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The New England Journal of Medicine Mar 2023
Topics: Humans; Behcet Syndrome; Exanthema
PubMed: 36876757
DOI: 10.1056/NEJMicm2209759 -
Internal Medicine (Tokyo, Japan) Dec 2019
PubMed: 31462590
DOI: 10.2169/internalmedicine.3214-19 -
Journal of Drugs in Dermatology : JDD Jun 2023Rosacea is a chronic skin disorder involving central facial erythema secondary to vascular instability and cutaneous inflammation. Rosacea is divided into different... (Review)
Review
Rosacea is a chronic skin disorder involving central facial erythema secondary to vascular instability and cutaneous inflammation. Rosacea is divided into different subtypes based on the morphology of the rash — erythematotelangiectatic, papulopustular, phymatous, and ocular rosacea. A less-known subtype called neurogenic rosacea has been proposed to categorize patients suffering from rosacea with erythematous flushing and burning sensation that is refractory to traditional treatment. There is minimal data on this subgroup of rosacea patients and its potential treatment options. This review aims to explore current medical literature to define characteristics of neurogenic rosacea and its management. We performed a systematic search of PubMed database and identified 6 articles meeting inclusion criteria with a total of 37 patients with suspected neurogenic rosacea. Combination treatments with topicals (eg, metronidazole, brimonidine), as well as oral medications including vascular (eg, beta blockers), psychiatric (eg, diazepam, duloxetine), neurologic (eg, pregabalin, sumatriptan), and antibiotic agents (eg, rifaximin), were often cited to have better outcomes, but this finding was highly variable between patients. There were isolated reports of effective management with onabotulinumtoxinA intradermal injections and endoscopic thoracic sympathectomy treatment. Current literature supports selecting agents aimed at treating the major symptom pattern (eg, erythema, telangiectasias, burning sensation). Neurogenic rosacea treatment: a literature review. Ivanic MG, Oulee A, Norden A, et al. J Drugs Dermatol. 2023;22(6):566-571. doi:10.36849/JDD.7181  .
Topics: Humans; Rosacea; Erythema; Metronidazole; Anti-Bacterial Agents; Brimonidine Tartrate
PubMed: 37276164
DOI: 10.36849/JDD.7181 -
Pediatric Dermatology Jul 2020
Topics: Drug Eruptions; Exanthema; Humans
PubMed: 32706466
DOI: 10.1111/pde.14164 -
Supportive Care in Cancer : Official... Aug 2011Epidermal growth factor receptor inhibitors (EGFRI) produce various dermatologic side effects in the majority of patients, and guidelines are crucial for the prevention... (Review)
Review
BACKGROUND
Epidermal growth factor receptor inhibitors (EGFRI) produce various dermatologic side effects in the majority of patients, and guidelines are crucial for the prevention and treatment of these untoward events. The purpose of this panel was to develop evidence-based recommendations for EGFRI-associated dermatologic toxicities.
METHODS
A multinational, interdisciplinary panel of experts in supportive care in cancer reviewed pertinent studies using established criteria in order to develop first-generation recommendations for EGFRI-associated dermatologic toxicities.
RESULTS
Prophylactic and reactive recommendations for papulopustular (acneiform) rash, hair changes, radiation dermatitis, pruritus, mucositis, xerosis/fissures, and paronychia are presented, as well as general dermatologic recommendations when possible.
CONCLUSION
Prevention and management of EGFRI-related dermatologic toxicities is critical to maintain patients' health-related quality of life and dose intensity of antineoplastic regimens. More rigorous investigation of these toxicities is warranted to improve preventive and treatment strategies.
Topics: Antineoplastic Agents; ErbB Receptors; Exanthema; Humans; Internationality; Practice Guidelines as Topic; Pruritus; Skin Diseases
PubMed: 21630130
DOI: 10.1007/s00520-011-1197-6 -
Dermatology (Basel, Switzerland) 2021The incidence of epidermal growth factor receptor inhibitor (EGFRI)-induced papulopustular rash is 60-85%. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The incidence of epidermal growth factor receptor inhibitor (EGFRI)-induced papulopustular rash is 60-85%.
