1
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Balagula Y, Ortega AA, Fazal MS, Pasieka HB, Mattei PL, Kuhn D, Leung S, Felipe Silva DL, Do TT, Orringer JS, Chien AL, Kang S. Atrophic acne scars, including scars less than 1.5 mm, may undergo spontaneous regression: A cohort study. JAAD Int 2023; 12:160-161. [PMID: 37456621 PMCID: PMC10338285 DOI: 10.1016/j.jdin.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Affiliation(s)
- Yevgeniy Balagula
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alyssa Ashbaugh Ortega
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria S. Fazal
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Helena B. Pasieka
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter L. Mattei
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diane Kuhn
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sherry Leung
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Thy Thy Do
- Department of Dermatology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Jeffrey S. Orringer
- Department of Dermatology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Anna L. Chien
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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2
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Patel S, Bibi A, Eisenberg R, Gendlina I, Murakhovskaya I, Ramesh M, Balagula Y, Kumthekar A. The Role of Early Subspeciality Consultation in the Timing of Hemophagocytic Lymphohistiocytosis Diagnosis and Management. J Clin Rheumatol 2022; 28:e462-e466. [PMID: 34262003 DOI: 10.1097/rhu.0000000000001759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the relation between timing of subspeciality consult and hemophagocytic lymphohistiocytosis (HLH) consideration, immunosuppression initiation, and in-hospital mortality in patients with HLH. METHODS We conducted a medical records review study of patients 18 years or older with definite or probable HLH at Montefiore Medical Center between 2006 and 2019. Earlier subspeciality consultation (rheumatology, hematology, and infectious disease) was defined as consultation in less than or equal to 18 hours from time of admission. Demographic, clinical characteristics, and outcomes were compared between patients with early and later subspecialty consultation. RESULTS A total of 28 patients were included. The median age was 40 years, and 61% of patients were male. Infection was identified as a cause of HLH in 13 patients (46%). Fifteen patients (54%) were classified as having an earlier subspeciality consultation with a median time (interquartile range) to HLH consideration of 1.0 day (0.3-4.2 days) compared with 7.9 days (3.1-9.9 days) for the later consultation group (p = 0.002). The median time (interquartile range) to immunosuppression initiation was 4.6 days (1.7-7.8 days) versus 10.9 days (5.1-13.4 days) (p = 0.01), respectively. Five patients (33%) had in-hospital deaths in the early consultation group compared with 7 patients (54%) in later consultation group (p = 0.27). Among the subset of patients who survived to discharge, the 90-day readmission rate was higher in the later consultation group (83% vs 30%, p = 0.12). CONCLUSIONS In patients with HLH, earlier subspeciality consultation may play a role in earlier HLH consideration and treatment initiation.
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Affiliation(s)
- Sneha Patel
- From the Division of Rheumatology, John Peter Smith Hospital, Fort Worth, TX
| | - Ayesha Bibi
- Division of Rheumatology, Montefiore Medical Center
| | - Ruth Eisenberg
- Division of Biostatistics, Albert Einstein College of Medicine
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3
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Deutsch A, Patel P, Balagula Y. Velvety Plaques on the Abdomen and Extremities. Cutis 2021; 108:E5-E7. [PMID: 34826283 DOI: 10.12788/cutis.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Alana Deutsch
- From the Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Parth Patel
- From the Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Yevgeniy Balagula
- From the Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
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4
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Mieczkowska K, Deutsch A, Amin B, Mir A, Abraham R, Balagula Y, Blasiak R, Mann RE, Patel P, Musaev T, Zhu TH, Kalnicki S, Packer SH, McLellan BN. Mitomycin extravasation injury: A case series. JAAD Case Rep 2021; 15:69-72. [PMID: 34409144 PMCID: PMC8361222 DOI: 10.1016/j.jdcr.2021.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Karolina Mieczkowska
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Alana Deutsch
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Bijal Amin
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Adnan Mir
- Dermpath Diagnostics, White Plains, New York
| | - Renu Abraham
- Patient Safety Committee, Montefiore Medical Center, Bronx, New York
| | - Yevgeniy Balagula
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Blasiak
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Ranon E Mann
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Parth Patel
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Tagai Musaev
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Tian Hao Zhu
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York
| | - Stuart H Packer
- Department of Medical Oncology, Albert Einstein College of Medicine, Bronx, New York
| | - Beth N McLellan
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
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5
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Pithadia DJ, Kerns ML, Golden WC, Balagula Y, Glick SA, Huang A, Natsis NE, Tom WL, Cohen BA. Heterogeneous cutaneous findings associated with intrauterine HSV infection: A case series and literature review. Pediatr Dermatol 2021; 38:831-841. [PMID: 34227161 DOI: 10.1111/pde.14682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Herpes simplex virus (HSV) infection acquired in utero may present with non-vesicular dermatologic findings in affected newborns, which may pose a diagnostic dilemma. We aimed to describe and assess the range of non-vesiculobullous skin lesions that neonates with intrauterine HSV infection may manifest at birth. METHODS We collected a multicenter case series and conducted a literature review of neonates with intrauterine HSV infection presenting with non-vesiculobullous cutaneous lesions. RESULTS Twenty-two cases were reviewed, including six managed clinically by members of our team and 16 identified in the literature. Four (18%) were associated with twin pregnancies, and thirteen (59%) cases occurred in premature infants. Only four (18%) mothers had a documented history of HSV infection. Twelve (55%) cases resulted in poor outcomes, including long-term neurologic sequelae or death. Cutaneous manifestations included erosions, ulcerations, crusted papules or plaques, calcinosis cutis, excoriations, macules (erythematous, hypopigmented, or hyperpigmented), cutaneous atrophy, contractures, and bruising. About one-third of neonates developed new-onset vesicular lesions within a week of birth; in each of these cases, accurate diagnosis and therapy were delayed until appearance of vesicles. CONCLUSIONS The range of dermatologic findings associated with intrauterine HSV is extremely broad, and the various morphologies present at birth likely reflect different stages of the ongoing evolution of an HSV infection that began in utero. Clinicians should have a low threshold for HSV testing in premature neonates born with atypical cutaneous lesions, since early detection and treatment of HSV may reduce morbidity and mortality from systemic complications.
