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Nowaczyk J, Fret K, Kaminska-Winciorek G, Rudnicka L, Czuwara J. EGFR inhibitor-induced folliculitis decalvans: a case series and management guidelines. Anticancer Drugs 2023; 34:942-948. [PMID: 36708507 PMCID: PMC10414157 DOI: 10.1097/cad.0000000000001494] [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: 11/20/2022] [Revised: 11/21/2022] [Indexed: 01/29/2023]
Abstract
Epidermal growth factor receptor (EGFR) is one of therapeutic targets in oncology for solid tumors originating from epithelial tissue, such as non-small-cell lung carcinoma (NSCLC) and breast cancer. EGFR inhibitors used in cancer treatment may cause a broad spectrum of dose-dependent cutaneous adverse events, including acneiform papulopustular rash, nail and hair disturbances, xerosis, and mucositis. The pathogenesis of the EGFR inhibitor-induced adverse reactions originates from disturbances in keratinocyte differentiation, cytokine secretion, and neutrophil chemotaxis. One of the rare, yet distressing adverse events may be folliculitis decalvans, a progressive neutrophil-driven scarring alopecia with hair tufts formation resembling doll's hair. Early diagnosis and introduction of treatment are crucial for disease prognosis since a long course of the disease leads to decreased quality of life. Here, we review the literature cases of EGFR inhibitor-induced folliculitis decalvans and provide guidance on management and prevention of this condition in oncologic patients. Furthermore, we report the first afatinib-associated folliculitis decalvans in three female patients with NSCLC.
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Affiliation(s)
- Joanna Nowaczyk
- Department of Dermatology, Medical University of Warsaw, Warsaw
| | - Kamil Fret
- Department of Dermatology, Medical University of Warsaw, Warsaw
| | - Grazyna Kaminska-Winciorek
- Department of Bone Marrow Transplantation and Onco-Haematology, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice Branch, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Warsaw
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2
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Shiraishi K, Tohyama M, Sayama K. Topical steroid-induced prurigo-like folliculitis in children: a case series of 10 patients. Eur J Dermatol 2023; 33:43-45. [PMID: 37178033 DOI: 10.1684/ejd.2023.4412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Ken Shiraishi
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Mikiko Tohyama
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan, Department of Dermatology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, 791-0280, Japan
| | - Koji Sayama
- Department of Dermatology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
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3
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Okroglic L, Sohier P, Martin C, Lheure C, Franck N, Honoré I, Kanaan R, Burgel PR, Carlotti A, Dupin N, Oulès B. Acneiform Eruption Following Elexacaftor-Tezacaftor-Ivacaftor Treatment in Patients With Cystic Fibrosis. JAMA Dermatol 2023; 159:68-72. [PMID: 36449298 PMCID: PMC9713678 DOI: 10.1001/jamadermatol.2022.5208] [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] [Received: 07/15/2022] [Accepted: 10/10/2022] [Indexed: 12/05/2022]
Abstract
Importance A new treatment for cystic fibrosis combining 3 CFTR modulators-elexacaftor (ELX), tezacaftor (TEZ), and ivacaftor (IVA)-has recently been approved for cystic fibrosis treatment. The cutaneous adverse effects following treatment with this combination are poorly described in the literature. Objective To describe the clinicopathological features and treatment response of ELX-TEZ-IVA-associated acneiform eruptions in patients with cystic fibrosis. Design, Setting, and Participants This case series study was conducted in the Dermatology Department of Cochin Hospital, Paris, France, from July 2021 to June 2022 in collaboration with the Cochin Reference Center for Cystic Fibrosis. Referred patients were examined by senior dermatologists. All patients with cystic fibrosis treated with ELX-TEZ-IVA and referred for an acneiform rash were included. Exposures Treatment with ELX-TEZ-IVA. Main Outcomes and Measures Onset of acneiform rash, type of lesions, and degree of severity, as well as treatments initiated and response, were evaluated. When performed, skin biopsies were reviewed. Results This study included 16 patients (11 women [68.7%]) with a median (range) age of 27 (22-38) years. Six patients (37.5%) developed new-onset acneiform rashes, whereas 10 patients (62.5%) had a relapse (5 patients) or worsening (5 patients) of previous acne. The median (range) onset of acneiform rash was 45 (15-150) days. At inclusion, 11 patients (68.7%) had facial hyperseborrhea, 15 patients (93.7%) had noninflammatory lesions, and 14 (87.5%) had inflammatory lesions of seborrheic regions. Four patients (25.0%) had severe acne with deep inflammatory lesions and pitted scars. A specific pathological pattern of necrotizing infundibular crystalline folliculitis was observed in 4 patients. Topical acne treatments, antibiotics, and isotretinoin were used successfully in these patients, resulting in partial or complete remission in 12 patients (85.7% of patients reevaluated). Conclusions and Relevance This case series study found that acneiform eruption is an adverse event associated with ELX-TEZ-IVA treatment in patients with cystic fibrosis. Most patients developed mild lesions. However, isotretinoin treatment may be necessary in some patients. The mechanism of ELX-TEZ-IVA-associated acneiform eruption is currently unknown, but the observation of necrotizing infundibular crystalline folliculitis in biopsied patients may guide further exploration.
