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Green M, Feschuk AM, Kashetsky N, Maibach HI. Clinical characteristics and treatment outcomes of Pityrosporum folliculitis in immunocompetent patients. Arch Dermatol Res 2023; 315:1497-1509. [PMID: 36517586 PMCID: PMC9750048 DOI: 10.1007/s00403-022-02506-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/10/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
Pityrosporum folliculitis (PF) is a fungal acneiform disease of the hair follicles that often presents with pruritic papules and pustules on the upper body and face. This condition is commonly mistaken for acne vulgaris and can be distinguished from bacterial acne by the presence of fungal spores in the follicular lumen. Although studies have been performed to describe PF in cohorts, little work has been done to aggregate these data. Thus, the goal of this review is to describe the clinical characteristics and treatment outcomes of PF in immunocompetent patients. PubMed, Web of Science, and Embase were searched using the terms "Pityrosporum folliculitis" or "Malassezia folliculitis." All cohorts reporting PF characteristics in patients classified as immunocompetent were reviewed. A total of 15 studies were included. Majority of patients were male (64%) with the average age of presentation of 24.26 years. The most common locations of lesions were the chest (70%) and back/shoulders (69.2%). Pruritus was reported by the majority of patients (71.7%). Additionally, 40.5% of patients reported a history of unsuccessful treatment regimens. Treatment was most successful with an oral antifungal (92%), followed by a topical antifungal (81.6%). In conclusion, majority of patients with PF were younger males. Many patients were primarily treated incorrectly, suggesting the importance of proper diagnosis. PF may be distinguishable from acne vulgaris by the presence of pruritus or suggested when a new acneiform eruption develops following antibiotic therapy or immunosuppression. When properly diagnosed, majority of cases of PF achieve complete response with oral or topical antifungals.
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Affiliation(s)
- Maxwell Green
- Tulane University School of Medicine, 131 S Robertson Ave, 15th Floor, New Orleans, LA, 70112, USA.
| | - Aileen M Feschuk
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland & Labrador, Canada
| | - Nadia Kashetsky
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland & Labrador, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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Bahbouhi I, Aboudourib M, Hocar O, Amal S. Vitamin B12 induced acneiform eruption. Heliyon 2023; 9:e16120. [PMID: 37305488 PMCID: PMC10256894 DOI: 10.1016/j.heliyon.2023.e16120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
A 47-year-old, north african, male patient, has recently been diagnosed with pernicious anemia, treated with weekly intramuscular hydroxocobalamin. 6 weeks after its initiation, the patient presented a sudden, extensive and monomorphic eruption of inflammatory papulo-pustules and nodules, affecting the face, and the trunk. The eruption was pruritic, and comedones were also present, on the chest. The patient was diagnosed with vitamin B12-induced acneiform eruption. Levels of vitamin B12 were normalized. Hydroxocobalamin was therefore stopped and lymecycline was started, allowing a complete resolution of the lesions within 3 months. Drug intake, sudden and uncommon age of onset, pruritus, a monomorphic pattern and an involvement of extra-seborrheic areas are features that distinguish acneiform eruptions from acne vulgaris.
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Ibraheim MK, Lo J, Gupta R, Parseghian C, Patel AB. Acneiform eruptions with combination targeted cancer therapy in colorectal cancer patients. Support Care Cancer 2022. [PMID: 35771289 DOI: 10.1007/s00520-022-07257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Epidermal growth factor receptor inhibitors (EGFRI) can be used with pathway inhibitors, including mitogen-activated protein kinase kinase inhibitors (MEKIs), BRAF inhibitors (BRAFIs), and checkpoint inhibitors such as programmed death-ligand 1 (PD-L1) and programmed cell death protein 1 (PD-1) to treat colorectal cancer. These can precipitate treatment-resistant acneiform eruptions, prompting dose modification or discontinuation. Predicting the likelihood of severe rash development and crafting effective treatments may promote adherence to life-saving chemotherapy. METHODS An Institutional Review Board-approved retrospective chart review of patients with colorectal cancer treated with EGFRI or MEKI in combination with HER2, BRAF, PI3K, or checkpoint inhibitors between January 1, 2016, and January 1, 2020, was performed. Surrogates for rash severity were investigated, including lower extremity involvement, utilization of oral steroids or retinoids, dose modification, and incidence of superinfection. RESULTS Of 122 patients treated with combination therapy, 105 developed a rash, and 87 developed an acneiform eruption. Common combinations included MEKI/PD-LI, EGFRI/MEKI, and MEKI/PD-1I. Patients treated with EGFRI/MEKI developed the most severe rashes (p = 0.02). Lower extremity involvement was more frequent with EGFRI/MEKI compared to alternative combinations (p = 0.05). Drug holiday correlated with all rash severity surrogates, including rash grade, lower extremity involvement, oral steroid or retinoid use, and incidence of superinfection. Use of oral steroids or retinoids was associated with development of superinfection (p = 0.002). Prophylactic tetracycline use did not impact rash severity or rash incidence. CONCLUSION This is the first descriptive analysis to characterize acneiform eruptions for patients with colorectal cancer on combination cancer therapy. Approximately 85% of patients developed a cutaneous toxicity with what appears to be synergistic effects of EGFRI and MEKI combination therapy causing the most severe eruptions. Superinfection rate correlated to systemic therapy use beyond oral tetracyclines. Further investigation into the utility of prophylactic oral tetracyclines in this population is needed.
