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Journal of the National Comprehensive... May 2015Dermatologic toxicities related to cancer therapies have become even more common with the use of targeted treatments. A proactive approach is necessary to reduce the...
Dermatologic toxicities related to cancer therapies have become even more common with the use of targeted treatments. A proactive approach is necessary to reduce the pain and suffering these patients experience. The oncologist should become comfortable in preventing and managing these complications to keep patients on optimal drugs and doses. At the NCCN 20th Annual Conference, Dr. Mario E. Lacouture advised clinicians on appropriate strategies to manage rash, paronychia, alopecia, and other dermatologic conditions frequently seen in patients with cancer.
Topics: Antineoplastic Agents; Disease Management; Drug-Related Side Effects and Adverse Reactions; Humans; Neoplasms; Skin Diseases
PubMed: 25995431
DOI: 10.6004/jnccn.2015.0204 -
The Journal of Emergency Medicine Oct 2017Cellulitis is a common clinical condition with low rates of morbidity and mortality if treated appropriately. Mimics of cellulitis presenting with erythema, edema,... (Review)
Review
BACKGROUND
Cellulitis is a common clinical condition with low rates of morbidity and mortality if treated appropriately. Mimics of cellulitis presenting with erythema, edema, warmth, and pain can be associated with grave morbidity and mortality if misdiagnosed.
OBJECTIVE
This review investigates the signs and symptoms of cellulitis, mimics of cellulitis, and an approach to the management of both cellulitis and its mimics.
DISCUSSION
The current emergency medicine definition of cellulitis includes erythema, induration, warmth, and swelling. Given the common pathophysiologic pathways, cellulitis mimics often present in an analogous manner. These conditions include septic bursitis, septic joint, deep vein thrombosis, phlegmasia cerulea dolens, necrotizing fasciitis, flexor tenosynovitis, fight bite (closed fist injury), orbital cellulitis, toxic shock syndrome, erysipelas, abscess, felon, paronychia, and gouty arthritis. Many of these diseases have high morbidity and mortality if missed by the emergency physician. Differentiating these mimics from cellulitis can be difficult in the fast-paced emergency setting. A combination of history, physical examination, and focused diagnostic assessment may assist in correctly identifying the underlying etiology. For many of the high mortality cellulitis mimics, surgical intervention is necessary.
CONCLUSION
Cellulitis and its mimics present similarly due to the same physiologic responses to skin and soft tissue infections. A combination of history, physical examination, and diagnostic assessment will help the emergency physician differentiate cellulitis from mimics. Surgical intervention is frequently needed for high morbidity and mortality mimics.
Topics: Bursitis; Cellulitis; Diagnosis, Differential; Edema; Emergency Service, Hospital; Erythema; Humans; Pain; Staphylococcal Infections; Thrombophlebitis; Venous Thrombosis
PubMed: 29079067
DOI: 10.1016/j.jemermed.2017.06.002 -
Skin Appendage Disorders Nov 2022Paronychia is the most common hand infection. Prior paronychia studies were limited by small patient numbers. We conducted a national-level analysis over two decades,...
INTRODUCTION
Paronychia is the most common hand infection. Prior paronychia studies were limited by small patient numbers. We conducted a national-level analysis over two decades, analyzing demographics, etiologies, and trends in paronychia cases.
METHODS
We conducted a retrospective analysis of paronychia cases in the 1999-2018 National Electronic Injury Surveillance System database. Sex, race, age, and cause were recorded and compared using χ, ANOVA, and tests. Multivariable linear regression analysis assessed changes in age, weight, and sex over time.
RESULTS
We analyzed a total of 2,512 cases, with an average age of 27.6 ± 20.6 years, 45.5% females, and 25.6% white and 28.6% black patients. In multivariable linear regression, both age and weight significantly increased over time. Manicuring was the most common etiology (30.9%), increasing in incidence over time and with a higher frequency in adults ( < 0.0001) and females ( < 0.0001). There was a significant decrease in pediatric paronychia cases over time, particularly in 0- to 4-year-olds. Possible limitations include missed paronychia cases or additional non-paronychia cases due to improper coding, infrequent race reporting, and inability to analyze treatments or distinguish between paronychia subtypes.