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Affiliation(s)
- Léa Okroglic
- Department of Dermatology, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Pierre Sohier
- Department of Pathology, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
- Faculté de Médecine Paris Centre Santé, University Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, UMR 8104, Paris, France
| | - Clémence Martin
- Faculté de Médecine Paris Centre Santé, University Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, UMR 8104, Paris, France
- Department of Respiratory Medicine and National Cystic Fibrosis Reference Center, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Coralie Lheure
- Department of Dermatology, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, UMR 8104, Paris, France
- Study Group on Facial Dermatoses of the French Society of Dermatology (DEFI), Paris, France
| | - Nathalie Franck
- Department of Dermatology, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Isabelle Honoré
- Department of Respiratory Medicine and National Cystic Fibrosis Reference Center, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Reem Kanaan
- Department of Respiratory Medicine and National Cystic Fibrosis Reference Center, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Pierre-Régis Burgel
- Faculté de Médecine Paris Centre Santé, University Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, UMR 8104, Paris, France
- Department of Respiratory Medicine and National Cystic Fibrosis Reference Center, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Agnès Carlotti
- Department of Pathology, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Nicolas Dupin
- Department of Dermatology, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
- Faculté de Médecine Paris Centre Santé, University Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, UMR 8104, Paris, France
- Study Group on Facial Dermatoses of the French Society of Dermatology (DEFI), Paris, France
| | - Bénédicte Oulès
- Department of Dermatology, Hôpital Cochin, AP-HP, AP-HP.Centre-Université Paris Cité, Paris, France
- Faculté de Médecine Paris Centre Santé, University Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, UMR 8104, Paris, France
- Study Group on Facial Dermatoses of the French Society of Dermatology (DEFI), Paris, France
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4
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Rikitake S, Kokubu H, Yamamoto B, Manabe T, Fujimoto N. Eosinophilic pustular folliculitis developing at the site of COVID-19 vaccination. Clin Exp Dermatol 2022; 47:2022-2024. [PMID: 35699624 PMCID: PMC9350174 DOI: 10.1111/ced.15293] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
We present a rare case of eosinophilic pustular folliculitis due to mRNA-based vaccines for COVID-19. Histology of the biopsy specimen was very interesting.
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Affiliation(s)
- Satona Rikitake
- Department of DermatologyShiga University of Medical ScienceShigaJapan
| | - Hiraku Kokubu
- Department of DermatologyShiga University of Medical ScienceShigaJapan
| | - Bunpei Yamamoto
- Department of DermatologyShiga University of Medical ScienceShigaJapan
| | | | - Noriki Fujimoto
- Department of DermatologyShiga University of Medical ScienceShigaJapan
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Li Pomi F, Di Bartolomeo L, Vaccaro M, Lentini M, Cristadoro S, Lucanto MC, Lombardo M, Costa S, Borgia F. Malassezia Folliculitis following Triple Therapy for Cystic Fibrosis. Medicina (B Aires) 2022; 58:medicina58091204. [PMID: 36143881 PMCID: PMC9503821 DOI: 10.3390/medicina58091204] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022] Open
Abstract
Triple-combination therapy with elexacaftor, tezacaftor and ivacaftor has been recently approved for cystic fibrosis patients with at least one F508del mutation in the transmembrane conductance regulator of the cystic fibrosis gene. Among the adverse events of elexacaftor, tezacaftor and ivacaftor, the cutaneous ones have been rarely reported, mainly dealing with urticarial-like rashes. On this topic, we report two cases of Malassezia folliculitis following triple therapy administration in two young females. In the first patient, a papulopustular rush appeared before the folliculitis while in the second patient it was not preceded by other skin manifestations. The diagnosis was confirmed both by dermoscopy and histology. The prompt response to systemic antimycotic drugs provided further evidence for the causative role of Malassezia, requiring no discontinuation of cystic fibrosis therapy. We could hypothesize that the triple regimen treatment may induce changes in the skin microbiome, potentially able to favor colonization and proliferation of Malassezia species. Physicians should be aware of such associations to allow prompt diagnosis and early interventions, avoiding useless drug removal.
