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Plachouri KM, Florou V, Georgiou V, Georgiou S. Cutaneous Side Effects of Modern Targeted Therapy and Immunotherapy in Patients with Dermatological Malignancies. Cancers (Basel) 2023; 15:3126. [PMID: 37370736 DOI: 10.3390/cancers15123126] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The advent of immunotherapy and targeted therapies in treating dermatological malignancies has dramatically changed the landscape of dermato-oncology in recent years. Their superior efficacy compared to previous therapeutic options, such as chemotherapy, has resulted in their use in treating devastating malignancies, such as melanoma or unresectable/metastatic basal cell and squamous cell carcinoma. Skin toxicity is a critical safety consideration, among other adverse reactions, that can occur under treatment with these agents. This article aims to summarize the cutaneous side effects of immune checkpoint inhibitors and targeted dermato-oncological therapies. Although the skin side effects of these agents are primarily mild, they can occasionally affect the decision for treatment continuation and the quality of life of the affected patients. Therefore, physicians must be acquainted with the specific cutaneous toxicity profile of such treatments to mitigate their impact on the patients and optimize the overall outcome of dermato-oncological therapy.
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Affiliation(s)
- Kerasia-Maria Plachouri
- Dermatology Department, University General Hospital of Patras, University of Patras, 265 04 Rio, Greece
| | - Vaia Florou
- Division of Oncology, Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 841112, USA
| | - Vasileios Georgiou
- School of Medicine, University General Hospital of Patras, University of Patras, 265 04 Rio, Greece
| | - Sophia Georgiou
- Dermatology Department, University General Hospital of Patras, University of Patras, 265 04 Rio, Greece
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Gonzalez-Canete M, Pinto-Pulido EL, Vega-Diez D, Rodriguez-Villa A, Moreno-Artero E, Andina Martinez D, Torrelo A. Erythema nodosum after COVID-19 vaccine: Report of two pediatric cases. Pediatr Dermatol 2022:10.1111/pde.15205. [PMID: 36451284 PMCID: PMC9877859 DOI: 10.1111/pde.15205] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
With the introduction of large-scale COVID-19 vaccination programs, a variety of cutaneous manifestations have been described. We present two girls (ages 12 and 5 years) who developed erythema nodosum (EN) 3 and 14 days after Pfizer-BioNTech COVID-19 vaccination, respectively. While EN after COVID-19 vaccination has been reported in adults, it is can also occur in children.
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Affiliation(s)
- Marta Gonzalez-Canete
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | | | - David Vega-Diez
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Ana Rodriguez-Villa
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Ester Moreno-Artero
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Aly MH, Alshehri AA, Mohammed A, Almalki AM, Ahmed WA, Almuflihi AM, Alwafi AA. First Case of Erythema Nodosum Associated With Pfizer Vaccine. Cureus 2021; 13:e19529. [PMID: 34934549 PMCID: PMC8668049 DOI: 10.7759/cureus.19529] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Accepted: 11/13/2021] [Indexed: 11/05/2022] Open
Abstract
Vaccine-related erythema nodosum is uncommon, especially after the coronavirus disease 2019 (COVID-19) vaccine. This study presents the first case of the Pfizer vaccine associated with erythema nodosum. A 22-year-old healthy woman presented with a five-day history of several red painful areas with swelling in the lower extremities that started one day after receiving the first dose of Pfizer vaccine. Past medical history, laboratory investigation, and chest radiograph revealed normal results. Erythema nodosum is an immune reaction that manifests as multiple, painful nodules commonly seen on the shin that resolved spontaneously two to eight weeks after the onset. In the absence of laboratory and chest radiograph abnormalities and shortly after receiving the Pfizer vaccine, vaccine-related erythema nodosum is the only possible explanation.