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Affiliation(s)
- Deeti J Pithadia
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle L Kerns
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William C Golden
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sharon A Glick
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Amy Huang
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Nicola E Natsis
- Department of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Wynnis L Tom
- Department of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Bernard A Cohen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Affiliation(s)
- Roya S Nazarian
- Albert Einstein College of Medicine, Bronx, New York.,Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Bijal Amin
- Albert Einstein College of Medicine, Bronx, New York
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7
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Ngo T, Hossain C, Guzman AK, Halmos B, Balagula Y, McLellan B. Spectrum of PD-1 and PD-L1 inhibitor cutaneous adverse events in skin of color: a retrospective, single-institutional study in an urban community. Acta Oncol 2021; 60:559-563. [PMID: 33522846 DOI: 10.1080/0284186x.2021.1878387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Tracy Ngo
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Claudia Hossain
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anthony K. Guzman
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Balazs Halmos
- Department of Oncology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yevgeniy Balagula
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Beth McLellan
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
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8
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Lally BJ, Guzman AK, Balagula Y, Dewall M, Jacobson M. Unilateral perniosis (chilblains) following hip arthroplasty. JAAD Case Rep 2020; 7:141-142. [PMID: 33426255 PMCID: PMC7779860 DOI: 10.1016/j.jdcr.2020.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Anthony K Guzman
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medcine, Bronx, New York
| | - Yevgeniy Balagula
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medcine, Bronx, New York
| | - Michael Dewall
- Division of Dermatopathology, Department of Pathology, St. Joseph Mercy Health System, Ann Arbor, Michigan
| | - Mark Jacobson
- Division of Dermatopathology, Department of Pathology, Albert Einstein College of Medicine, Bronx, New York
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9
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Kost Y, Hejazi E, Hui Y, Amin B, Balagula Y. Necrotic plaque on the abdomen after liver transplant. JAAD Case Rep 2020; 6:1307-1309. [PMID: 33294571 PMCID: PMC7700986 DOI: 10.1016/j.jdcr.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Yana Kost
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Emily Hejazi
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Yiang Hui
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Bijal Amin
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Yevgeniy Balagula
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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10
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Babbush K, Manning JR, Amin B, Balagula Y. 15672 A cutaneous crypt for cryptococcosis: The skin as a marker for disseminated disease. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Deutsch A, Balagula Y, McLellan BN. Anticancer therapies associated with secondary cutaneous malignancies: A review of the literature. J Am Acad Dermatol 2020; 83:1425-1433. [DOI: 10.1016/j.jaad.2020.04.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/03/2020] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
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12
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Guzman AK, Gittler JK, Amin B, Srikantha R, Balagula Y. Acute inflammatory Demodex-induced pustulosis in an immunocompetent patient related to topical steroid use. Pediatr Dermatol 2020; 37:985-986. [PMID: 32729151 DOI: 10.1111/pde.14315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Abstract
Demodex spp. mites are a common colonizer of sebaceous adult skin. Though usually clinically insignificant, demodicosis may be associated with a wide spectrum of skin diseases in immunocompetent hosts, such as erythematotelangiectatic and papulopustular rosacea, Demodex folliculorum, and blepharitis. We present a case of a healthy 9-year-old boy with an exuberant, inflammatory, Demodex-associated pustular eruption of the face, induced by the use of a high-potency topical steroid and successfully treated with oral ivermectin.