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Kikuchi K, Yamazaki N, Nozawa K, Fukuda H, Shibata T, Machida R, Hamaguchi T, Takashima A, Shoji H, Boku N, Takatsuka S, Takenouchi T, Nishina T, Yoshikawa S, Takahashi M, Hasegawa A, Kawazoe A, Masuishi T, Mizutani H, Kiyohara Y. Topical corticosteroid therapy for facial acneiform eruption due to EGFR inhibitors in metastatic colorectal cancer patients: a randomized controlled trial comparing starting with a very strong or a weak topical corticosteroid (FAEISS study, NCCH1512, colorectal part). Support Care Cancer 2022; 30:4497-4504. [PMID: 35113224 DOI: 10.1007/s00520-022-06874-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/27/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Although pre-emptive therapy with oral tetracycline, moisturizer, sunscreen, and topical corticosteroid is useful for preventing acneiform eruption (AfE) due to epidermal growth factor receptor (EGFR) inhibitors, no studies have examined the efficacy of topical corticosteroids themselves, or investigated the optimal potency of corticosteroid for treating facial AfE (FAfE). PATIENTS AND METHODS Screened patients with RAS wild-type colorectal cancer started pre-emptive therapy with oral minocycline and moisturizer on initiation of cetuximab or panitumumab therapy. Patients who developed grade 1 or 2 FAfE were randomly allocated to two groups: a ranking-down (RD) group that started with a very strong corticosteroid and serially ranked down every 2 weeks unless FAfE exacerbated; and a ranking-up (RU) group that started with a weak corticosteroid and serially ranked up at exacerbation. FAfE grade, patient quality of life, and adverse events (AEs) with topical corticosteroid were evaluated every 2 weeks. The primary endpoint was the total number of times grade 2 or higher FAfE was identified in the central review of the 8-week treatment period. RESULTS No significant differences in total numbers of grade 2 or higher FAfE or in AEs caused by topical corticosteroids were observed between groups during the 8 weeks. Incidence of grade 2 or higher FAfE tended to be lower in the RD group during the first 2 weeks. CONCLUSION Considering the long-term care of FAfE, the RU regimen appears suitable and should be considered the standard treatment for FAfE due to EGFR inhibitor therapy. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN000024113).
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Affiliation(s)
- Katsuko Kikuchi
- Tohoku University School of Medicine, Sendai, Japan.
- Sendai Taihaku Dermatology Clinic, AEON Supercenter 2F, 1-21-1 Kagitori Honcho, Taihaku Ku, Sendai, Miyagi, 982-0805, Japan.