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Affiliation(s)
- Mohammed H Aly
- Department of Internal Medicine, Security Forces Hospital, Makkah, SAU
| | | | | | - Abdulrahman M Almalki
- Department of Medicine, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Walaa A Ahmed
- Department of Medicine, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Alhanouf M Almuflihi
- Department of Medicine, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Atheer A Alwafi
- Department of Medicine, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
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Abdulkarim LS, Motley RJ. First-line Advanced Cutaneous Melanoma Treatments: Where Do We Stand? JMIR Cancer 2021; 7:e29912. [PMID: 34914610 PMCID: PMC8717133 DOI: 10.2196/29912] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/08/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Cutaneous melanoma has always been a dreaded diagnosis because of its high mortality rate and its proclivity for invasiveness and metastasis. Historically, advanced melanoma treatment has been limited to chemotherapy and nonspecific immunotherapy agents that display poor curative potential and high toxicity. However, during the last decade, the evolving understanding of the mutational burden of melanoma and immune system evasion mechanisms has led to the development of targeted therapy and specific immunotherapy agents that have transformed the landscape of advanced melanoma treatment. Despite the considerable strides in understanding the clinical implications of these agents, there is a scarcity of randomized clinical trials that directly compare the efficacy of the aforementioned agents; hence, there are no clear preferences among the available first-line options. In addition, the introduction of these agents was associated with a variety of dermatologic adverse events, some of which have shown a detrimental effect on the continuity of treatment. This holds especially true in light of the current fragmentation of care provided by the managing health care professionals. In this study, we attempt to summarize the current understanding of first-line treatments. In addition, the paper describes the indirect comparative evidence that aids in bridging the gap in the literature. Furthermore, this paper sheds light on the impact of the scarcity of dermatology specialist input in the management of dermatologic adverse events associated with advanced melanoma treatment. It also looks into the potential avenues where dermatologic input can bridge the gap in the care provided by oncologists, thus standardizing the care provided to patients with melanoma presenting with dermatologic adverse events.
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Yıldırım N, Karatas A, Cengiz M, Onalan E, Yazıcı GN, Sunar M, Mammadov R, Coban A, Suleyman H. Protective effect of adenosine triphosphate against sunitinib-related skin damage in rats. Hum Exp Toxicol 2020; 39:1737-1746. [PMID: 32677474 DOI: 10.1177/0960327120940365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cutaneous side effects associated with sunitinib use are a major problem in patients receiving cancer treatment. The aim of this study was to investigate the protective effect of adenosine triphosphate (ATP) against possible skin damage resulting from sunitinib use in rats. Thirty Albino Winstar rats were divided into the following three groups: healthy controls (HCs, n = 10), sunitinib (SUN, n = 10), and sunitinib + ATP (SAT, n = 10). ATP was injected intraperitoneally at a dose of 2 mg/kg. One hour subsequent to the administration of ATP and 0.9% NaCl, the SAT and SUN groups were orally administered a dose of 25 mg/kg sunitinib to the stomach. Macroscopic evaluation of the skin indicated lower levels of skin damage in the SAT group than in the SUN group. As an indicator of oxidative stress, malondialdehyde (MDA), total oxidant status (TOS), and oxidative stress index (OSI) levels were significantly higher in the SUN group than in the HC group, while total glutathione (tGSH) and total antioxidant status (TAS) levels were significantly lower. However, MDA, TOS, and OSI levels were significantly lower in the SAT group than in the SUN group, while tGSH and TAS levels were significantly higher. Histopathological examination revealed keratin plugs with edema, vasopathology, and inflammatory cell infiltration in the SUN group. The SAT group showed less necrotic epithelium, keratin plugs, edema, and vasopathology than the SUN group. ATP can be effective in preventing skin damage caused by sunitinib use by reducing oxidative stress.
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Affiliation(s)
- N Yıldırım
- Department of Medical Oncology, 64177Firat University Faculty of Medicine, Elazığ, Turkey
| | - A Karatas
- Department of Internal Medicine, 64177Firat University Faculty of Medicine, Elazıg, Turkey
| | - M Cengiz
- Department of Internal Medicine, Faculty of Medicine, 472600Biruni University, Istanbul, Turkey
| | - E Onalan
- Department of Internal Medicine, 64177Firat University Faculty of Medicine, Elazıg, Turkey
| | - G N Yazıcı
- Department of Histology and Embryology, Faculty of Medicine, Binali Yıldırım University, Erzincan, Turkey
| | - M Sunar
- Department of Anatomy, Faculty of Medicine, Binali Yıldırım University, Erzincan, Turkey
| | - R Mammadov
- Department of Pharmacology, Faculty of Medicine, Binali Yıldırım University, Erzincan, Turkey
| | - A Coban
- Department of Biochemistry, Faculty of Medicine, Binali Yıldırım University, Erzincan, Turkey
| | - H Suleyman
- Department of Pharmacology, Faculty of Medicine, Binali Yıldırım University, Erzincan, Turkey
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Khurana A, Gupta A, Sardana K, Sethia K, Panesar S, Aggarwal A, Ghadlinge M. A prospective study on patterns of topical steroids self-use in dermatophytoses and determinants predictive of cutaneous side effects. Dermatol Ther 2020; 33:e13633. [PMID: 32449316 DOI: 10.1111/dth.13633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/09/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022]
Abstract
Nonprescription use of topical corticosteroids (TCS) is a significant concern. This can lead to cutaneous adverse effects, altered morphology of skin disorders and chronicity of cutaneous infections. To record and analyze the patterns of TCS use in patients with tinea corporis/cruris and analyze factors determining the development of cutaneous side effects. Hundred patients with a clinical diagnosis of tinea corporis/cruris who could recall the TCS preparation/s used were included. The TCS usage patterns were recorded and analyzed. Most patients had used very potent TCS (n = 66). Most reported using TCS intermittently for duration ranging from 1 to 4 weeks (n = 78). Relapse of symptoms occurred within 1 to 2 weeks of stopping TCS, triggering reuse. Cutaneous adverse effects were present in 44 patients (striae [n = 29], hypo/depigmentation [n = 11], skin thinning [n = 8], hypertrichosis [n = 1], tinea pseudoimbricata [n = 1]). There was a significant correlation between presence of cutaneous adverse effects and the total duration of TCS use (P = .0016), duration of disease (P = .016), and total amount of TCS used (P = .012). Use for >60 days and of >32 g were associated with 89% and 96.3% (respectively) probability of developing cutaneous adverse effects. Self-use of TCS is a worrisome trend. Intermittent use is a plausible reason for development of cutaneous side effects in only 44% patients.