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Affiliation(s)
- Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98122 Messina, Italy
| | - Luca Di Bartolomeo
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98122 Messina, Italy
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98122 Messina, Italy
| | - Maria Lentini
- Department of Human Pathology of Adult and Childhood Gaetano Barresi, University of Messina, 98122 Messina, Italy
| | - Simona Cristadoro
- Cystic Fibrosis Center, Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology of Adult and Childhood Gaetano Barresi, University of Messina, 98122 Messina, Italy
| | - Maria Cristina Lucanto
- Cystic Fibrosis Center, Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology of Adult and Childhood Gaetano Barresi, University of Messina, 98122 Messina, Italy
| | - Mariangela Lombardo
- Cystic Fibrosis Center, Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology of Adult and Childhood Gaetano Barresi, University of Messina, 98122 Messina, Italy
| | - Stefano Costa
- Cystic Fibrosis Center, Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology of Adult and Childhood Gaetano Barresi, University of Messina, 98122 Messina, Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98122 Messina, Italy
- Correspondence:
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Kossard S. Eruptive Necrotizing Infundibular Crystalline Folliculitis: An Expression of an Abortive Sebaceous Follicular Repair Pathway Linked to Committed Infundibular Stem Cells? Am J Dermatopathol 2021; 43:867-870. [PMID: 34735106 PMCID: PMC8601669 DOI: 10.1097/dad.0000000000002022] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT Necrotizing infundibular crystalline folliculitis is a rare entity, which is a distinctive clinical and histopathological entity. Eruptive yellow waxy umbilicated folliculocentric plugs clinically correspond to pale crystalline filaments embedded in an amorphous sebum-rich material. Remarkably, only the superficial infundibular ostia remain, and the distended cavity is devoid of a follicular or sebaceous gland remnant. The pathogenesis of this enigmatic event remains to be established. The emergence of necrotizing infundibular crystalline folliculitis (NICF) as a paradoxical side effect of antitumor inhibitors epidermal growth factor receptor vascular endothelial growth factor and more recently programmed death-1 represents the expression of altered molecular pathways that underpin the pathogenesis of NICF. To explore these pathways, it is necessary to explore the hierarchy of follicular stem cells, particularly the potential role of committed infundibular stem cells that play a key role in wound healing. Committed infundibular stem cells are closely linked to the sebaceous gland stem cell axis, and this has relevance in the process of homeostatic repair of sebaceous follicles in the wake of folliculitis. The unscheduled modulation of this infundibular homeostatic sebaceous repair axis by epidermal growth factor receptor vascular endothelial growth factor, and programmed death-1 may lead to an aberrant outcome with metaplasia of infundibular keratinocytes to sebocytes. In the absence of sebaceous gland differentiation, these metaplastic infundibular sebocyte cells would lead to the consumption and loss of the infundibulum as a result of holocrine sebum production. This conceptual pathogenic pathway for NICF is constructed by incorporating recent advances in the fields of follicular stem cells, wound repair, follicular homeostasis, regulatory T cells, and molecular pathways linked to the biologicals inducing NICF.
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Affiliation(s)
- Steven Kossard
- Laverty Pathology, Kossard Dermatopatholgists, Sydney, New South Wales, Australia
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7
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Konstantinou MP, Jendoubi F, Hegazy S, Bouznad A, Tauber M, Bulai-Livideanu C, Paul C. Tapinarof-induced folliculitis: The paradigm of activation of the aryl hydrocarbon signaling pathway. J Am Acad Dermatol 2021; 85:e37-e38. [PMID: 33677000 DOI: 10.1016/j.jaad.2021.01.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/09/2021] [Accepted: 01/25/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Maria Polina Konstantinou
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France.
| | - Fatma Jendoubi
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
| | - Salama Hegazy
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
| | - Amel Bouznad
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
| | - Marie Tauber
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
| | - Cristina Bulai-Livideanu
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
| | - Carle Paul
- Dermatology Department, Paul Sabatier University, University Hospital of Toulouse, Toulouse, France
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8
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Affiliation(s)
- Shing Ching
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China; Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong, China.
| | - Yim Kwan Lam
- Division of Medical Oncology, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
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9
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Affiliation(s)
- Ken Shiraishi
- Department of Dermatology , Ehime University Graduate School of Medicine, 791-0295 Toon, Japan.
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Wollina U, Hercogovấ J, Fioranelli M, Gianfaldoni S, Chokoeva AA, Tchernev G, Tirant M, Novotny F, Roccia MG, Maximov GK, França K, Lotti T. A multi-centred open trial of Dr Michaels® (also branded as Soratinex®) topical product family in psoriasis. J BIOL REG HOMEOS AG 2016; 30:1-7. [PMID: 27498651] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Psoriasis is a chronic, recurring skin disease affecting 2-4% of the population. Genetic predisposition and precipitating factors play a role in its etiology. The disease can occur in any age or gender group. The most frequently affected areas of the body include scalp, extensor surfaces of the extremities, skin folds and nails. While a number of therapies exist for the treatment of psoriasis with a total resolution of the skin, achieving remission in a high percentage of sufferers, a treatment that results in the maintenance of remission and is free of side effects is still a desirable goal. The aim of the study was to investigate the efficacy and tolerability of Dr Michaels® (Soratinex®) topical product family in psoriasis, in terms of decreasing parakeratosis, inflammation, infiltration and involved area. Seven-hundred-and-twenty-two subjects, mean age 42.3 years (range: 18-68 years) with mild to moderately severe psoriasis, with no other current anti-psoriatic therapy, consisting of 382 males and 340 females, above 18 years of age were included and the observations were subjected to statistical analysis. Triphasic application of Dr Michaels® (Soratinex®) products was employed for 8 weeks, using Cleansing Gel, Scalp and Body Ointment and Skin Conditioner. The treatment proved to be ineffective for 22 patients (3.1%) out of 722. 84 patients (11.6%) had moderate improvement with 26-50% of cleared skin lesions; 102 patients (14.1%) had good improvement with 51-75% of cleared skin lesions; 484 patients (67.0%) experienced outstanding improvement with 76-100% of the cleared skin lesions, with 52% of them achieving total resolution. Twelve patients worsened and discontinued treatment; 18 patients discontinued because of non-compliance; 33 patients developed folliculitis as a side effect. Based on the results of this study, the Dr Michaels® (Soratinex®) product family can be successfully applied in mild to moderately severe psoriasis when considering the exclusion criteria.