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Keiko Nozawa
- Department of Nursing, Faculty of Nursing, Mejiro University, Saitama, Japan
- Appearance Support Center, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Data Management Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taro Shibata
- Biostatistics Section, Research Management Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ryunosuke Machida
- Biostatistics Section, Research Management Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Hamaguchi
- Department of Medical Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsuo Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Shoji
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Narikazu Boku
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Sumiko Takatsuka
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Tatsuya Takenouchi
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Tomohiro Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Shusuke Yoshikawa
- Dermatology Division, Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - Masanobu Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Akiko Hasegawa
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akihito Kawazoe
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Toshiki Masuishi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - Yoshio Kiyohara
- Dermatology Division, Shizuoka Cancer Center Hospital, Sunto-gun, Japan
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Nikolaou V, Voudouri D, Tsironis G, Charpidou A, Stamoulis G, Triantafyllopoulou I, Panoutsopoulou I, Xidakis E, Bamias A, Samantas E, Aravantinos G, Gogas H, Rigopoulos D, Syrigos K, Stratigos A. Cutaneous toxicities of antineoplastic agents: data from a large cohort of Greek patients. Support Care Cancer 2019; 27:4535-42. [PMID: 30919155 DOI: 10.1007/s00520-019-04751-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Cutaneous toxicities from novel anticancer treatments are an emerging problem in dermato-oncology. However, the prevalence of those toxicities and necessity of skin consultations are currently unknown. The purpose of our study was to perform an epidemiologic analysis of cutaneous toxicities that were referred to our cutaneous toxicity clinic in Athens, Greece. METHODS All patients examined at the oncodermatology department over a 42-month period were included. Gender, age, type of cancer, type of antineoplastic treatment, and type of toxicity were recorded and analyzed. RESULTS Four hundred fifty-nine patients (182 males, 277 females) with mean age (SD) 60.6 years (13.05) were included in the analysis. Six hundred seventy-two cutaneous toxicities were recorded. Chemotherapy-induced toxicities were the most commonly recorded incidents, with taxanes being the most commonly involved agent. Immune-related adverse events (IRAEs) have steadily increased over the past 3 years. Treatment modifications due to skin toxicities were more common in patients treated with targeted agents and immune checkpoint inhibitors than in those treated with chemotherapy. The toxicities that led to the most treatment modifications were acneiform eruptions and perionychias. The most common IRAEs recorded were psoriasis in 11 patients, followed by pruritus, macular rash, and lichenoid-type eruptions. In addition, 4 interesting cases of IRAEs are discussed. CONCLUSION Antineoplastic treatments can lead to a wide range of cutaneous toxicities. Our study underlines the need for a multidisciplinary approach in oncologic patients. The dermatologists' role is crucial in effectively managing those reactions and preventing antineoplastic drug dose adjustments or discontinuation of treatment.
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Abstract
We report the case of a 24-year-old college girl, presenting with numerous acneiform papular eruptions over the central part of the face.
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Affiliation(s)
- Atul Jain
- Department of Dermatology, Venereology and Leprosy, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Banashree Majumdar
- Department of Dermatology, Venereology and Leprosy, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Debashis Sen
- Department of Dermatology, Venereology and Leprosy, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Sumit Sen
- Department of Dermatology, Venereology and Leprosy, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Pranshu Mishra
- Department of Dermatology, Venereology and Leprosy, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Ayan Samanta
- Department of Dermatology, Venereology and Leprosy, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
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Abstract
Epidermal growth factor receptor (EGFR) inhibitor therapy has become the standard treatment for non-small cell lung cancer and head neck malignancy. This class of drug comprises EGFR inhibitors (erlotinib and gefitinib) and monoclonal antibody (cetuximab). Use of this class of drugs has been associated frequently with dermatological side effects termed as PRIDE complex–Papulopustules and/or paronychia, Regulatory abnormalities of hair growth, Itching, Dryness due to EGFR inhibitors. We hereby report the cutaneous side effects of EGFR inhibitor therapy in 15 patients of lung and head/neck cancer. The major clinical findings being acneiform eruption and severe xerosis of skin. Management of these dermatological adverse effects rarely requires discontinuation of targeted therapy and can be managed symptomatically.
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Affiliation(s)
- Bhushan Madke
- Department of Dermatology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Prachi Gole
- Department of Dermatology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Prabhash Kumar
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Uday Khopkar
- Department of Dermatology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Abstract
Drug-induced acne is a specific subset of acne that usually has some specific features, namely monomorphic pattern, unusual location of the lesions beyond the seborrheic areas, uncommon age of onset, a resistance to conventional acne treatment. Several drugs have been associated with the development of eruptions that may simulate acne vulgaris. However, so far, there are a few cases of vitamin B12-induced acne. We report a case of acneiform eruption induced by vitamin B12 injection in a 37-year-old female patient.
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Affiliation(s)
- Ilknur Balta
- Dermatology, Ministry of Health, Kecioren Training and Research Hospital , Ankara , Turkey and
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