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Affiliation(s)
- Ananta Khurana
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Aastha Gupta
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Khushboo Sethia
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Sanjeet Panesar
- Department of Community Medicine, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Aastha Aggarwal
- Department of Dermatology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
| | - Manik Ghadlinge
- Department of Pharmacology, Dr Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
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Cossio ML, Genois A, Jantchou P, Hatami A, Deslandres C, McCuaig C. Skin Manifestations in Pediatric Patients Treated With a TNF-Alpha Inhibitor for Inflammatory Bowel Disease: A Retrospective Study [Formula: see text]. J Cutan Med Surg 2020; 24:333-339. [PMID: 32527153 DOI: 10.1177/1203475420917387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tumor necrosis factor (TNF) alpha inhibitors (anti-TNF) are effective in the treatment of inflammatory bowel disease (IBD) as well as psoriasis. Their increasing use has raised the identification of cutaneous side effects (CSEs). Evidence in children is limited. OBJECTIVES The objective of this study is to describe CSEs of anti-TNF treatment in a pediatric population with IBD. METHODS This is a retrospective single-center study of children with IBD under anti-TNF treatment between 2013 and 2016. A total of 40 patients with CSEs related to anti-TNF were referred to our pediatric dermatology clinic. A control group was randomly selected from patients receiving anti-TNF for IBD, who were referred to the dermatology clinic for other conditions unrelated to anti-TNF. RESULTS Of 343 patients with IBD, 40 (11.3%) presented CSEs potentially related to the treatment. No differences in sex, age, and underlying disease were found between those with and without CSEs. The most frequent CSEs were psoriasiform eruptions (41%) which were more exudative than usual, located especially in skin folds and on the scalp; skin infections (20%); and eczematous eruptions (10%). Only 5% of patients changed or discontinued the current anti-TNF because of CSEs. CONCLUSION This is one of the largest pediatric cohorts of IBD patients with CSEs. Psoriasiform eruptions were the most common CSEs, with predilection for skin folds and scalp, and frequent superimposed bacterial infection. Topical and/or systemic antibiotics were required in addition to topical corticosteroids in 25% of patients. The rate of discontinuation of anti-TNF therapy due to CSEs was low.
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Affiliation(s)
- María-Laura Cossio
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
- 28033Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Annie Genois
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Prévost Jantchou
- 25461Division of Gastroenterology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Afshin Hatami
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Colette Deslandres
- 25461Division of Gastroenterology, CHU Sainte-Justine, University of Montreal, QC, Canada
| | - Catherine McCuaig
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, QC, Canada
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Koumaki D, Koumaki V, Lagoudaki E, Bertsias G. Palmoplantar Pustulosis-like Eruption Induced by Baricitinib for Treatment of Rheumatoid Arthritis. Eur J Case Rep Intern Med 2019; 7:001383. [PMID: 32015973 PMCID: PMC6993915 DOI: 10.12890/2019_001383] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/23/2019] [Indexed: 01/28/2023] Open
Abstract
Objectives Baricitinib is an orally active Janus kinase (JAK) inhibitor used in the treatment of moderate to severe rheumatoid arthritis (RA). Materials and methods Here, we report the case of a 56-year-old Caucasian male diagnosed with RA who developed palmoplantar pustulosis (PPP) while being treated with baricitinib. Results The patient’s PPP resolved after discontinuation of baricitinib and recurred when this was restarted. Based on causality assessment, it was considered a drug-induced PPP. Conclusion To the authors’ knowledge, this is the first case of baricitinib-induced PPP. LEARNING POINTS
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Affiliation(s)
- Dimitra Koumaki
- Dermatology Department, University Hospital of Heraklion, Crete, Greece
| | - Vasiliki Koumaki
- Microbiology Department, Medical School of Athens, Athens, Greece
| | - Eleni Lagoudaki
- Pathology Department, University Hospital of Heraklion, Crete, Greece
| | - George Bertsias
- Rheumatology Department, University Hospital of Heraklion, Crete, Greece
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Fekete GL, Fekete L. Cutaneous leukocytoclastic vasculitis associated with erlotinib treatment: A case report and review of the literature. Exp Ther Med 2018; 17:1128-1131. [PMID: 30679984 DOI: 10.3892/etm.2018.6988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/06/2018] [Accepted: 08/23/2018] [Indexed: 02/07/2023] Open