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Affiliation(s)
- U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - J Hercogovấ
- 2nd Medical Faculty, Charles University, Bulovka Hospital, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - M Fioranelli
- Department of Nuclear Physics, Sub-nuclear and Radiation, G. Marconi University, Rome, Italy
| | - S Gianfaldoni
- Dermatological Department University of Pisa, Pisa, Italy
| | - A A Chokoeva
- Onkoderma- Policlinic for dermatology and dermatologic surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical faculty, Plovdiv, Bulgaria
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - M Tirant
- Psoriasis and Skin Clinic, Melbourne, Australia
| | - F Novotny
- PRO SANUM Ltd., Sanatorium of Prof. Novotný, Štěpánská Prague 1, Czech Republic
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - G K Maximov
- Department Medicinal Information and Non-interventional studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - K França
- Department of Dermatology and Cutaneous Surgery, Department of Psychiatry and Behavioral Sciences, Institute for Bioethics and Health Policy, University of Miami, Miller School of Medicine - Miami, FL, USA; Centro Studi per la Ricerca Multidisciplinare e Rigenerativa. Università Degli Studi "G. Marconi", Rome, Italy
| | - T Lotti
- Chair of Dermatology, University of Rome G. Marconi Rome, Italy
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Eberst E, Rigau V, Pageaux GP, Guillot B, Kluger N. Perforating folliculitis-like reaction related to sorafenib. Cutis 2014; 93:E8-E10. [PMID: 24505595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
| | | | | | | | - Nicolas Kluger
- Skin and Allergy Hospital, HUS, PO Box 160, Helsinki, Finland 00029.
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12
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Andreu-Barasoain M, Gómez de la Fuente E, Pinedo F, Nuño A, López-Estebaranz JL. Intravesical mitomycin C-induced generalized pustular folliculitis. J Am Acad Dermatol 2012; 67:e142-3. [PMID: 22980268 DOI: 10.1016/j.jaad.2011.11.932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 10/30/2011] [Accepted: 11/06/2011] [Indexed: 11/29/2022]
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13
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Bachet JB, Peuvrel L, Bachmeyer C, Reguiai Z, Gourraud PA, Bouché O, Ychou M, Bensadoun RJ, Dreno B, André T. Folliculitis induced by EGFR inhibitors, preventive and curative efficacy of tetracyclines in the management and incidence rates according to the type of EGFR inhibitor administered: a systematic literature review. Oncologist 2012; 17:555-68. [PMID: 22426526 DOI: 10.1634/theoncologist.2011-0365] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 02/07/2023] Open
Abstract
INTRODUCTION Folliculitis is the most common side effect of epidermal growth factor receptor (EGFR) inhibitors (EGFRIs). It is often apparent, altering patients' quality of life and possibly impacting compliance. Variations in terms of the treatment-related incidence and intensity have not been fully elucidated. Tetracyclines have been recommended for the prophylaxis and treatment of folliculitis but their efficacy is yet to be established. MATERIALS AND METHODS We carried out two systematic literature reviews. The first assessed the preventive and curative efficacy of tetracyclines. The second assessed the incidence of grade 3-4 folliculitis in the main clinical studies published. RESULTS In four randomized studies, preventive tetracycline treatment was associated with a significantly lower incidence of grade 2-3 folliculitis and a better quality of life in three of the four studies. In curative terms, tetracycline efficacy was not evaluated in any randomized study, but an improvement in grade ≥2 folliculitis was reported in case series. The frequency and severity of folliculitis seem to be greater with the antibodies than with the tyrosine kinase inhibitors. Analysis restricted to lung cancer studies showed a statistically greater incidence in terms of grade 3-4 folliculitis with cetuximab (9%) and erlotinib (8%) than with gefitinib (2%) (p < .0001). CONCLUSION Unless contraindicated, a tetracycline should be routinely prescribed prophylactically for patients treated with an EGFRI (level of evidence, B2). In curative therapy, the level of evidence for tetracycline efficacy is low (level of evidence, D). The incidence of grade 3-4 folliculitis induced by EGFRIs appears to be lower with gefitinib.
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Affiliation(s)
- Jean-Baptiste Bachet
- Department of Hepato-Gastro-Enterology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre & Marie Curie, Paris, France
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14
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Rallis E, Petronic-Rosic V, Korfitis C. Erlotinib-induced scalp perifolliculitis. Skinmed 2012; 10:70-71. [PMID: 22545319] [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] [Indexed: 05/31/2023]
Abstract
Erlotinib is a highly specific epidermal growth factor receptor tyrosine kinase inhibitor used to treat various metastatic cancers. The most commonly reported side effects in patients receiving erlotinib are dermatitis and diarrhea. The authors present two cases of erlotinib-induced severe scalp perifolliculitis, which is an adverse reaction that has not been reported to date. Both patients developed pustules and thick yellow-green crusted plaques on the scalp within weeks of starting treatment with erlotinib for metastatic non-small cell lung carcinoma. Skin biopsies revealed a perifollicular accumulation of inflammatory cells, lymphocytes, and neutrophils. Both patients were treated with oral doxycycline and achieved complete resolution within 2 to 3 weeks and no recurrence despite continuing the epidermal growth factor receptor tyrosine kinase inhibitor. This is a unique presentation of an erlotinib-induced skin eruption.
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Affiliation(s)
- Efstathios Rallis
- Department of Dermatology, Veterans Administration Hospital (NIMTS), Athens, Greece.