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Affiliation(s)
- Anthony K Guzman
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Julia K Gittler
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bijal Amin
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rithu Srikantha
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yevgeniy Balagula
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Guzman AK, Balagula Y. Drug-induced cutaneous vasculitis and anticoagulant-related cutaneous adverse reactions: insights in pathogenesis, clinical presentation, and treatment. Clin Dermatol 2020; 38:613-628. [PMID: 33341196 DOI: 10.1016/j.clindermatol.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Drug-induced vasculitis and anticoagulant-related skin reactions are commonly encountered in the inpatient and outpatient settings. The spectrum of clinical presentation is broad and ranges from focal, skin-limited disease, to more extensive cutaneous and soft tissue necrosis, to potentially fatal systemic involvement. The prompt recognition of these adverse events can have a significant impact on patient morbidity and mortality. We highlight the key features of the clinical presentation with an emphasis on primary lesion morphology, distribution, and epidemiology of purpuric drug reactions. The proposed pathophysiology, histologic findings, and therapeutic interventions of these potentially life-threatening diseases are discussed.
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Affiliation(s)
- Anthony K Guzman
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Yevgeniy Balagula
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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14
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Deutsch A, Guzman AK, Hossain C, Balagula Y. Persistent eyelid ulceration in an immunocompromised host: A cutaneous sign with the potential for early diagnosis and intervention in disseminated cryptococcosis. JAAD Case Rep 2020; 6:388-389. [PMID: 32382625 PMCID: PMC7200202 DOI: 10.1016/j.jdcr.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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16
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Rzepecki AK, Park M, Amin B, Dunec A, McLellan BN, Balagula Y. A unique clinical and histologic presentation of catastrophic systemic calciphylaxis in a nonuremic patient with systemic lupus erythematosus. JAAD Case Rep 2019; 5:245-248. [PMID: 30854415 PMCID: PMC6393691 DOI: 10.1016/j.jdcr.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Alexandra K Rzepecki
- University of Michigan Medical School, Ann Arbor, Michigan.,Department of Medicine, Division of Dermatology, Bronx, New York
| | - Michelle Park
- Department of Medicine, Division of Dermatology, Bronx, New York
| | - Bijal Amin
- Department of Medicine, Division of Dermatology, Bronx, New York.,Department of Pathology, Montefiore Medical Center, Bronx, New York
| | - Amanda Dunec
- Department of Medicine, Division of Dermatology, Bronx, New York
| | - Beth N McLellan
- Department of Medicine, Division of Dermatology, Bronx, New York
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17
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Fresco A, Wang J, Krausz A, Chan A, Franco L, Garelik J, Gatica M, Balagula Y, McLellan B, Jacobson M, Amin B. Cryptococcus-like changes in the setting of vasculitis. J Cutan Pathol 2018; 46:143-147. [PMID: 30362142 DOI: 10.1111/cup.13380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 11/30/2022]
Abstract
Cutaneous vasculitis has many underlying causes, and the clinical and histological findings often overlap. Inflammatory vasculitis can mimic infection; however, distinction is critical for the timely institution of appropriate therapy. We present two patients who had generalized polymorphous eruptions whose cutaneous pathology showed vasculitis with unusual haloed yeast-like cells within the inflammatory infiltrate, mimicking Cryptococcus. The unusual cells stained negatively with Gomori methenamine silver and periodic acid-Schiff fungal stains, but positively for CD68 and had cytoplasmic reactivity with antibody to myeloperoxidase (MPO). Both patients had positive serum anti-MPO antibodies. The first patient experienced a rapidly fatal course, whereas the second patient improved with prompt initiation of systemic corticosteroids. Interestingly, the second case had prior biopsy showing Sweet syndrome with crypotoccoid-appearing cells. Cryptococcoid cells have been described previously in association with neutrophilic dermatoses, but not in the setting of vasculitis as was seen in our patients. Our cases add to the existing literature on crypotoccoid mimickers, and are the first to be reported in association with vasculitis.
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Affiliation(s)
- Amber Fresco
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | - Jenny Wang
- Albert Einstein College of Medicine, New York, New York
| | - Aimee Krausz
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | - Aegean Chan
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York.,Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | - Loren Franco
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | - Jessica Garelik
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | - Michelle Gatica
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York.,Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | - Yevgeniy Balagula
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | - Beth McLellan
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | - Mark Jacobson
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York.,Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
| | - Bijal Amin
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York.,Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York
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18
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Rzepecki AK, Wald J, Amin B, Leung E, Choi E, Balagula Y. Kava-induced acute cutaneous toxicity: An increasingly recognized characteristic clinicohistologic pattern. JAAD Case Rep 2018; 4:1037-1038. [PMID: 30456280 PMCID: PMC6232697 DOI: 10.1016/j.jdcr.2018.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alexandra K Rzepecki
- Department of Dermatology, University of Michigan Medical School, Ann Arbor.,Department of Medicine, Division of Dermatology, Montefiore Medical Center, Bronx
| | - Jenna Wald
- Department of Medicine, Division of Dermatology, Montefiore Medical Center, Bronx
| | - Bijal Amin
- Department of Medicine, Division of Dermatology, Montefiore Medical Center, Bronx.,Department of Pathology, Montefiore Medical Center, Bronx
| | - Edison Leung
- Department of Medicine, Montefiore Medical Center, Bronx
| | - Evan Choi
