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Journal of the American Academy of... Feb 2015There has been a rapid emergence of numerous targeted agents in the oncology community in the last decade. This exciting paradigm shift in drug development lends promise... (Review)
Review
There has been a rapid emergence of numerous targeted agents in the oncology community in the last decade. This exciting paradigm shift in drug development lends promise for the future of individualized medicine. Given the pace of development and clinical deployment of targeted agents with novel mechanisms of action, dermatology providers may not be familiar with the full spectrum of associated skin-related toxicities. Cutaneous adverse effects are among the most frequently observed toxicities with many targeted agents, and their intensity can be dose-limiting or lead to therapy discontinuation. In light of the often life-saving nature of emerging oncotherapeutics, it is critical that dermatologists both understand the mechanisms and recognize clinical signs and symptoms of such toxicities in order to provide effective clinical management. Part I of this continuing medical education article will review in detail the potential skin-related adverse sequelae, the frequency of occurrence, and the implications associated with on- and off-target cutaneous toxicities of inhibitors acting at the cell membrane level, chiefly inhibitors of epidermal growth factor receptor, KIT, and BCR-ABL, angiogenesis, and multikinase inhibitors.
Topics: Alopecia; Angiogenesis Inhibitors; Antineoplastic Agents; Cell Membrane; Dermatitis, Photoallergic; Dose-Response Relationship, Drug; Drug Eruptions; ErbB Receptors; Fusion Proteins, bcr-abl; Hair Diseases; Humans; Molecular Targeted Therapy; Mucositis; Nail Diseases
PubMed: 25592338
DOI: 10.1016/j.jaad.2014.07.032 -
Dermatologic Clinics Apr 2015Nail disorders are difficult to treat and often frustrating both for patients and clinicians. Because of the slow growth rate of the nail plate and the difficulty of... (Review)
Review
Nail disorders are difficult to treat and often frustrating both for patients and clinicians. Because of the slow growth rate of the nail plate and the difficulty of getting the drug actives to penetrate the nail tissues, it is usually necessary to wait several months before seeing the results of treatments. This delay often leads to discontinuation of therapy by the patients. This article therefore helps clinicians to find the right treatment of the 5 most common nail disorders (brittle nails, onycholysis, paronychia, psoriasis, and onychomycosis) and provides practical tips that might improve patients' compliance.
Topics: Acute Disease; Chronic Disease; Foot Dermatoses; Hand Dermatoses; Humans; Nail Diseases; Onycholysis; Onychomycosis; Paronychia; Psoriasis
PubMed: 25828710
DOI: 10.1016/j.det.2014.12.001 -
The Journal of Hand Surgery Jan 2019Infections are common in hand surgery and proper management is important to achieve optimal outcomes. Although most cases are not urgent, less common, severe infections... (Review)
Review
Infections are common in hand surgery and proper management is important to achieve optimal outcomes. Although most cases are not urgent, less common, severe infections such as flexor tenosynovitis and necrotizing fasciitis require urgent identification with both medical and surgical management. It is common for diagnoses to be missed or delayed because clinical and laboratory indicators are often variably present. Delayed identification and management can result in poor outcomes with permanent deficits. This article will provide a review of hand infections with a focus on identifying serious hand infections requiring urgent or emergent treatment, and distinguishing these from less urgent scenarios.
Topics: Abscess; Animals; Anti-Bacterial Agents; Arthritis, Infectious; Biomarkers; Bites and Stings; Cellulitis; Debridement; Diagnosis, Differential; Drainage; Emergencies; Hand; Humans; Leukocyte Count; Necrosis; Osteomyelitis; Pyoderma Gangrenosum; Soft Tissue Infections; Tenosynovitis; Tetanus Toxoid
PubMed: 30017648
DOI: 10.1016/j.jhsa.2018.05.027 -
The Orthopedic Clinics of North America Apr 2024The fingertip is the interface between humans and the world, including the various thorns, dirty needles, and other hazards to be found there. It is unsurprising that... (Review)
Review
The fingertip is the interface between humans and the world, including the various thorns, dirty needles, and other hazards to be found there. It is unsurprising that this is the site where hand infections most frequently occur. Although commonly encountered by hand surgeons and other physicians, fingertip infections have several mimics, and diagnosis and management is not always straightforward. Early diagnosis and treatment are key to success. As with all infections, they are more common and are more aggressive in immunosuppressed patients. This article reviews fingertip anatomy, common and uncommon fingertip infections and their mimics, and recommendations for management.