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15
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Oberholzer PA, Borradori L, Beltraminelli H. Cetuximab-associated folliculitis predominantly affecting the lower limbs. J Dtsch Dermatol Ges 2011; 9:703-4. [PMID: 21627774 DOI: 10.1111/j.1610-0387.2011.07716.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Lacarrubba F, Dall'oglio F, Micali G. Massive tufted hair folliculitis associated with chronic use of systemic corticosteroids. GIORN ITAL DERMAT V 2011; 146:164-165. [PMID: 21505403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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17
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Franck N, Barete S, Moguelet P, Blanchet B, Carlotti A, Ropert S, Avril MF, Francès C, Billemont B, Goldwasser F. Spiny follicular hyperkeratosis eruption: a new cutaneous adverse effect of sorafenib. J Clin Oncol 2010; 28:e640-2. [PMID: 20855839 DOI: 10.1200/jco.2010.31.3783] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Manganoni AM, Farisoglio C, Ferrari V, Zaniboni A, Beretta G, Meriggi F, Calzavara-Pinton P. Grading of severe follicular rash in patients receiving EGFR inhibitors. Ann Surg Oncol 2009; 17:349. [PMID: 19821000 DOI: 10.1245/s10434-009-0714-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Indexed: 11/18/2022]
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20
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Campbell TM, Brown CW. Dimorphic cutaneous manifestation of a toxic eruption due to erlotinib therapy. J Drugs Dermatol 2008; 7:1161-1163. [PMID: 19137770] [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] [Indexed: 05/27/2023]
Abstract
The epidermal growth factor receptor (EGFR) inhibitor class of agents have been reported to cause multiple cutaneous adverse events. These drug eruptions are thought by some to indicate a good prognosis. The authors report of a case of a psoriasiform scalp eruption simultaneously occurring with an acneiform or follicular rash in a single patient. To present knowledge, this is the first report of a psoriasiform eruption triggered by erlotinib. In addition, this case report demonstrates 2 completely distinct cutaneous morphologies occurring simultaneously with erlotinib therapy in a single patient.
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Tan AR, Steinberg SM, Parr AL, Nguyen D, Yang SX. Markers in the epidermal growth factor receptor pathway and skin toxicity during erlotinib treatment. Ann Oncol 2008; 19:185-90. [PMID: 17878175 DOI: 10.1093/annonc/mdm444] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Skin toxicity is a common adverse effect of erlotinib and other anti-epidermal growth factor receptor (EGFR) agents. The aim of the study was to explore the relationship between markers in the EGFR pathway and skin rash. PATIENTS AND METHODS Eighteen patients with metastatic breast cancer were treated with daily oral erlotinib at 150 mg. Skin biopsies were obtained at baseline and after 1 month of treatment in 15 patients. EGFR, phosphorylated EGFR (pEGFR), phosphorylated mitogen-activated protein kinase (pMAPK), and phosphorylated Akt (pAkt) or Ki67 were examined quantitatively by immunohistochemistry. RESULTS 11 of 18 (61%, 95% confidence interval 35.7% to 82.7%) patients developed skin rash. pAkt at baseline was significantly higher in patients with no rash than those with a grade 1 or 2 rash (18.8 +/- 8.3 versus 2.4 +/- 1.2 versus 3.3 +/- 3.3; P = 0.0017 for trend). There was a trend towards a significant increase of pMAPK in skin posttreatment with increasing grade of rash (no rash versus grade 1 versus grade 2 rash: 4.5 +/- 2.3 versus 8.4 +/- 4.2 versus 19.4 +/- 4.6; P = 0.036). Other markers were not associated with rash. CONCLUSIONS pAkt was significantly associated with not developing a rash and may have a predictive utility for skin toxicity in patients treated with erlotinib and possibly with other anti-EGFR agents.
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Affiliation(s)
- A R Tan
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Abstract
Treatment with epidermal growth factor receptor (EGFR) inhibitors is associated with cutaneous adverse events, including acneiform folliculitis, dry skin, and nail disorders. Acneiform folliculitis is a class effect of EGFR inhibitors that is thought to be a direct result of EGFR blockade in the hair follicle. The folliculitis is typically mild to moderate in severity and reversible without scarring upon treatment completion. Dose modification or treatment discontinuation is rarely necessary, except in severe cases. Standard acne treatments (e.g. benzoyl peroxide, oral or topical antibacterials, retinoic acid) may provide some benefit, based on anecdotal reports. Clinicians should be aware of the possibility of superinfection with Staphylococcus aureus, in some cases involving meticillin-resistant strains, which may require treatment with oral antibacterials. Further study is needed to determine how the presence and severity of acneiform folliculitis are related to clinical outcomes, and which patients taking EGFR inhibitors are more likely to develop this disorder.
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Affiliation(s)
- Madeleine Duvic
- Department of Dermatology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Chua S, Affleck A, Kulkarni K. Florid hyperplastic folliculitis on the chin in a male renal transplant patient. Clin Exp Dermatol 2007; 33:98-9. [PMID: 18039343 DOI: 10.1111/j.1365-2230.2007.02593.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gilaberte Y, Coscojuela C, Vázquez C, Roselló R, Vera J. Perforating folliculitis associated with tumour necrosis factor-? inhibitors administered for rheumatoid arthritis. Br J Dermatol 2007; 156:368-71. [PMID: 17223880 DOI: 10.1111/j.1365-2133.2006.07598.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [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: 11/28/2022]
Abstract
Perforating dermatoses are characterized by transepithelial elimination of dermal structures. We report a 61-year-old man with rheumatoid arthritis who developed a perforating folliculitis following the administration of two tumour necrosis factor (TNF)-alpha inhibitors, infliximab and etanercept. To our knowledge, no perforating disorders have been reported associated with these drugs. This report suggests, for the first time, a role for TNF-alpha in the pathogenesis of perforating folliculitis.