CONCLUSIONS
Paronychia cases were associated with increased age and weight over time with different presentations by age. Manicuring represents the largest growing paronychia etiology.
PubMed: 36407642
DOI: 10.1159/000525032 -
Presse Medicale (Paris, France : 1983) Nov 2014Nail diseases are varied, and their diagnosis is often difficult. Misdiagnosis can result in failure to recognize a severe disease in urgent need of treatment and in the... (Review)
Review
Nail diseases are varied, and their diagnosis is often difficult. Misdiagnosis can result in failure to recognize a severe disease in urgent need of treatment and in the prescription of treatments that are inappropriate, long, ineffective, and expensive. Acute paronychia must be managed rapidly, treated with antiseptics several times a day, and closely monitored. Nail lichen must be recognized early and treated rapidly and appropriately to prevent permanent scarring. All chronic pain (to shocks or cold) of the tip of a finger or toe should suggest a glomus tumor. Any unexplained persistent single-finger onychopathy should in principle cause the physician to suspect a tumor, carcinoma, or melanoma and to order a histologic examination. An onychopathy must not be treated as an onychomycosis without diagnostic certainty. Repeated microtraumas of the toenails cause injuries that absolutely must be differentiated from onychomycosis. In growth of the big toenail can often be avoided by appropriate cutting of the nails, leaving in place the lateral parts of the nail plate.
Topics: Diagnosis, Differential; Diagnostic Imaging; Dissection; Humans; Nail Diseases; Nails; Skin Neoplasms
PubMed: 25451634
DOI: 10.1016/j.lpm.2014.06.015 -
British Journal of Hospital Medicine... Mar 2016
Review
Topics: Burns; Fractures, Bone; Hand Injuries; Humans; Paronychia; Tendon Injuries; Tenosynovitis
PubMed: 26961459
DOI: 10.12968/hmed.2016.77.3.C41 -
La Revue Du Praticien Feb 2024HAND INFECTIONS. Hand and finger infections are very common. They result from the inoculation of a germ through the skin barrier. They can range from simple paronychia...
HAND INFECTIONS. Hand and finger infections are very common. They result from the inoculation of a germ through the skin barrier. They can range from simple paronychia to extremely serious necrotizing fasciitis. Certain infections, such as those resulting from bites, have their own specific characteristics, which will determine how they are managed. While management can be medical in the early stages, it is important not to ignore the need for surgical treatment, otherwise serious complications may arise, leading to functional and aesthetic sequelae. Delays in treatment cannot be made up. Any infectious lesion can be potentially serious and must be treated in an appropriate department if there is the slightest doubt.
Topics: Humans; Fasciitis, Necrotizing; Paronychia; Bites and Stings
PubMed: 38415419
DOI: No ID Found -
Cureus Sep 2023Background and objective Nail disorders encompass a wide spectrum of conditions, spanning congenital, developmental, infectious, neoplastic, degenerative,...
