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Journal of Cutaneous Medicine and... 2024
Topics: Humans; Acitretin; Methotrexate; Acantholysis; Ichthyosis
PubMed: 37991057
DOI: 10.1177/12034754231211567 -
Diseases (Basel, Switzerland) Nov 2023Chromoblastomycosis (CBM) is a neglected human disease, caused by different species of pigmented dematiaceous fungi that cause granulomatous and suppurative dermatosis....
Chromoblastomycosis (CBM) is a neglected human disease, caused by different species of pigmented dematiaceous fungi that cause granulomatous and suppurative dermatosis. This infection is difficult to treat and there are limited therapeutic options, including terbinafine, itraconazole, and tioconazole. Classic treatment is administered for a long period of time, but some patients do not respond properly, and therefore, such therapeutic approaches possess low cure rates. Therefore, it is vital to develop new strategies for the treatment of CBM. In this regard, it has been observed that the association of immunomodulatory molecules such as glucan with therapy carried out with antifungal drugs improves cutaneous lesions in comparison to treatment with antifungal drugs alone, suggesting that drug association may be an interesting and significant approach to incorporate into CBM therapy. Thus, the aim of this work was to associate classical antifungal therapy with the adjuvants imiquimod and acitretin. In the present case, we reported a patient with extensive CBM caused by , that affected an extensive area of the right leg, that was left without treatment for 11 years. He was treated with a classical combination of itraconazole and terbinafine via the oral route plus topical imiquimod and oral acitretin, as an adjuvant therapy. After five months of treatment, a significant regression of verrucous plaques was observed, suggesting that the use of these adjuvants combined with the classical antifungal drugs, intraconazole plus terbinafine, can reduce treatment time and rapidly improve the patient's quality of life. This result confirms that the use of coadjuvant drugs may be effective in the treatment of this infectious disease.
PubMed: 37987273
DOI: 10.3390/diseases11040162 -
Dermatologic Surgery : Official... Dec 2023According to the curriculum guidelines of the Accreditation Council of Graduate Medical Education and the American Board of Dermatology, Mohs micrographic surgery &...
Education and Perspectives on the Use of Oral Skin Cancer Chemoprophylaxis: A Cross-Sectional Survey of Current Fellows in Mohs Micrographic Surgery & Dermatologic Oncology.
BACKGROUND
According to the curriculum guidelines of the Accreditation Council of Graduate Medical Education and the American Board of Dermatology, Mohs micrographic surgery & dermatologic oncology (MSDO) fellows must demonstrate competency in the use of oral skin cancer chemoprophylaxis. The current level of education in this area is unknown.
OBJECTIVE
To characterize oral skin cancer chemoprophylaxis education for acitretin and nicotinamide among current MSDO fellows and to compare the clinical indications felt most appropriate for prescribing to a previously published expert consensus.
METHODS
An electronic survey was distributed to all active MSDO fellows by the American College of Mohs Surgery.
RESULTS
Responses were received from 63 (69.2%) MSDO fellows. Twenty (31.7%) and 37 (58.7%) fellows reported receiving fellowship training on acitretin and nicotinamide, respectively. Fifty-seven (90.5%) intend to prescribe chemoprophylaxis after training. Sixteen (28.1%) and 43 (75.4%) report feeling very comfortable prescribing acitretin and nicotinamide, respectively. Fellow concordance with a previously published expert consensus opinion on appropriate prescribing indications is variable. Forty-one (65.1%) indicated that additional education would increase the likelihood to prescribe after training.
CONCLUSION
Although most MSDO fellows intend to prescribe oral skin cancer chemoprophylaxis, a standardized curriculum may promote increased use and concordance with expert consensus recommendations.
Topics: Humans; United States; Mohs Surgery; Cross-Sectional Studies; Acitretin; Skin Neoplasms; Curriculum; Educational Status; Education, Medical, Graduate; Mouth Neoplasms; Niacinamide; Fellowships and Scholarships; Surveys and Questionnaires
PubMed: 37962150
DOI: 10.1097/DSS.0000000000003962 -
Applied Bionics and Biomechanics 2023[This retracts the article DOI: 10.1155/2022/9640326.].
[This retracts the article DOI: 10.1155/2022/9640326.].
PubMed: 37946840
DOI: 10.1155/2023/9873418 -
Dermatology Online Journal Aug 2023
Topics: Humans; Acitretin; Mycosis Fungoides; Skin Neoplasms; Purpura; Patients
PubMed: 37921829
DOI: 10.5070/D329461918 -
Clinical Drug Investigation Nov 2023Acitretin has long-lasting teratogenic properties. Therefore, pregnancies must be avoided during and within 3 years after acitretin treatment. We aimed to describe (i)...
BACKGROUND AND OBJECTIVE
Acitretin has long-lasting teratogenic properties. Therefore, pregnancies must be avoided during and within 3 years after acitretin treatment. We aimed to describe (i) acitretin use in women of childbearing age in Germany, (ii) the occurrence of acitretin-exposed pregnancies, and (iii) malformations among children exposed in utero.
METHODS
Using 2004-2019 data from the German Pharmacoepidemiological Research Database (GePaRD-claims data from ~ 20% of the German population), we determined annual age-standardized prevalence of acitretin use among girls and women aged 13-49 years. In longitudinal analyses, we estimated the number of exposed pregnancies by assessing whether the exposure window assigned to the last dispensation before pregnancy (days covered by dispensation plus 3 years) overlapped the onset of pregnancy or whether there was a dispensation in the first eight weeks of pregnancy. Data of live-born children with in utero exposure to acitretin were reviewed to assess the presence of congenital malformations.