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Affiliation(s)
- Y Gilaberte
- Deapartment of Dermatology, San Jorge General Hospital, Huesca, Spain.
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Matheis P, Socinski MA, Burkhart C, Warren S, Thomas NE. Treatment of gefitinib-associated folliculitis. J Am Acad Dermatol 2006; 55:710-3. [PMID: 17010757 DOI: 10.1016/j.jaad.2006.06.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 06/20/2006] [Accepted: 06/24/2006] [Indexed: 11/19/2022]
Abstract
Gefitinib (Iressa), an epidermal growth factor inhibitor approved for treatment of advanced nonsmall cell lung carcinoma, is associated with an acneiform distributed folliculitis. Treatment attempts for this folliculitis have been noted in the literature, but photodocumentation of results has not been reported. We report 3 consecutive cases of gefitinib-associated folliculitis with photodocumentation of their treatment responses to combination therapy with topical metronidazole and oral tetracyclines.
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Affiliation(s)
- Patricia Matheis
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
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28
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Abstract
Erlotinib is a small-molecule tyrosine kinase inhibitor of the EGF receptor which has become an important oncological agent, used primarily in treating non-small-cell lung cancer. The most common side effects of this class of EGF receptor antagonists are cutaneous rashes. The severity of the skin rash seems to be correlated to clinical response and should be a motivating factor to continue therapy. We report a case of a patient who developed a follicular rash during therapy with erlotinib.
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Affiliation(s)
- Sascha Gerdes
- Clinic for Dermatology, Venerology and Allergology, University Clinic Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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29
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Abstract
Cetuximab belongs to a newly developed group of anti-cancer drugs, which have an inhibitory effect on the epidermal growth factor receptor (EGF-R). EGF-R plays a major role in the homeostasis of the epidermis and epidermal appendages. In addition, EGF-R is expressed on a variety of carcinomas of different origin and is thought to be partly associated with tumor progression. For this reason, inhibition of EGF-R seems a promising anti-cancer therapy, as shown in a few clinical trials. As a side effect of the therapy, a follicular rash often develops in the seborrheic areas; this cutaneous reaction is associated with longer survival. We present a typical case and discuss the important features of the follicular rash occurring after EGF-R inhibition.
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Affiliation(s)
- M Braun-Falco
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München.
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Hannoud S, Rixe O, Bloch J, Le Pelletier F, Lebrun-Vignes B, Doarika A, Khayat D, Chosidow O. [Skin signs associated with epidermal growth factor inhibitors]. Ann Dermatol Venereol 2006; 133:239-42. [PMID: 16800173 DOI: 10.1016/s0151-9638(06)70887-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 12/14/2022]
Abstract
BACKGROUND Inhibitors of epidermal growth factor receptors (EGFR) constitute a new alternative treatment for patients presenting certain advanced stage solid cancers (bowel, breast, ovary). Adverse cutaneous effects of these drugs are now starting to be described. OBSERVATIONS Our study involved 2 men and 2 women with no previous history of acne included in a treatment protocol comprising EGFR inhibitors. Mean age was 52 years. The primary cancers were breast, ovary, bowel and unidentified. The EGFR inhibitors used were gefitinib (ZD1839) (2 cases), carnetinib (Cl1033) and cetuximab (IMC-C225). Skin lesions appeared after 7 days and included erythematous papules and follicular pustules of the face, back and upper chest. No comedons were seen, and there were no nodules or cysts. The severity of the rash resulted in discontinuation of treatment in 2 patients with complete disappearance of skin lesions in both cases. In one patient, reduction of the dosage of gefitinib (IMC-C225) led to gradual resolution of the rash. Histological examination of papules and pustules concluded on an acute suppurative folliculitis. Smears and cultures ofa nasal lesion and pustules revealed coagulase-positive Staphylococcus aureus in 2 patients. Combined doxycycline 100 mg daily and benzoyl peroxide was prescribed for 3 months and a favourable outcome was achieved after a mean 2 weeks. DISCUSSION EGFR inhibitors act by inhibiting mechanisms oftumour proliferation in certain cancers at advanced stages or refractory to other treatments. Our findings in these four patients are similar to the published cases in terms of rapid onset of monomorphous, papulopustular, follicular eruption without comedons. Rapid response to cyclines and benzoyl peroxide is also reported in literature. This treatment must be instituted rapidly and patients must be informed about the cutaneous side-effects of EGFR inhibitors before the start of therapy. The pathophysiology of these eruptions is still unknown. Skin signs are probably due to interaction with EGFR functions, including overexpression of EGFR in keratinocytes and hair follicles.
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Affiliation(s)
- S Hannoud
- Service de Médecine Interne, AP-HP et Université Paris VI, Groupe Hospitalier Pitié-Salpêtrière, 47, boulevard de l'Hopital, 750I3 Paris.