Background and objective Nail disorders encompass a wide spectrum of conditions, spanning congenital, developmental, infectious, neoplastic, degenerative, dermatological, and systemic diseases. A comprehensive exploration of their clinical manifestations, incidence, and associations is crucial for precise diagnosis and effective management. Methods This observational cross-sectional study conducted at B.J. Medical College and Civil Hospital, Ahmedabad involved 300 consecutive patients with nail changes from July 2017 to June 2019 reporting diverse dermatological and systemic conditions. The inclusion criteria involved patients of both genders and all age groups displaying nail changes associated with dermatological and systemic diseases. Data collection entailed a comprehensive clinical history, systemic and dermatological examinations, nail assessment using Dermoscope (DermLite 3, 10x), and supplementary tests. Analyses were performed on Microsoft Excel 2007 software. The study was approved by the Institute Ethics Committee. Results Among the 300 cases, females had a higher prevalence of nail involvement (57%), with a female-to-male ratio of 1.3:1. The most affected age group was 21-40 years, with 6-10 nails typically affected. Notably, housewives showed a higher prevalence. The most frequent nail condition was onychomycosis (24.33%) followed by psoriatic nail changes (20%). Less frequent nail changes involved eczema (5.7%), paronychia (5%), drug-induced (4.3%), lichen planus (3.7%), trauma-induced (3%), twenty nail dystrophy (2.33%), Darier's disease (2%), pemphigus vulgaris (2%), alopecia areata (1.67%), median Heller dystrophy (1.33%), atopic dermatitis (1%), epidermolysis bullosa (1%), racquet nail (1%), leprosy (1%), pityriasis rubra pilaris (0.67%), vitiligo (0.67%), secondary syphilis (0.67%), pachyonychia congenita (0.67%), as well as a case each of total leukonychia, subungual warts, Koenen tumor, and periungual fibroma(0.33%). Systemic autoimmune connective tissue disorders (CTD) accounted for 9%; the most common nail finding observed was nail fold erythema (48.1%) followed by nail fold telangiectasis (44.4%). In systemic sclerosis (SS), the most common finding was nail fold telangiectasia, and in systemic lupus erythematosus (SLE), the most common was nail fold erythema. Scleroderma capillary pattern on nail fold capillaroscopy was found in seven patients with SS, two patients with dermatomyositis, and only one patient with SLE. Nail changes observed in systemic diseases include onychomycosis in diabetes mellitus and chronic renal failure patients, splinter hemorrhages in ischemic heart disease and hypertension, longitudinal melanonychia in HIV, and koilonychia and platynychia in iron deficiency anemia. Other systemic diseases, such as Addison's disease and renal failure, also exhibited various nail changes. Conclusions Beyond their cosmetic importance, nails hold a vital pathologic role. Proficiency in nail terminology and classification is key for skillful evaluation. Understanding normal and abnormal nail variants, along with their disease associations, benefits diagnosis and tailored management. Nails, often overlooked but accessible, serve as a window into patients' general health and should be an integral part of thorough examinations. This study highlights an intricate clinical panorama of nail disorders, highlighting their significant role in both dermatological and systemic contexts.
PubMed: 37701161
DOI: 10.7759/cureus.45007 -
Dermatologic Clinics Apr 2015This article includes the etiology and pathophysiological data of each entity, classifying them as dermatologic, systemic, infectious, neoplastic, traumatic, and other... (Review)
Review
This article includes the etiology and pathophysiological data of each entity, classifying them as dermatologic, systemic, infectious, neoplastic, traumatic, and other classifications. The entities inherent to the periungual folds are also included, such as acute paronychia, chronic paronychia, retronychia, hangnails, hematomas of the proximal fold caused by oximeter, onychocryptosis, hypertrophy of the lateral folds, and infections caused by Candida albicans, Pseudomonas, and Staphylococcus aureus. Additionally, pathologies caused by diabetes mellitus, sepsis, endocarditis, drug reactions, and finally less frequent diseases that also affect the nail folds are discussed.
Topics: Acute Disease; Chronic Disease; Finger Injuries; Foot Dermatoses; Hand Dermatoses; Humans; Nail Diseases; Nails, Ingrown; Paronychia; Toes
PubMed: 25828713
DOI: 10.1016/j.det.2014.12.004 -
Journal of Feline Medicine and Surgery Dec 2021The aim of this case series was to describe the clinical features and treatment of paronychia in cats diagnosed with patellar fracture and dental anomaly syndrome...
