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Journal of Cutaneous Medicine and... 2021Immune checkpoint inhibitors have proven to be efficacious for a broad spectrum of solid organ malignancies. These monoclonal antibodies lead to cytotoxic T-cell... (Review)
Review
Immune checkpoint inhibitors have proven to be efficacious for a broad spectrum of solid organ malignancies. These monoclonal antibodies lead to cytotoxic T-cell activation and subsequent elimination of cancer cells. However, they can also lead to immune intolerance and immune-related adverse event (irAEs) that are new and specific to these therapies. Cutaneous irAEs are the most common, arising in up to 34% of patients on PD-1 inhibitors and 43% to 45% on CTLA-4 inhibitors. The most common skin manifestations include maculopapular eruption, pruritus, and vitiligo-like lesions. A grading system has been proposed, which guides management of cutaneous manifestations based on the percent body surface area (BSA) involved. Cutaneous irAEs may prompt clinicians to reduce drug doses, add systemic steroids to the regiment, and/or discontinue lifesaving immunotherapy. Thus, the goal is for early identification and concurrent management to minimize treatment interruptions. We emphasize here that the severity of the reaction should not be graded based on BSA involvement alone, but rather on the nature of the primary cutaneous pathology. For instance, maculopapular eruptions rarely affect <30% BSA and can often be managed conservatively with skin-directed therapies, while Stevens-Johnson syndrome (SJS) affecting even 5% BSA should be managed aggressively and the immunotherapy should be discontinued at once. There is limited literature available on the management of the cutaneous irAEs and most studies present anecdotal evidence. We review the management strategies and provide recommendations for psoriatic, immunobullous, maculopapular, lichenoid, acantholytic eruptions, vitiligo, alopecias, vasculitides, SJS/toxic epidermal necrolysis, and other related skin toxicities.
Topics: Alopecia Areata; Body Surface Area; Drug Eruptions; Humans; Immune Checkpoint Inhibitors; Lichenoid Eruptions; Neoplasms; Pemphigoid, Bullous; Psoriasis; Severity of Illness Index; Stevens-Johnson Syndrome; Vasculitis; Vitiligo
PubMed: 32746624
DOI: 10.1177/1203475420943260 -
Dermatologic Therapy Mar 2021In this systematic review, we anticipated in summarizing clinical features, histopathological hallmarks, and possible pathology behind the maculopapular skin eruptions... (Review)
Review
In this systematic review, we anticipated in summarizing clinical features, histopathological hallmarks, and possible pathology behind the maculopapular skin eruptions occurring in Covid-19 patients. A literature search was executed using MEDLINE/PubMed and Embase databases for articles published till 20 November 2020. All eligible articles including observational studies, case reports, and case series reporting the maculopapular skin lesion in Covid-19 patients were included. Data were obtained for 354 Covid-19 patients presenting with maculopapular lesions from 40 studies. The mean age of these patients was 53 years, and with 42% of them being male. These maculopapular lesions differed considerably in terms of distribution and appearance, ranging from diffuse erythematous maculopapular lesions to scattered erythematous macules coalescing into papules to maculopapular lesions in plaques. The mean duration of the lesion was 8 days. These lesions were frequently localized on trunks and extremities. Superficial perivascular dermatitis with lymphocytic infiltrate was a histopathological hallmark of these lesions. As these skin lesions may have a possible association with diagnosis, management, prognosis, and severity of the disease, all health practitioners need to be well acquainted with these Covid-19 skin lesions. Also, in the middle of this worldwide pandemic, early identification of this eruption may help manage this infection's further spread.
Topics: COVID-19; Drug Eruptions; Exanthema; Humans; Male; Middle Aged; Pandemics; SARS-CoV-2
PubMed: 33481314
DOI: 10.1111/dth.14788 -
American Journal of Clinical Dermatology Nov 2018Targeted therapies and immunotherapies are associated with a wide range of dermatologic adverse events (dAEs) resulting from common signaling pathways involved in... (Review)
Review
Targeted therapies and immunotherapies are associated with a wide range of dermatologic adverse events (dAEs) resulting from common signaling pathways involved in malignant behavior and normal homeostatic functions of the epidermis and dermis. Dermatologic toxicities include damage to the skin, oral mucosa, hair, and nails. Acneiform rash is the most common dAE, observed in 25-85% of patients treated by epidermal growth factor receptor and mitogen-activated protein kinase kinase inhibitors. BRAF inhibitors mostly induce secondary skin tumors, squamous cell carcinoma and keratoacanthomas, changes in pre-existing pigmented lesions, as well as hand-foot skin reactions and maculopapular hypersensitivity-like rash. Immune checkpoint inhibitors (ICIs) most frequently induce nonspecific maculopapular rash, but also eczema-like or psoriatic lesions, lichenoid dermatitis, xerosis, and pruritus. Of the oral mucosal toxicities observed with targeted therapies, oral mucositis is the most frequent with mammalian target of rapamycin (mTOR) inhibitors, followed by stomatitis associated to multikinase angiogenesis and HER inhibitors, geographic tongue, oral hyperkeratotic lesions, lichenoid reactions, and hyperpigmentation. ICIs typically induce oral lichenoid reactions and xerostomia. Targeted therapies and endocrine therapy also commonly induce alopecia, although this is still underreported with the latter. Finally, targeted therapies may damage nail folds, with paronychia and periungual pyogenic granuloma distinct from chemotherapy-induced lesions. Mild onycholysis, brittle nails, and a slower nail growth rate may also be observed. Targeted therapies and immunotherapies often profoundly diminish patients' quality of life, which impacts treatment outcomes. Close collaboration between dermatologists and oncologists is therefore essential.