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Laing ME, Laing TA, Mulligan NJ, Keane FM. Eosinophilic pustular folliculitis induced by chemotherapy. J Am Acad Dermatol 2006; 54:729-30. [PMID: 16546603 DOI: 10.1016/j.jaad.2005.10.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2005] [Revised: 09/12/2005] [Accepted: 10/08/2005] [Indexed: 11/24/2022]
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33
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Abstract
Use of human epidermal growth factor receptor inhibitors by oncologists has led to the occurrence of an acne-like eruption that is technically a folliculitis. Misidentification of the rash often leads to unfruitful treatment attempts as its morphologic features do not correlate well with its histologic findings. We describe a case history, diagnosis, and management of a man undergoing treatment with cetuximab for colorectal carcinoma who experienced the characteristic follicular eruption. Our patient responded well to daily moisturizers and 1% clindamycin gel and experienced near complete resolution of the rash. The evolving research and understanding of this unique entity are also discussed.
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Affiliation(s)
- Derrick H Adams
- David Grant Medical Center, Travis Air Force Base, California, USA.
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Abstract
OBJECTIVE To characterize the relationship of new eosinophilic folliculitis (EF) cases between June 30, 1994, and January 5, 2000, and antiretroviral therapy (ART) status and immune reconstitution. DESIGN Retrospective cohort analysis. SETTING Dermatology clinics at a county hospital. SUBJECTS Fifty-seven consecutive subjects with biopsy-proved EF from the pathology database. Subject groups were as follows: naïve to ART, receiving ART without protease inhibitors/nonnucleoside reverse transcriptase inhibitors, and receiving ART containing protease inhibitors/nonnucleoside reverse transcriptase inhibitors. MAIN OUTCOME MEASURES Onset of EF, CD4 cell count and nadir at EF onset, and time of ART initiation. RESULTS Among the 3 groups previously described, mean CD4 cell counts (86.26/microL vs 113.82/microL vs 145.65/microL, respectively [Kruskal-Wallis rank sum test, P = .15]) and nadir (68.43/microL vs 66.18/microL vs 64.17/microL, respectively [Kruskal-Wallis rank sum test, P = .41]) at EF diagnosis were not statistically different. Fifty-two subjects (91%), regardless of treatment group, had a nadir below 200/microL. Of the subjects undergoing ART, 28 (82%) developed EF within 6 months of initiating ART; their average CD4 cell count increase was 108/microL. Of the 23 subjects receiving protease inhibitor/nonnucleoside reverse transcriptase inhibitor-containing ART regimens, 17 (74%) were diagnosed as having EF within 3 months, with 4 additional subjects diagnosed as having EF within 6 months (a total of 21 [91%] of the 23 subjects). This is not significantly different from the 7 (64%) of 11 subjects diagnosed as having EF at 3 and 6 months of starting ART without protease inhibitors/nonnucleoside reverse transcriptase inhibitors (P = .07) (odds ratio, 0.18; 95% confidence interval, 0.01-1.54). CONCLUSIONS Our study shows an association between low nadir (66.28/microL) and low CD4 cell count (115.54/microL) and the development of EF, regardless of subjects' ART status. However, most subjects receiving ART were diagnosed as having EF within 3 to 6 months of ART initiation, regardless of the regimen.
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35
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Oh RC. Folliculitis after smallpox vaccination: a report of two cases. Mil Med 2005; 170:133-6. [PMID: 15782834] [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] [Indexed: 05/02/2023] Open
Abstract
Rashes are frequent and potentially serious adverse consequences of smallpox vaccination. Life-threatening rashes must be differentiated from benign, self-limiting ones. Generalized vaccinia, erythema multiforme, and folliculitis are distinct self-limiting entities but may be difficult to differentiate from one another. Two cases of folliculitis after smallpox vaccination are described. Both patients received anthrax vaccination within 2 weeks before smallpox vaccination. Both presented with a papulopustular rash 9 days after smallpox vaccination. Although the rashes were initially diagnosed as erythema multiforme, the clinical features were more consistent with folliculitis. Self-limiting rashes after smallpox vaccination are common and may be difficult to distinguish from each other. These rashes are clinically distinct, with characteristic features. Improvement in diagnosis may help classify the frequency and risk of rashes after smallpox vaccination. The association of vaccine-associated folliculitis, anthrax vaccine, and other potential antigenic triggers should be further explored.
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Affiliation(s)
- Robert C Oh
- Department of Family Practice, Madigan Army Medical Center, Tacoma, WA 98431, USA
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36
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Abstract
Eosinophilic pustular folliculitis (EPF) (Ofuji's disease) is a rare dermatosis of unknown etiology. We describe a 45-year-old Chinese woman who developed EPF on her face seven years after having nose and chin augmentation with subcutaneous silicone injections.
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Affiliation(s)
- Tak-Wah Wong
- Department of Dermatology, National Cheng-Kung University Hospital, 138 Sheng-Li Road, 704 Tainan, Taiwan
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Harman KE, Higgins EM. Case 4: eruption on the face of a diabetic man suffering from retinopathy, hypertension, and nephropathy. Diagnosis: ciclosporin-associated hyperplastic folliculitis. Clin Exp Dermatol 2003; 28:341-2. [PMID: 12780737 DOI: 10.1046/j.1365-2230.2003.01276.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- K E Harman
- Department of Dermatology, King's College Hospital, Denmark Hill, London, UK.