Topics: Humans; Fingers; Hand
PubMed: 38403372
DOI: 10.1016/j.ocl.2023.10.003 -
Journal of the American Podiatric... May 2020Retronychia is an uncommonly reported condition among the category of nail pathologies. It often presents mimicking similar nail disorders, such as onychocryptosis,... (Review)
Review
Retronychia is an uncommonly reported condition among the category of nail pathologies. It often presents mimicking similar nail disorders, such as onychocryptosis, onychomycosis, and paronychia. This pathologic condition has recently seen an increased presence in the literature, mainly in the form of case studies. Literature on retronychia was collected using PubMed, the US National Library of Medicine, the National Institutes of Health's online database, life science journals, and online books. References cited by these articles were also reviewed for additional relevant publications. Reviews, case studies, and retrospective articles were compiled and analyzed for commonalities in cause, patient demographics, clinical signs, and treatment. Retronychia may be more common than previously suggested. Proper knowledge and education of this pathologic nail condition is important to health-care professionals to achieve early and correct diagnosis.
Topics: Humans; Nail Diseases; Nails; Nails, Ingrown; Paronychia; Retrospective Studies; United States
PubMed: 32730608
DOI: 10.7547/17-155 -
Veterinary Journal (London, England :... Apr 2024Malassezia are members of the mycobiome of dogs and cats. In the presence of an underlying disease, these yeasts can proliferate, attach to the skin or mucosa to induce... (Review)
Review
Malassezia are members of the mycobiome of dogs and cats. In the presence of an underlying disease, these yeasts can proliferate, attach to the skin or mucosa to induce a secondary Malassezia dermatitis, otitis externa or paronychia. Since allergic dermatitis is one of the most common underlying causes, diagnostic investigation for allergy is often indicated. Cats may suffer from various other underlying problems, especially where Malassezia dermatitis is generalised. Malassezia dermatitis in dogs and cats is chronic, relapsing and pruritic. Direct cytology from dermatological lesions and the ear canal, showing "peanut-shaped" budding yeasts, facilitates a rapid and reliable diagnosis. Topical treatment includes antiseptic and antifungal azole-based products. Systemic treatment with oral antifungals is indicated only in severe or refractory disease. Identification and treatment of the underlying cause is essential for an optimal response. In this evidence-based narrative review, we discuss the clinical presentation of Malassezia dermatitis in dogs and cats, underlying comorbidities, and diagnostic considerations. Treatment is discussed in light of emerging evidence of antifungal resistance and the authors' clinical experience.
Topics: Animals; Cats; Dogs; Malassezia; Dermatomycoses; Cat Diseases; Antifungal Agents; Dog Diseases; Neoplasm Recurrence, Local; Dermatitis
PubMed: 38431127
DOI: 10.1016/j.tvjl.2024.106084 -
Presse Medicale (Paris, France : 1983) Nov 2014Paronychia is an inflammation of the folds of tissue surrounding the nail; proximal and/or lateral nail folds. Acute paronychia is mainly due to bacterial infection,... (Review)
Review
Paronychia is an inflammation of the folds of tissue surrounding the nail; proximal and/or lateral nail folds. Acute paronychia is mainly due to bacterial infection, Staphyloccus aureus or Streptococcus sometimes viral infection (herpetic whitlow). Chronic paronychia is the result of numerous conditions in which the main factor is the disappearance of the cuticle. On fingers, etiology is often a contact dermatitis; bacterial or mycological infections are secondary colonizations. Onychomycosis due to moulds (Fusarium) or dematiae (Scytalidium dimitiadum) are often associated with paronychia. Paronychia is a frequent side-effect of chemotherapies and targeted therapies. Paronychia is a common complication of lateral or proximal (retronychia) ingrown nail and systemic antibiotics are ineffective unless infection is proved. Do not use systematically systemic antibiotics.