Topics: Antineoplastic Agents; Dermatology; Drug Eruptions; Hair; Humans; Immunotherapy; Interdisciplinary Communication; Medical Oncology; Molecular Targeted Therapy; Mouth Mucosa; Nails; Neoplasms; Quality of Life; Skin; Treatment Outcome
PubMed: 30374901
DOI: 10.1007/s40257-018-0384-3 -
Critical Reviews in Microbiology Aug 2012Id reactions are a type of secondary inflammatory reaction that develops from a remote localized immunological insult. To date, id reactions caused by various fungal,... (Review)
Review
Id reactions are a type of secondary inflammatory reaction that develops from a remote localized immunological insult. To date, id reactions caused by various fungal, bacterial, viral, and parasitic infections have been reported. Superficial fungal infections, especially tinea pedis, are the most common cause of id reactions. Id reactions exhibit multiple clinical presentations, including localized or widespread vesicular lesions, maculopapular or scarlatiniform eruptions, erythema nodosum, erythema multiforme, erythema annulare centrifugum, Sweet's syndrome, guttate psoriasis, and autoimmune bullous disease. The mechanisms underlying id reactions vary depending on the type of clinical presentation. The most important aspect of therapy involves the identification and adequate treatment of the underlying infection or dermatitis. This review comprehensively discusses the current state of the field concerning cutaneous id reactions, including diagnostic criteria, clinical presentations, underlying infectious conditions, etiologic agents, immunologic characteristics, histopathologic findings, and management strategies.
Topics: Dermatomycoses; Humans; Parasitic Diseases; Skin; Skin Diseases; Virus Diseases
PubMed: 22300403
DOI: 10.3109/1040841X.2011.645520 -
Cureus Oct 2020Dyshidrotic eczema (DE) or acute palmoplantar eczema is a common cause of hand and foot dermatitis in adults. It is a recurrent vesicular eruption affecting the soles,...
Dyshidrotic eczema (DE) or acute palmoplantar eczema is a common cause of hand and foot dermatitis in adults. It is a recurrent vesicular eruption affecting the soles, palms, or both. It is very pruriginous and generally appears suddenly. It creates vesicles that, on physical examination, can look similar to "tapioca pudding", which is the characteristic clinical feature of this disorder. It is more common in young adults and affects men and women equally. In this report, we present the case of a 56-year-old man with no relevant past medical history who presented to the hospital with vesicular lesions in his hands and maculopapular lesions in his arms and legs. The patient had characteristic lesions in his right hand consistent with DE and negative workup for bullous pemphigoid, scabies, and bacterial, fungal, and viral infections.
PubMed: 33173645
DOI: 10.7759/cureus.10839 -
The Journal of Allergy and Clinical... Jan 2016Cutaneous lesions in patients with mastocytosis are highly heterogeneous and encompass localized and disseminated forms. Although a classification and criteria for... (Review)
Review
Cutaneous manifestations in patients with mastocytosis: Consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology.
Cutaneous lesions in patients with mastocytosis are highly heterogeneous and encompass localized and disseminated forms. Although a classification and criteria for cutaneous mastocytosis (CM) have been proposed, there remains a need to better define subforms of cutaneous manifestations in patients with mastocytosis. To address this unmet need, an international task force involving experts from different organizations (including the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology) met several times between 2010 and 2014 to discuss the classification and criteria for diagnosis of cutaneous manifestations in patients with mastocytosis. This article provides the major outcomes of these meetings and a proposal for a revised definition and criteria. In particular, we recommend that the typical maculopapular cutaneous lesions (urticaria pigmentosa) should be subdivided into 2 variants, namely a monomorphic variant with small maculopapular lesions, which is typically seen in adult patients, and a polymorphic variant with larger lesions of variable size and shape, which is typically seen in pediatric patients. Clinical observations suggest that the monomorphic variant, if it develops in children, often persists into adulthood, whereas the polymorphic variant may resolve around puberty. This delineation might have important prognostic implications, and its implementation in diagnostic algorithms and future mastocytosis classifications is recommended. Refinements are also suggested for the diagnostic criteria of CM, removal of telangiectasia macularis eruptiva perstans from the current classification of CM, and removal of the adjunct solitary from the term solitary mastocytoma.
Topics: Allergy and Immunology; Consensus; Humans; Mastocytosis, Cutaneous; Societies, Medical
PubMed: 26476479
DOI: 10.1016/j.jaci.2015.08.034 -
Acta Medica Indonesiana Jan 2024Mpox is caused by the Monkeypox virus, which belongs to the Orthopoxvirus genus and Poxviridae family. The Monkeypox virus was first identified as a cause of disease in...