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Belda-Iniesta C, Casado E, Corral de la Calle M, Castelo B, Barón MG. Re: Folliculitis associated with weekly paclitaxel treatment. J Natl Cancer Inst 2003; 95:410. [PMID: 12618506 DOI: 10.1093/jnci/95.5.410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Busam KJ, Capodieci P, Motzer R, Kiehn T, Phelan D, Halpern AC. Cutaneous side-effects in cancer patients treated with the antiepidermal growth factor receptor antibody C225. Br J Dermatol 2001; 144:1169-76. [PMID: 11422037 DOI: 10.1046/j.1365-2133.2001.04226.x] [Citation(s) in RCA: 330] [Impact Index Per Article: 14.3] [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: 11/20/2022]
Abstract
BACKGROUND C225 is an antibody to the epidermal growth factor receptor (EGFR), and inhibits growth of various tumour cells. The antibody is currently being used as a therapeutic agent in several clinical trials of patients with carcinomas. Objectives To determine and investigate the cutaneous side-effects in cancer patients treated with C225. Methods We clinically examined 10 patients treated with C225, and performed immunohistochemical and in situ hybridization studies on skin biopsies. Results The most common cutaneous reaction to C225 therapy was the development of an acneiform follicular eruption, which was most pronounced on the face, chest and upper back and typically manifested a week after the onset of treatment. The consistency of the morphology and timing of the clinical findings in 10 different patients following monotherapy with C225 strongly suggested a direct biological effect of the antibody. Additional dermatological side-effects included focal areas of tender paronychial inflammation of toes and fingers and small aphthous ulcers of the oral mucosa. Serial punch biopsies of chest skin before and after treatment (at 8 days) revealed two main reaction patterns: a superficial dermal inflammatory cell infiltrate surrounding hyperkeratotic and ectatic follicular infundibula, and a suppurative superficial folliculitis. In two biopsies focal intraepidermal acantholysis was found. Microbiological cultures failed to reveal an infectious aetiology. Immunohistochemical and in situ hybridization studies on a subset of the biopsies showed an increase in the expression of p27Kip1 in epidermal keratinocytes after treatment with C225. Conclusions Our findings support the concept that p27Kip1 plays a part in the in vivo regulation of follicular and epidermal homeostasis by EGFR.
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Affiliation(s)
- K J Busam
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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41
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Abstract
The task of evaluating a cutaneous eruption in the patient receiving chemotherapy can be quite formidable. Most of the time, these patients are receiving a multitude of agents and have profound immunosuppression. These factors may alter the more common manifestations of cutaneous eruptions. This article presents some of the more common cutaneous eruptions that may occur in an oncology patient receiving chemotherapy. It is hoped we may recognize clinical patterns seen with chemotherapeutic agents in the immunosuppressed population and, by recognizing these cutaneous eruptions, we may avoid the pitfalls of discontinuing medicines that may certainly be needed or altering the treatment course in a patient.
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Affiliation(s)
- R A Koppel
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA
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42
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Roos TC, Albrecht H. Foscarnet-associated eosinophilic folliculitis in a patient with AIDS. J Am Acad Dermatol 2001; 44:546-7. [PMID: 11209138 DOI: 10.1067/mjd.2000.111336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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43
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Flaitz CM. Mustache grooming associated with angular cheilitis. Am J Dent 2000; 13:287-8. [PMID: 11764118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- C M Flaitz
- Department of Stomatology, University of Texas-Houston Health Science Center, USA.
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45
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Mizukawa Y, Shiohara T. Eosinophilic pustular folliculitis induced after prolonged treatment with systemic corticosteroids in a patient with pustulosis palmoplantaris. Acta Derm Venereol 1998; 78:221-2. [PMID: 9602232 DOI: 10.1080/000155598441585] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Affiliation(s)
- S Mizoguchi
- Department of Dermatology, Kagoshima University, Faculty of Medicine, Sakuragaoka, Japan
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47
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Kwon PS, Maurer T, LeBoit PE, Aly R, Berger TG. Hormone-induced acneiform eruption in human immunodeficiency virus disease. Arch Dermatol 1998; 134:374-6. [PMID: 9521041 DOI: 10.1001/archderm.134.3.374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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48
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Paul C, Giachetti S, Pinquier L, Flageul B, Dubertret L, Calvo F. Cutaneous effects of granulocyte colony-stimulating factor in healthy volunteers. Arch Dermatol 1998; 134:111-2. [PMID: 9449927 DOI: 10.1001/archderm.134.1.111] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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49
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Jansen T, Plewig G. [Gram negative folliculitis. A complication of antibiotic therapy of acne vulgaris. 2: Diagnosis and differential diagnosis--therapy]. Fortschr Med 1997; 115:42-44. [PMID: 9157043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- T Jansen
- Klinik und Poliklinik der Univ., Klinikum Innenstadt, München
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50
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Jansen T, Plewig G. [Gram-negative folliculitis. Complication of antibiotic therapy of acne vulgaris, 1: Disease picture and classification--special form: whirlpool dermatitis]. Fortschr Med 1997; 115:37-8. [PMID: 9102387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- T Jansen
- Klinik und Poliklinik der Univ, Klinikum Innenstadt, München
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