Topics: Acute Disease; Chronic Disease; Drug-Related Side Effects and Adverse Reactions; Humans; Inflammation; Nails, Ingrown; Neoplasms; Paraneoplastic Syndromes; Paronychia; Skin Diseases
PubMed: 25441843
DOI: 10.1016/j.lpm.2014.06.009 -
Anais Brasileiros de Dermatologia 2018Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. It is suspected when there is persistent... (Review)
Review
Retronychia is a recently described disorder caused by ingrowth of the proximal nail plate into the proximal nail fold. It is suspected when there is persistent paronychia, particularly in the setting of trauma. This disease is probably underdiagnosed due to limited knowledge among dermatologists and the presence of incomplete clinical forms. Nail plate avulsion is the diagnostic and curative procedure of choice, despite reports of relapse.
Topics: Humans; Nail Diseases; Nails, Ingrown; Onycholysis; Paronychia
PubMed: 30156621
DOI: 10.1590/abd1806-4841.20187908 -
Lung Cancer (Amsterdam, Netherlands) Nov 2022The Epidermal Growth Factor Receptor (EGFR) is mutated in 10-15% of patients with lung adenocarcinoma. At metastatic stage EGFR tyrosine kinase inhibitors (TKIs) are...
Management of cutaneous toxicities under amivantamab (anti MET and anti EGFR bispecific antibody) in patients with metastatic non-small cell lung cancer harboring EGFR Exon20ins: towards a proactive, multidisciplinary approach.
CONTEXTE
The Epidermal Growth Factor Receptor (EGFR) is mutated in 10-15% of patients with lung adenocarcinoma. At metastatic stage EGFR tyrosine kinase inhibitors (TKIs) are used front line for patients harboring targetable mutations. Novel anti-EGFR therapies are being developed. Amivantamab is a bispecific anti-EGFR and anti-MET antibody with expected skin toxicities.
OBJECTIVE
We developed here guidelines for prevention and treatment of cutaneous toxicities under amivantamab according to our experience at Institut Curie.
MATERIEL & METHOD
The first patients with metastatic lung cancer harboring EGFR Exon20ins mutation, included in the phase 1 CHRYSALIS trial and cured at Institute Curie from November 1st 2019 until December 31st 2021 were selected for this work. Retrospectively, all cutaneous adverse events were registered and classified according to the CTCAE 6.0 classification, and actions we implemented to minimize and treat these adverse events were collected. We then developed guidelines based on these datas.
RESULTS
A total of seven patients started amivantamab as monotherapy. The two most frequent dermatological adverse events were: acneiform rash and paronychia (100 % of patients). Other adverse events presented by the patients were reported: modification of hair growth with hypertrichosis in 50 % of men (n = 1/2) and hirsutism in 80 % of women (n = 4/5); skin abrasion of the scalp in 71 % (n = 5/7); and skin fissure in 57 % (n = 4/7). We recommend first a rigorous inspection of the skin and teguments to determine the risk rate to have dryer skin under treatment; second a prevention of paronychia/acneiform rash/and skin fissures with prophylactic tetracycline, skin moisturizing, and hygienic measures starting at least 14 days before treatment initiation; third a particular attention to the psychological impact of skin toxicities with access to psychological support.
CONCLUSION
We propose here guidelines for the management of dermatological toxicities under amivantamab with a multidisciplinary approach for the proactive management of cutaneous toxicities with a focus on preventive actions.
Topics: Female; Humans; Male; Carcinoma, Non-Small-Cell Lung; ErbB Receptors; Exanthema; Lung Neoplasms; Mutation; Paronychia; Protein Kinase Inhibitors; Skin Diseases
PubMed: 36198244
DOI: 10.1016/j.lungcan.2022.09.012