- Department of Medicine, Montefiore Medical Center, Bronx
| | - Yevgeniy Balagula
- Department of Medicine, Division of Dermatology, Montefiore Medical Center, Bronx
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Loss M, Balagula Y, Fischer A, Cuda J, Ates D, Taube J, Xu H, Qi J, Leung S, Wang T, Chien A, Kang S. LB782 Cancer progression to squamous cell carcinoma is associated with increase in c-Jun expression in human skin in vivo. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Pasieka H, Qi J, Jang M, Jefferson J, Balagula Y, Kim N, Leung S, Kuhn D, Shapiro J, Kang S, Chien A. 148 A case-control study of the skin manifestations of osteogenesis imperfecta. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Qi J, Jourabchi N, Balagula Y, Sheu M, Fischer MK. Folliculocentric cutaneous presentation of disseminated Candida krusei infection in a patient with acute myeloid leukemia. Dermatol Online J 2015; 21:13030/qt52j7w4g1. [PMID: 26632935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 06/05/2023] Open
Abstract
Candida krusei (C. krusei) is a multidrug-resistant opportunistic fungal pathogen that may cause disseminated infections in immunocompromised hosts. However, its clinical and histologic features are not well-characterized. We present a unique case to contribute to the growing knowledge base associated with this organism. During hospitalization for neutropenic fever, a 19-year-old man with acute myeloid leukemia, who underwent hematopoietic stem cell transplantation, developed a generalized folliculocentric eruption following initiation of antifungal therapy for newly diagnosed C. krusei fungemia. Despite adequate antifungal coverage and negative blood cultures, the follicular-based erythematous papules persisted. Biopsies demonstrated yeast within ruptured follicles, without angiotropism or involvement of the interfollicular dermis, subcutaneous tissue, or stratum corneum. Concurrent skin tissue cultures confirmed C. krusei. The patient remained febrile despite aggressive antifungal therapy, with relapse of leukemia and subsequent death. Our case is unusual given the development of cutaneous lesions following clearance of fungemia, with yeast limited to ruptured follicular lumina, possibly indicating a primary cutaneous source or early transfollicular/transepidermal elimination. Given the limited available descriptions of cutaneous histopathology for C. krusei, we seek to add to the understanding of its pathophysiology and aid in the diagnosis and treatment of this often fatal infection.
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Qi J, Jourabchi N, Balagula Y, Sheu M, Fischer MK. Folliculocentric cutaneous presentation of disseminated Candida krusei infection in a patient with acute myeloid leukemia. Dermatol Online J 2015. [DOI: 10.5070/d32111029299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Balagula Y, Erdag G, Alhariri J. Dermoscopy of a clonal (inverted type A) nevus in a child. J Am Acad Dermatol 2014; 71:e187-9. [PMID: 25437985 DOI: 10.1016/j.jaad.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 01/21/2014] [Accepted: 02/04/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Yevgeniy Balagula
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore.
| | - Gulsun Erdag
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore
| | - Jihad Alhariri
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore
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Mitkov M, Balagula Y, Taube JM, Lockshin B. Plaque-like syringoma with involvement of deep reticular dermis. J Am Acad Dermatol 2014; 71:e206-7. [DOI: 10.1016/j.jaad.2014.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 11/28/2022]
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Balagula Y, Mattei PL, Wisco OJ, Erdag G, Chien AL. The great imitator revisited: the spectrum of atypical cutaneous manifestations of secondary syphilis. Int J Dermatol 2014; 53:1434-41. [PMID: 25312512 DOI: 10.1111/ijd.12518] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Syphilis is a well-known sexually transmitted infection infamous for its protean cutaneous manifestations. Over the last decade, the rate of infection in the USA has risen, particularly among human immunodeficiency virus (HIV)-infected individuals and certain ethnic groups. Although the primary chancre developing at the site of inoculation usually has typical and well-characterized features, cutaneous manifestations of secondary syphilis span a wide spectrum and mimic those of other dermatoses. This may be particularly evident in patients with HIV. Such deviations from the expected typical papulosquamous eruption may present a diagnostic challenge and delay diagnosis and therapy. Given the increasing incidence of syphilis among the immunosuppressed patient population, recognition of atypical cutaneous manifestations is critical for adequate management. We review a range of cutaneous manifestations of secondary syphilis and the skin diseases it may mimic.
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Affiliation(s)
- Yevgeniy Balagula
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Mitkov M, Balagula Y, Lockshin B. Circumscribed plantar hypokeratosis. Int J Dermatol 2014; 54:e203-5. [DOI: 10.1111/ijd.12598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 09/29/2013] [Accepted: 11/30/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Mario Mitkov
- Creighton University School of Medicine; St. Joseph's Hospital and Medical Center; Phoenix AZ USA
| | - Yevgeniy Balagula
- Department of Dermatology; Johns Hopkins School of Medicine; Baltimore MD USA
| | - Benjamin Lockshin
- Department of Dermatology; Johns Hopkins School of Medicine; Baltimore MD USA
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Balagula Y, Taube JM, Wang T, Dorafshar AH, Sweren RJ. Regression of cutaneous invasive squamous cell carcinoma in a patient with chronic cutaneous graft versus host disease. Dermatol Online J 2014; 20:22614. [PMID: 24852774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 06/03/2023] Open
Abstract
Numerous complications can be observed in the post-transplant period among recipients of hematopoietic stem cells including graft-versus-host disease (GVHD), which is associated with significant morbidity and mortality. On the other hand, graft versus tumor (GVT) effect is a well-described phenomenon in patients with hematologic malignancies and has also been reported in renal cell cancer, ovarian cancer, breast carcinoma, and melanoma. We describe spontaneous regression of a cutaneous invasive squamous cell carcinoma and multifocal atypical intraepidermal proliferations in a patient with chronic graft-versus-host disease following initiation of extracorporeal photopheresis (ECP). This observation raises questions regarding the GVT in cutaneous neoplasms and potential immunomodulatory effects of ECP.
