Hematology and Oncology, University of Mannheim, Mannheim
| | - J C Hassel
- Department of Dermatology, University of Heidelberg, Heidelberg
| | - M Volkenandt
- Department of Dermatology and Allergology, Ludwig-Maximilians-University of Munich, Munich
| | - F Lordick
- Department of Hematology and Oncology, Klinikum Braunschweig, Braunschweig
| | - J T Hartmann
- Department of Hematology and Oncology, University of Tuebingen, Tuebingen
| | - M Karthaus
- Department of Hematology and Oncology, Städtisches Klinikum Neuperlach, Munich
| | - H Riess
- Department of Medical Oncology and Hematology, Charité University, Berlin
| | - H P Lipp
- Department of Pharmacology, University of Tuebingen, Tuebingen
| | - A Hauschild
- Department of Dermatology, University of Kiel, Kiel
| | - T Trarbach
- Department of Hematology and Oncology, University of Essen, Essen, Germany
| | - A Wollenberg
- Department of Dermatology and Allergology, Ludwig-Maximilians-University of Munich, Munich
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