RESULTS
The age-standardized prevalence of acitretin use per 1000 girls and women was 0.04 in 2019. We identified 35 acitretin-exposed pregnancies; 94.3% of these pregnancies were classified as exposed because they occurred within 3 years after stopping acitretin treatment. Among 18 live-born children linked to their mother, four children (22.2%) had congenital malformations (three children with a major malformation).
CONCLUSIONS
We observed 35 acitretin-exposed pregnancies mainly because treatment ended too late before pregnancy. Approximately one in five children born from these pregnancies had malformations, highlighting the importance of drawing more attention to the long-lasting teratogenicity of this drug.
Topics: Pregnancy; Child; Humans; Female; Acitretin; Abnormalities, Drug-Induced; Germany
PubMed: 37906397
DOI: 10.1007/s40261-023-01314-2 -
Frontiers in Medicine 2023Chronic pruritus of unknown origin (CPUO) is poorly understood and lacks effective treatment options.
BACKGROUND
Chronic pruritus of unknown origin (CPUO) is poorly understood and lacks effective treatment options.
OBJECTIVES
We aimed to elucidate abnormalities in the sweat apparatus of patients with CPUO, and to assess efficacy and safety of treatment with systemic retinoids.
METHODS
An initial case-control study included 20 affected patients and five healthy controls, for whom heat and sweating were induced, either through a standardized exercise protocol or ingestion of hot water. high-definition optical coherence tomography, whole-body starch-iodine testing, and skin biopsy for immunofluorescence staining were done to evaluate for sweat duct obstruction. A subsequent retrospective cohort analysis included 56 patients with CPUO, seen at an Itch subspecialty clinic of a single tertiary referral centre, who failed conventional treatments and were treated with isotretinoin and/or acitretin from May 2014 to November 2020. Treatment response to retinoids was defined as a sustained reduction in itch score of ≥2/10. Safety was assessed by proportion stopping treatment due to side effects.
RESULTS
imaging in 19 (95%) patients revealed features of partial keratinaceous sweat duct obstruction with statistically significant luminal dilatation compared to controls. Immunofluorescence studies of three patients' paired lesional/non-lesional biopsies revealed dermcidin accumulation within sweat glands coupled with dermcidin leakage in itchy skin. Fifty-six patients (mean [SD] age 55.2 [17.5] years, 69.6% male) were treated with systemic retinoids. Mean (SD) duration of itch was 116.3 (140.4) months and mean (SD) itch score was 8.2 (1.8). Forty-one (73.2%) initially received isotretinoin, and 15 (26.8%) acitretin. At three months, mean itch score reduced by 2.38 (95% CI -3.2 to -1.6, < 0.0001). Thirty-eight (67.9%) had a sustained response. Eight (14.81%) achieved an itch score of 0 or 1, with four stopping treatment for a mean (SD) of 318.5 (291.2) days without relapse. Eight (14.3%) stopped or switched retinoid due to adverse effects, with similar incidences between both retinoids, the commonest being dryness.
CONCLUSION
Based on novel findings from physiological imaging studies identifying partial keratinaceous sweat duct obstruction in CPUO, we instituted systemic retinoid treatment to address the underlying pathology. In patients who failed conventional therapies, the treatment appears effective and safe.
PubMed: 37809345
DOI: 10.3389/fmed.2023.1265148 -
Photodiagnosis and Photodynamic Therapy Dec 2023Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease characterised by sterile, relapsing pustules on erythematous, scaly backgrounds on the palms and...
Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease characterised by sterile, relapsing pustules on erythematous, scaly backgrounds on the palms and soles. PPP impairs quality of life and is notoriously challenging to manage. Here, we presented the case of a 79-year-old male who suffered from recalcitrant PPP for 9 years and responded not well to halometasone, acitretin capsules and oral Chinese traditional medicine. The patient showed improvement with a great reduction of erythema, scales, pustules after 5 sessions of 5-aminolevulinic acid photodynamic therapy (ALA-PDT), suggesting that ALA-PDT could be a potentially safe and effective therapeutic option for PPP.
Topics: Male; Humans; Aged; Quality of Life; Photochemotherapy; Photosensitizing Agents; Psoriasis; Skin; Chronic Disease; Acute Disease
PubMed: 37806607
DOI: 10.1016/j.pdpdt.2023.103829 -
A case of trichodysplasia spinulosa related to ruxolitinib treated successfully with oral acitretin.Skin Health and Disease Oct 2023Trichodysplasia spinulosa (TS) is a rare disease that affects immunocompromised patients, characterized by hair-like growths caused by infection. Little is known about...
Trichodysplasia spinulosa (TS) is a rare disease that affects immunocompromised patients, characterized by hair-like growths caused by infection. Little is known about specific immunosuppressive drugs that can precipitate the condition. We report a case of TS presenting after initiating the oral Janus-associated kinase inhibitor (JAKi) ruxolitinib. A 67-year-old female with a history of allogeneic bone marrow transplant requiring immunosuppression with tacrolimus, prednisone and, more recently, ruxolitinib 5 mg twice daily due to Graft versus Host Disease presented to the clinic with a facial rash. The clinical and histopathological findings in the setting of immunosuppression were consistent with TS. Initial treatments were ineffective, but oral acitretin showed significant improvement after 3 months. Due to the close temporal relationship between the initiation of ruxolitinib and the development of TS, this case suggests that JAKis may contribute to TS development by suppressing the JAK-signal transducer and activator of the transcription pathway's antiviral functions.
PubMed: 37799360
DOI: 10.1002/ski2.276 -
Pediatric Dermatology 2023
PubMed: 37767651
DOI: 10.1111/pde.15190