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Balagula Y, Kang S, Patel MJ. Synergism between mTOR pathway and ultraviolet radiation in the pathogenesis of squamous cell carcinoma and its implication for solid-organ transplant recipients. Photodermatol Photoimmunol Photomed 2014; 31:15-25. [PMID: 24517835 DOI: 10.1111/phpp.12115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 12/22/2022]
Abstract
Nonmelanoma skin cancers (NMSCs) are the most common malignancies in the United States in immunocompetent patients. Among the solid-organ transplant recipients, NMSCs represent a significant disease burden, and they tend to be multiple and more aggressive. While the precise mechanisms responsible for the higher risk of developing cutaneous squamous cell carcinomas (SCCs) have not been completely elucidated, ultraviolet (UV) light has been established to be critical in initiation and promotion of tumor development. More recently, significant emphasis has been placed on the role of the mammalian target of rapamycin (mTOR) pathway in SCC pathogenesis. Furthermore, some studies have demonstrated the ability of mTOR inhibitors to decrease the incidence of new SCCs in the immunosuppressed transplanted patient population. In this review, we will highlight and examine the most recent available data on the role of UV radiation and its interaction with mTOR pathway signaling in SCC pathogenesis.
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Affiliation(s)
- Yevgeniy Balagula
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, USA
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Balagula Y, Taube JM, Wang T, Dorafshar AH, Sweren RJ. Regression of cutaneous invasive squamous cell carcinoma in a patient with chronic cutaneous graft versus host disease. Dermatol Online J 2014. [DOI: 10.5070/d3205022614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Rosen AC, Case EC, Dusza SW, Balagula Y, Gordon J, West DP, Lacouture ME. Impact of dermatologic adverse events on quality of life in 283 cancer patients: a questionnaire study in a dermatology referral clinic. Am J Clin Dermatol 2013; 14:327-33. [PMID: 23625802 DOI: 10.1007/s40257-013-0021-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Anticancer therapies cause a wide range of dermatologic adverse events (AE). Although the frequency and severity of these events have been described, their effects on health-related quality of life (QoL) remain poorly understood, and the ones having a greater impact have not been ascertained. OBJECTIVE To assess QoL in patients on conventional versus targeted anti-cancer therapies using a dermatology-specific questionnaire. METHODS Patients (n = 283) completed the Skindex-16, a QoL questionnaire measuring the effects on three domains: symptoms, emotions, and function. Patients were grouped into two categories according to the types of oncology treatments received: (1) targeted therapies and (2) non-targeted therapies. Correlations of Skindex-16 scores with type of anti-cancer therapy, number of AEs, and specific dermatologic AEs were investigated. RESULTS Significant differences between patients treated with targeted versus non-targeted therapy with regards to total Skindex-16 (p = 0.02) and emotion subdomain (p = 0.02) scores were observed. Additionally, patients on targeted therapies experienced a significantly greater number of AEs (p < 0.001) compared with patients on non-targeted therapies. Patients who exhibited epidermal growth factor receptor (EGFR) inhibitor-induced rash had higher Skindex-16 scores (p = 0.009) and higher scores in the symptom (p < 0.001), emotion (p = 0.01), and function (p = 0.001) subdomains than patients without this AE. Similar results were observed for pruritus. All p values were two sided. CONCLUSIONS Dermatologic AEs are associated with a diminished QoL. Targeted therapies are associated with a significantly increased number of AEs and worse total and emotion Skindex-16 scores in comparison with non-targeted therapies. EGFR inhibitor rash and pruritus produced the greatest negative impact.