Mpox is caused by the Monkeypox virus, which belongs to the Orthopoxvirus genus and Poxviridae family. The Monkeypox virus was first identified as a cause of disease in humans in the 1970s in the Democratic Republic of the Congo. Mpox was considered endemic in several African countries. A global outbreak of Mpox was first recognized in Europe in May 2022 and was declared a public health emergency of international concern on July 23, 2022. The first reported Mpox case in Indonesia was in October 2022 which was identified as an imported case, there were no new confirmed Mpox cases until 13 October 2023. Since then there were 72 cases of confirmed Mpox cases in Indonesia by the end of 2023, distributed across 6 provinces, mostly in the Java island.We present two different spectrums of Mpox skin lesions in patients living with HIV, with a positive polymerase chain reaction test for Mpox. The first patient is a 48-year-old male, who developed a maculopapular lesion, that was initially noticed on the face, the lesions were then spread to the back and hand. He identifies as men who have sex with men and living with HIV for the past 18 years. There were no lesions on the genitalia or mucosa. The second patient is a 28-year-old male, the initial symptom was fever, followed by skin lesions after around 1 week of fever. The lesion initially appears as pustules on the face and then spreads throughout the whole body, the lesions also grow larger and become pseudo-pustules and ulcers. There were also mucosal involvements in the mouth, making oral intake difficult. This patient also identified as men who have sex with men with multiple partners, HIV status was not known at the initial presentation. HIV screening was done with positive results.
Topics: Male; Humans; Middle Aged; Adult; Homosexuality, Male; Mpox (monkeypox); Sexual and Gender Minorities; Disease Outbreaks; HIV Infections
PubMed: 38561878
DOI: No ID Found -
Turkish Journal of Medical Sciences Dec 2020Sars-CoV-2 virus infection (COVID-19) was observed in China in the last months of 2019. In the period following, this infection spread all over the world. In March 2020... (Review)
Review
BACKGROUND/AIM
Sars-CoV-2 virus infection (COVID-19) was observed in China in the last months of 2019. In the period following, this infection spread all over the world. In March 2020 the World Health Organization announced the existence of a pandemic. The aim of this manuscript is to investigate skin diseases associated with COVID-19 under three main headings: skin problems related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections, and skin findings due to COVID-19 treatment agents.
MATERIALS AND METHODS
In PubMed, Google Scholar databases, skin lesions related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections and skin findings due to COVID-19 treatment agents subjects are searched in detail.
RESULTS
Pressure injury, contact dermatitis, itching, pressure urticaria, exacerbation of preexisting skin diseases, and new skin lesion occurrence/new skin disease occurrence may be due to personal protective equipment. Skin problems related to personal hygiene measures could include itching, dryness, and contact dermatitis. Skin findings may also be observed in SARS-CoV-2 virus infections. The incidence of skin lesions due to COVID-19 was reported to be between 0.2% and 29%. Many skin lesions including maculopapular, urticarial, vesicular, chilblain-like, thrombotic/ischemic, etc. are observed in COVID-19 patients. Some authors have stated that there is an absence of SARS-CoV-2 virus infection-specific skin findings. However, in asymptomatic or presymptomatic COVID-19 patients in particular, skin lesions can lead to the diagnosis of COVID-19. In addition, skin lesions may occur due to COVID-19 treatment agents.
CONCLUSION
Many skin lesions may appear as a result of COVID-19. Even in the absence of a COVID-19 diagnosis, skin findings should be evaluated carefully in this pandemic period.
Topics: COVID-19; Dermatology; Diagnosis, Differential; Humans; Personal Protective Equipment; SARS-CoV-2; Skin Diseases; COVID-19 Drug Treatment
PubMed: 32599968
DOI: 10.3906/sag-2005-182 -
Indian Journal of Dermatology 2023Cutaneous mastocytosis is a neoplasm characterized by the proliferation and accumulation of mast cells in the skin. There can be involvement of other organ systems as... (Review)
Review
Cutaneous mastocytosis is a neoplasm characterized by the proliferation and accumulation of mast cells in the skin. There can be involvement of other organ systems as well. Cutaneous manifestations can vary from mastocytoma to maculopapular lesions to diffuse cutaneous form. There can be symptoms associated with mast cell mediators release like itching, flushing, hypotension, diarrhoea, abdominal pain, and anaphylaxis. Hence, the mainstay of treatment is avoidance of triggers causing these mediators to release, anti-histamines, topical/intra-lesional/systemic steroids, mast cell-targeted therapy, epinephrine, and omalizumab depending upon the severity of symptoms/signs. Childhood cases usually have a good prognosis except in a few cases, especially those with systemic involvement. Such situations might warrant cytoreductive therapy, polychemotherapy, or autologous stem cell transplantation. Here, we intend to review the English literature on childhood cutaneous mastocytosis.
PubMed: 37151240
DOI: 10.4103/ijd.ijd_264_22