OBJECTIVE
To investigate prophylactic topical treatment for EGFRI-induced rash.
METHODS
A single-center, randomized, double-blind, placebo-controlled trial. Adult cancer patients initiating treatment with EGFRIs were randomized to receive facial topical treatment with chloramphenicol 3% + prednisolone 0.5% (CHL-PRED) ointment, chloramphenicol 3% (CHL) ointment, or aqua cream (AQUA). The primary end points were the incidence of ≥grade 3 rash using the Common Terminology Criteria for Adverse Events (CTCAE), on days 14 and 30. A subanalysis was conducted for incidence of a protocol-specified significant rash, defined as ≥10 facial papulopustular lesions.
RESULTS
The per-protocol analysis on day 14 included 69 patients, who received CHL-PRED (21), CHL (23), or AQUA (25). The incidence of CTCAE ≥grade 3 rash was not statistically significant between arms; however, the incidence of the protocol-specified significant rash was: CHL-PRED 14%, CHL 39%, and AQUA 48% (p = 0.03, CHL-PRED vs. AQUA). At 30 days, the CTCAE ≥grade 3 incidence was similar, but the incidences of protocol-specified significant rash were 6%, 16%, and 43% (p = 0.03, CHL-PRED vs. AQUA). No significant differences were found between CHL and CHL-PRED and between CHL and AQUA.
CONCLUSIONS
Prophylactic topical CHL-PRED was efficacious when compared to AQUA, in the treatment of EGFRI-induced facial papulopustular rash.
Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Chloramphenicol; Double-Blind Method; ErbB Receptors; Exanthema; Female; Humans; Male; Middle Aged; Neoplasms; Prednisolone; Protein Kinase Inhibitors
PubMed: 33378750
DOI: 10.1159/000511869 -
Cutaneous and Ocular Toxicology Sep 2019Papulopustular rash is the most common cutaneous adverse effect during targeted tumour therapy particularly with epidermal growth factor receptor inhibitors (EGFRIs)....
Papulopustular rash is the most common cutaneous adverse effect during targeted tumour therapy particularly with epidermal growth factor receptor inhibitors (EGFRIs). To evaluate the adverse skin reactions, mainly papulopustular rash, caused by targeted tumour therapy. We retrospectively analysed the data of patients who were diagnosed papulopustular rash due to targeted chemotherapeutic agents between January 2016 and August 2018. Demographic characteristics of the patients, the type of malignancy, chemotherapeutic agents causing papulopustular rash, clinical features and grade of the rash, treatment modalities used for the rash, other associated cutaneous adverse reactions, and the need for dose-modification or discontinuation of the chemotherapy were recorded. A total of 39 patients (26 males, 13 females) with a median age of 60 (range 32-86) years were included in the study. EGFRIs such as erlotinib, lapatinib, cetuximab, and panitumumab were the main drugs causing papulopustular rash in 2 (5.1%), 3 (7.6%), 18 (46.1%), and 13 (33.3%) patients, respectively. Imatinib, bevacizumab in combination with oxaliplatin, and everolimus in combination with exemestane and goserelin were responsible in three patients. The most commonly affected area was the face (87.1%) followed by the trunk (56.4%), scalp (25.6%), and extremities (23%). The rash was recorded as grade 1, 2, and 3 in 18, 13, and 6 of the patients, respectively. Grade 3 rash was lead to dose interruptions in 5 (12.8%) patients with subsequent reintroduction at a lower dose in 4 (10.2%) of them and discontinuation of the therapy in 1 (2.5%) patient. Pruritus, xerosis, paronychia, increased growth of the eyelashes, mucositis, hand-foot syndrome (HSF), and symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) are other skin toxicities associated with the targeted tumour therapy. With the increasing use of targeted therapies, dermatologists are now confronted with extensive spectrum of skin toxicities. Therefore, it is critical for dermatologists to be aware of these toxicities so as to develop the best approach without discontinuation of cancer therapy.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Cetuximab; ErbB Receptors; Erlotinib Hydrochloride; Exanthema; Female; Humans; Lapatinib; Male; Middle Aged; Molecular Targeted Therapy; Panitumumab; Pruritus; Retrospective Studies
PubMed: 31010330
DOI: 10.1080/15569527.2019.1594874 -
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 -
The Journal of Dermatology Feb 2020Papulopustular rash, an acneiform rash, appears on the seborrheic region during the first to second week of treatment with an epidermal growth factor receptor inhibitor...