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Balagula Y, Rosen A, Tan BH, Busam KJ, Pulitzer MP, Motzer RJ, Feldman DR, Konner JA, Reidy-Lagunes D, Myskowski PL, Lacouture ME. Clinical and histopathologic characteristics of rash in cancer patients treated with mammalian target of rapamycin inhibitors. Cancer 2012; 118:5078-83. [PMID: 22437824 DOI: 10.1002/cncr.27505] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/27/2012] [Accepted: 01/31/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dermatologic adverse events stemming from anticancer therapies have become an increasingly frequent clinical problem. Inhibitors of mammalian target of rapamycin (mTOR), such as temsirolimus and everolimus, have been associated with a high rate of skin eruptions, but their clinical and histopathologic characteristics have not been explored. METHODS A retrospective analysis of patients who were referred to the Dermatology Service for diagnosis and management of rash in the setting of therapy with the mTOR inhibitors everolimus and temsirolimus was performed. The parameters that were studied included the time to onset, clinical presentation at the time of dermatologic evaluation, associated symptoms, evolution, results of microbiologic studies, concomitant medications, the need for dose reduction and/or treatment interruption because of rash, and routine histopathology. RESULTS In total, 13 patients were analyzed. Most rashes were mild (grade 1; 31%) and moderate (grade 2; 54%) in severity, and grade 3 rashes were observed only in 2 patients (15%). The trunk was the most frequently affected region (77%), with the scalp (23%), face (38%), neck (54%), and extremities (69%) also commonly involved. Erythematous papules and pustules constituted the predominant primary lesion morphology (62%). No unique or uniform histopathologic reaction pattern was observed. The most common reaction pattern was that of a mixed, spongiotic interface and perivascular dermatitis, which was observed in 7 of 11 patients (63%). CONCLUSIONS Although mTOR inhibitors may commonly induce erythematous papules and pustules, they are associated with a spectrum of lesion morphologies and a variety of histopathologic findings. Further clinicohistologic correlation studies are needed.
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Affiliation(s)
- Yevgeniy Balagula
- Department of Medicine, Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA
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Liebman TN, Jaimes-Lopez N, Balagula Y, Rabinovitz HS, Wang SQ, Dusza SW, Marghoob AA. Dermoscopic Features of Basal Cell Carcinomas: Differences in Appearance Under Non-Polarized and Polarized Light. Dermatol Surg 2012; 38:392-9. [DOI: 10.1111/j.1524-4725.2011.02205.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gavrilovic IT, Balagula Y, Rosen AC, Ramaswamy V, Dickler MN, Dunkel IJ, Lacouture ME. Characteristics of oral mucosal events related to bevacizumab treatment. Oncologist 2012; 17:274-8. [PMID: 22282905 DOI: 10.1634/theoncologist.2011-0198] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bevacizumab, a monoclonal antibody targeting a vascular endothelial growth factor (VEGF) protein, has been reported to induce mucosal toxicities. However, the clinical characteristics of these particular toxicities have not been well characterized. We aimed at providing a detailed clinical description of signs and symptoms limited to the tongue mucosa in patients treated with bevacizumab. METHODS A retrospective review of medical records and clinical photographs was performed with specific attention to clinical presentation, evolution, associated symptoms, concomitant medications, and treatment methods. RESULTS In total, four patients presented to the dermatology service with clinical findings characterized by multifocal, erythematous circinate and serpiginous erosions on the dorsal tongue surrounded by white hyperkeratotic rims that were temporally related to bevacizumab therapy. Associated increased sensitivity to spicy foods was frequently observed. CONCLUSION These characteristic clinical findings are consistent with geographic tongue. However, large prospective evaluations are necessary to confirm this potential relationship. If bevacizumab is indeed associated with geographic tongue, increased awareness may result in improved reporting and characterization of this particular adverse event.
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Affiliation(s)
- Igor T Gavrilovic
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA
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Balagula Y, Jaimes-Lopez N, Lopez NJ, Busam KJ, Quigley EA. Erythematous patches and plaques on the chest with induration of the breasts. Metastatic papillary RCC in dermal lymphatics. ACTA ACUST UNITED AC 2011; 147:1215-20. [PMID: 22006141 DOI: 10.1001/archdermatol.2011.284-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Balagula Y, Pulitzer MP, Maki RG, Myskowski PL. Pigmentary changes in a patient treated with imatinib. J Drugs Dermatol 2011; 10:1062-1066. [PMID: 22052279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Imatinib mesylate (STI 571; Gleevec; Novartis Pharmaceuticals, Basel, Switzerland) is an orally available tyrosine kinase inhibitor that targets a constitutively activated BCR-ABL tyrosine kinase with additional inhibitory effects on platelet derived growth factor (PDGF) receptors alpha and beta, and KIT. It has revolutionized the treatment of adult and pediatric patients with Philadelphia chromosome positive chronic myelogenous leukemia (CML) and is also FDA-approved for KIT-positive advanced gastrointestinal tumor (GIST) and dermatofibrosarcoma protuberans. A wide spectrum of dermatologic toxicities has been associated with this agent, among which a maculopapular rash is the most common event. In addition, a variety of pigmentary abnormalities of the skin and mucosal surfaces have been reported. Hypopigmentation is a well-recognized adverse effect. In contrast, paradoxical hyperpigmentation has only rarely been documented. In this case report we describe imatinib-induced cutaneous hyperpigmentation and graying of hair occurring in the same patient with dermatofibrosarcoma protuberans treated with imatinib.