CASE SERIES SUMMARY
The aim of this case series was to describe the clinical features and treatment of paronychia in cats diagnosed with patellar fracture and dental anomaly syndrome (PADS). Clinical records, photographs, microbiology, cytology and histopathology reports were collected, and follow-up was obtained. Five cats with paronychia were included. All five cats had multiple digits of multiple limbs affected and eventually underwent amputation of the third phalanx of one or multiple digits. A total of 36 digits were affected, 17% (n = 6/36) resolved with medical management and 83% (n = 30/36) were eventually treated successfully by amputation. The cats had treatment with numerous courses of antibiotics (range 7-20; mean 11 courses) over periods of time ranging from 10 to 67 months (mean 32 months).
RELEVANCE AND NOVEL INFORMATION
Chronic paronychia may be an additional clinical feature of PADS and the probable mechanism involves poor integrity of osteopetrotic bone, loss of normal nailbed anatomy and secondary osteomyelitis of the distal phalanx. Medical management with antibiotics, anti-inflammatory therapy and steroid treatment may improve the clinical signs in the short term; however, in severe instances, amputation of the third phalanx of the affected digit seems to be necessary to resolve repeated recurrences and discomfort. Additional information on the long-term outcome is required. In any cat with atraumatic patellar fractures and/or retained deciduous teeth, paronychia may require surgical management if medical management is unsuccessful.
Topics: Animals; Cat Diseases; Cats; Fractures, Bone; Paronychia; Syndrome
PubMed: 33759602
DOI: 10.1177/1098612X21998612 -
Investigational New Drugs Feb 2023Potential novel strategies for adverse event (AE) management of osimertinib therapy, including therapeutic drug monitoring and the use of biomarkers, have not yet been... (Observational Study)
Observational Study
Population Pharmacokinetics, Pharmacogenomics, and Adverse Events of Osimertinib and its Two Active Metabolites, AZ5104 and AZ7550, in Japanese Patients with Advanced Non-small Cell Lung Cancer: a Prospective Observational Study.
BACKGROUND
Potential novel strategies for adverse event (AE) management of osimertinib therapy, including therapeutic drug monitoring and the use of biomarkers, have not yet been fully investigated. This study aimed to evaluate (1) the relationship between exposure to osimertinib, especially its active metabolites (AZ5104 and AZ7550), and AEs, and (2) the relationship between germline polymorphisms and AEs.
METHODS
We conducted a prospective, longitudinal observational study of 53 patients with advanced non-small cell lung cancer receiving osimertinib therapy from February 2019 to April 2022. A population pharmacokinetic model was developed to estimate the area under the serum concentration-time curve from 0 to 24 h (AUC) of osimertinib and its metabolites. Germline polymorphisms were analyzed using TaqMan® SNP genotyping and CycleavePCR® assays.
RESULTS
There was a significant association between the AUC of AZ7550 and grade ≥ 2 paronychia (p = 0.043) or anorexia (p = 0.011) and between that of osimertinib or AZ5104 and grade ≥ 2 diarrhea (p = 0.026 and p = 0.049, respectively). Furthermore, the AUC of AZ5104 was significantly associated with any grade ≥ 2 AEs (p = 0.046). EGFR rs2293348 and rs4947492 were associated with severe AEs (p = 0.019 and p = 0.050, respectively), and ABCG2 rs2231137 and ABCB1 rs1128503 were associated with grade ≥ 2 AEs (p = 0.008 and p = 0.038, respectively).
CONCLUSION
Higher exposures to osimertinib, AZ5104, and AZ7550 and polymorphisms in EGFR, ABCG2, and ABCB1 were related to higher severity of AEs; therefore, monitoring these may be beneficial for osimertinib AE management.
Topics: Humans; Aniline Compounds; Carcinoma, Non-Small-Cell Lung; East Asian People; ErbB Receptors; Lung Neoplasms; Mutation; Pharmacogenetics; Prospective Studies; Protein Kinase Inhibitors; ATP Binding Cassette Transporter, Subfamily B, Member 2; ATP Binding Cassette Transporter, Subfamily B
PubMed: 36637703
DOI: 10.1007/s10637-023-01328-9