Papulopustular rash, an acneiform rash, appears on the seborrheic region during the first to second week of treatment with an epidermal growth factor receptor inhibitor (EGFRi). The rash gradually disappears after the fourth week; however, it persists or newly develops in other regions during EGFRi treatment. Because Staphylococcus aureus is frequently isolated from late-phase papulopustular rash, we assessed the incidence of bacterial infection and treatment outcomes of patients with late-phase papulopustular rash. Sixty-four cases treated with an EGFRi over 4 weeks who presented with papulopustular rash were assessed retrospectively. The median duration of EGFR inhibitor treatment was 5 months. Grade 2 and 3 papulopustular rash was observed in 47 and eight cases, respectively. Bacterial culture was performed in 51 cases, 50 of which yielded positive results: methicillin-sensitive S. aureus in 29, methicillin-resistant S. aureus in 14, Staphylococcus species in five, Pseudomonas aeruginosa in three, and other in four cases. Of the S. aureus isolates, 42% were resistant to minocycline and 40% to levofloxacin. After treatment with topical and/or oral antibiotics without topical corticosteroids, the papulopustular rash rapidly improved by an average of 2.9 ± 3.4 weeks. However, use of a combination of antibiotics and a topical corticosteroid prolonged the recovery period to an average of 18.9 ± 11.4 weeks. In conclusion, folliculitis that develops over 4 weeks after the initiation of EGFRi treatment is typically caused by staphylococcal infection. Bacterial culture is necessary due to the high rate of antibiotic resistance. It is important to distinguish late- from early-phase papulopustular rash and to treat using different approaches.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antineoplastic Agents, Immunological; Cetuximab; Drug Resistance, Bacterial; ErbB Receptors; Exanthema; Female; Folliculitis; Humans; Incidence; Male; Middle Aged; Neoplasms; Panitumumab; Pseudomonas Infections; Pseudomonas aeruginosa; Staphylococcal Infections; Staphylococcus aureus; Time Factors
PubMed: 31803963
DOI: 10.1111/1346-8138.15170 -
Seminars in Oncology Nursing Aug 2014To present a thorough literature review on the assessment, grading, and treatment of rash associated with targeted therapies for cancer treatment. To identify ways that... (Review)
Review
OBJECTIVES
To present a thorough literature review on the assessment, grading, and treatment of rash associated with targeted therapies for cancer treatment. To identify ways that nursing can impact a patient's treatment experience by understanding and properly managing treatment for the rash.
DATA SOURCES
Peer-reviewed journal articles, textbooks.
CONCLUSION
Identification and management of rash induced by targeted therapies may improve quality of life and allow patients to continue drug therapy for their cancer to offer best outcomes.
IMPLICATIONS FOR NURSING PRACTICE
Nurses are in a unique position to assess, grade, and manage rash in patients receiving targeted therapies. Nurses will often be the first point of contact for the patient experiencing a rash, and the proper triage and advice on management can help the patient tolerate these drugs and enable them to remain on treatment.
Topics: Antineoplastic Agents; ErbB Receptors; Exanthema; Humans; Molecular Targeted Therapy; Neoplasms
PubMed: 25085026
DOI: 10.1016/j.soncn.2014.06.001