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Affiliation(s)
- Yevgeniy Balagula
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
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Luu M, Boone SL, Patel J, Sullivan P, Rademaker AW, Balagula Y, Lacouture ME. Higher severity grade of erlotinib-induced rash is associated with lower skin phototype. Clin Exp Dermatol 2011; 36:733-8. [DOI: 10.1111/j.1365-2230.2011.04117.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Garg V, Balagula Y, Raisch DW, Anadkat MJ, Lacouture ME. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in a setting of chemotherapy treatment: An assessment of FDA MedWatch database. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gordon J, Balagula Y, Dusza SW, Chen D, Berg S, West DP, Lacouture ME. Quality of life in patients with dermatologic toxicities: Experience from the SERIES clinic. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gomez Fernandez C, Balagula Y, Wu S, Su X, Feldman DR, Rathkopf DE, Lacouture ME. Risk of rash and stomatitis with temsirolimus, a mammalian target of rapamycin (mTOR) inhibitor: A meta-analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chen D, Gordon J, Ibrahim O, Balagula Y, Rademaker A, West DP, Lacouture ME. Management of dermatologic toxicities associated with epidermal growth factor inhibitors (EGFRIs) and multikinase inhibitors (MKIs). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Balagula Y, Garbe C, Myskowski PL, Hauschild A, Rapoport BL, Boers-Doets CB, Lacouture ME. Clinical presentation and management of dermatological toxicities of epidermal growth factor receptor inhibitors. Int J Dermatol 2011; 50:129-46. [PMID: 21244375 DOI: 10.1111/j.1365-4632.2010.04791.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The last decade in oncology has been highlighted by the emergence of novel, highly specific anti-cancer agents, targeting a variety of molecular structures and able to inhibit aberrantly activated oncogenic pathways. Epidermal growth factor receptor inhibitors (EGFRIs) represent one type of such "targeted" agents. Their use made treatment more tolerable and resulted in significant reduction of systemic adverse effects. However, EGFRIs are associated with toxicities affecting the skin and adnexal structures, and mucosal surfaces that affect the majority of treated patients. Significant dermatologic toxicities have changed the role and involvement of dermatologists in their care. It is essential to be familiar with these adverse effects, potential complications, long-term sequelae, and available effective treatment strategies in order to appropriately manage these patients. This review will describe the clinical presentation, histopathology, underlying mechanisms, and management options, emphasizing evidence-based approaches.
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Balagula Y, Straus DJ, Pulitzer MP, Lacouture ME. Necrobiotic Xanthogranuloma Associated With Immunoglobulin M Paraproteinemia in a Patient With Waldenström Macroglobulinemia. J Clin Oncol 2011; 29:e305-7. [DOI: 10.1200/jco.2010.32.4921] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Balagula Y, Wu S, Su X, Lacouture ME. The effect of cytotoxic chemotherapy on the risk of high-grade acneiform rash to cetuximab in cancer patients: a meta-analysis. Ann Oncol 2011; 22:2366-2374. [PMID: 21402620 DOI: 10.1093/annonc/mdr016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The effect of chemotherapy on the risk of cetuximab-induced acneiform rash is unknown. We carried out a systematic review and meta-analysis of published studies to quantify the incidence and risk of high-grade acneiform rash with combination therapy. METHODS Relevant studies were identified from PubMed database, abstracts presented at the American Society of Clinical Oncology conferences, and Web of Science. Incidence of acneiform rash to cetuximab monotherapy was estimated based on updated data from our previously published meta-analysis. Incidence, relative risk (RR), and 95% confidence intervals (CIs) were calculated based on the heterogeneity of included studies. RESULTS A total of 5333 patients from nine trials were included in the analysis. The incidence of high-grade acneiform rash was significantly increased in patients receiving combination treatment (12.8%, 95% CI 9.1% to 17.7%) as compared with cetuximab monotherapy (6.3%, 95% CI 3.7% to 10.5%), with a risk ratio of 2.03 (95% CI 1.52-2.71, P < 0.01). Cetuximab significantly increased the risk of high-grade rash in patients receiving combination therapy (RR = 37.7, 95% CI 17.8-80.0, P < 0.001). CONCLUSIONS Addition of cytotoxic chemotherapy to cetuximab significantly increases the risk of high-grade acneiform rash compared with cetuximab monotherapy. This emphasizes the need for effective management strategies.
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Affiliation(s)
- Y Balagula
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York
| | - S Wu
- Division of Hematology and Oncology, Stony Brook University Cancer Center, Stony Brook, USA
| | - X Su
- Division of Hematology and Oncology, Stony Brook University Cancer Center, Stony Brook, USA
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York.