Abstract
Erlotinib is a targeted anticancer therapy used for treating epidermal growth factor receptor (EGFR) mutation positive lung cancer in advanced stage as well as for other malignancies. The most common cutaneous side effect of erlotinib, are well documented; however the number of reports regarding cutaneous leukocytoclastic vasculitis (CLCV) are limited. We report a case, a 58-year-old, 60 kg weight, non-smoking woman suffering of lung adenocarcinoma and brain metastases treated with erlotinib monotherapy with 150 mg/day dose, who presents cutaneous leukocytoclastic vasculitis after 8 months of initiating the treatment. The administration of the drug was discontinued and oral prednisolone treatment was introduced at 1 mg/kg body weight dose for two weeks, decreasing the dose with 5 mg, at every 3 days. The treatment was combined with topical potent steroid and antibiotic therapy used once, daily. The lesions cleared within 7 weeks without recurrence. The treatment with erlotinib was restarted after 14 days with a lower dose of 100 mg/day. The skin lesions have not occurred anymore. Unfortunately the evolution was unfavorable, our patient died 3 months after the vasculitis healing, due to the complications of new metastases that occurred. This may indicate the inefficiency of erlotinib. The late onset of 240 days of the vasculitis and the presumed inefficiency of the drug lead to the speculation that the appearance of cutaneous vasculitis could be a worsening clinical marker of the tumor response. This limited number of cases precludes any meaningful interpretation of data about the erlotinib induced cutaneous vasculitis. Further investigations are needed to assess cutaneous vasculitis.
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Affiliation(s)
- Gyula László Fekete
- Dermatology Clinic, University of Medicine and Pharmacy, 540530 Târgu Mureş, Romania
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Müller CSL, Oertel A, Körner R, Pföhler C, Vogt T. Socio-epidemiologic aspects and cutaneous side effects of permanent tattoos in Germany - Tattoos are not restricted to a specific social phenotype. Dermatoendocrinol 2016; 9:e1267080. [PMID: 28405265 PMCID: PMC5386101 DOI: 10.1080/19381980.2016.1267080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 11/30/2022]
Abstract
Background: More and more people of all age classes have a tattoo. Intriguingly, there are multiple prejudices in the general population and published data that concern tattooed persons, such as being criminals, having a low education, being alcohol or drug abusers, or more risky in their life style. Objective: To obtain and to evaluate sociodemographic data on tattooed persons, to investigate the incidence of tattoo-related cutaneous complications and to define personal risk factors and course of the persons after being tattooed concerning behavior of personal environment. Patients and Methods: We interviewed 426 participants with already existing tattoos and 20 participants just before getting a new tattoo by using an online questionnaire. The participators were asked about socio-epidemiologic aspects of tattoos in general and special aspects of their own tattoo(s) in particular. There were no exclusion criteria. Results: Tattoos are interesting for people seeking popular body art, esp. university graduates and financially-secure individuals. 446 persons participated in this study. Most of the persons were female with a mean age of 35. Local pruritus around the tattooed area was the most common cutaneous side effect among the participants. 93.5% of the participants did not want a tattoo removal. Intriguingly, most of the participants experienced no career problems related to the tattoo(s). Limitations: The study population is not representative as we included only persons being tattooed prior to or getting newly tattooed. Furthermore, there is a potential selection bias as the participation in this study was voluntary. Only persons that felt involved by the flyer did answer the questionnaire. Conclusion: The present data shows that common tattooed persons are not low educated criminals with any drug or alcohol abuse or with risky life style. Nowadays being tattooed encompasses a kind of body art and displays a certain kind of lifestyle habit.
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Affiliation(s)
| | - Angela Oertel
- Städtisches Klinikum Karlsruhe, Department of Obstetrics and Gynecology , Germany
| | | | - Claudia Pföhler
- Saarland University Hospital, Department of Dermatology, Homburg/Saar , Germany
| | - Thomas Vogt
- Saarland University Hospital, Department of Dermatology, Homburg/Saar , Germany
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Affiliation(s)
| | | | - Pier Alessandro Fanti
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna
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