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Balagula Y, Wu S, Su X, Feldman DR, Lacouture ME. The risk of hand foot skin reaction to pazopanib, a novel multikinase inhibitor: a systematic review of literature and meta-analysis. Invest New Drugs 2011; 30:1773-81. [DOI: 10.1007/s10637-011-9652-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 02/27/2011] [Indexed: 10/18/2022]
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Balagula Y, Wu S, Su X, Lacouture ME. Hand–foot skin reaction, an anticipated dermatologic toxicity to pazopanib, with an unexpected low incidence: A systematic review of literature and meta-analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
365 Background: Pazopanib is a novel multikinase inhibitor that has been approved for the treatment of advanced renal cell carcinoma (RCC). It shares a similar spectrum of target receptors with sorafenib and sunitinib, including VEGFR, PDGFR, and c-kit tyrosine kinases. We have performed a systematic analysis to investigate the risk of HFSR to pazopanib. Exploring the differences in the incidence of HFSR between sorafenib, sunitinib, and pazopanib may offer additional insights into underlying mechanisms of this toxicity. Methods: Relevant studies were identified from PubMed (1998-2010) and abstracts presented at the American Society of Clinical Oncology Conferences between 2004 and 2010. Eligible studies were limited to prospective phase II-III clinical trials in which cancer patients were treated with pazopanib 800 mg orally once daily. Incidence, relative risk (RR), and 95% confidence intervals were calculated using random-effects or fixed-effects models based on the heterogeneity of included studies. Results: A total of 942 patients from 10 prospective clinical trials were included in the analysis. The overall incidence of all-grade and high-grade HFSR was 4.5% (95% CI: 2.5-7.9%) and 1.5% (95% CI: 0.7-3.1 %), respectively. The relative risks of all-grade and high-grade HFSR to pazopanib monotherapy in comparison with controls were increased, reaching statistical significance for all-grade (RR=6.05, 95% CI: 1.11-33.12, p=0.038), but not for high-grade (RR=2.51, 95% CI: 0.12-51.9, p=0.55). The incidence of all-grade HFSR was significantly higher in patients with RCC as compared to patients with non-RCC malignancies (7.8% vs. 2.4%, p value=0.015). Conclusions: Despite sharing the same spectrum of target receptors with sorafenib and sunitinib, pazopanib is associated with an unexpectedly low risk of HFSR. Further investigations are needed to elucidate HFSR pathogenesis. [Table: see text]
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Affiliation(s)
- Y. Balagula
- Memorial Sloan-Kettering Cancer Center, New York, NY; Division of Hematology and Oncology, Stony Brook University Cancer Center, Stony Brook, NY
| | - S. Wu
- Memorial Sloan-Kettering Cancer Center, New York, NY; Division of Hematology and Oncology, Stony Brook University Cancer Center, Stony Brook, NY
| | - X. Su
- Memorial Sloan-Kettering Cancer Center, New York, NY; Division of Hematology and Oncology, Stony Brook University Cancer Center, Stony Brook, NY
| | - M. E. Lacouture
- Memorial Sloan-Kettering Cancer Center, New York, NY; Division of Hematology and Oncology, Stony Brook University Cancer Center, Stony Brook, NY
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Balagula Y, Hensley JR, Gerami P, Lacouture ME. Acneiform Rash as a Reaction to Radiotherapy in a Breast Cancer Patient. ACTA ACUST UNITED AC 2010; 8:268-71. [DOI: 10.1016/j.suponc.2010.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Balagula Y, Barth Huston K, Busam KJ, Lacouture ME, Chapman PB, Myskowski PL. Dermatologic side effects associated with the MEK 1/2 inhibitor selumetinib (AZD6244, ARRY-142886). Invest New Drugs 2010; 29:1114-21. [PMID: 20978926 DOI: 10.1007/s10637-010-9567-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/11/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Selumetinib (AZD6244, ARRY-142886) is a second generation MEK inhibitor that is currently in clinical trials for various solid malignancies. MEK kinase inhibitors are associated with dermatologic toxicities. While reactions affecting the skin, hair and nails to other targeted agents, such as epidermal growth factor receptor inhibitors (EGFRIs) have been abundantly described in recent years, the dermatologic toxicities associated with MEK inhibitors have not been well characterized. Similarly, their management may present a challenge in clinical trials. We reviewed the clinical presentation, evolution and management of dermatologic toxicities associated with selumetinib. METHODS A retrospective review of medical records of 11 patients referred to the Dermatology Service with dermatologic toxicities secondary to selumetinib was performed. Data from two phase II trials in which selumetinib was used to treat advanced metastatic cutaneous, mucosal, or uveal melanomas were reviewed. Parameters studied included the time to onset, clinical presentation, histology and management. In addition, the clinical database was accessed to retrieve clinical photographs when available. RESULTS Eight patients received selumetinib suspension orally at 100 mg twice a day and three patients received a newer capsule formulation at the maximum tolerated dose of 75 mg with the same frequency. The following adverse effects were observed: papulopustular rash (100%), xerosis (36%), pruritus (45%), fissures (9%), telangiectasias (27%), hyperpigmentation (9%), alopecia (9%), angular cheilitis (9%), and paronychia (9%). In addition, secondary bacterial infection with Staphylococcus aureus was documented in 3 patients (27%). CONCLUSIONS Dermatologic side-effects associated with selumetinib were similar to those seen with epidermal growth factor receptor inhibitors (EGFRIs). Treatment approaches used for EGFRI-induced dermatologic reactions may be potentially utilized to manage those associated with selumetinib.
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Affiliation(s)
- Yevgeniy Balagula
- Dermatology Service, Department of Medicine, Rockefeller Outpatient Pavilion, Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA
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