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Dermatologie (Heidelberg, Germany) Jun 2024Hand-foot syndrome (HFS) and nail changes are frequent adverse events of anticancer therapies. (Review)
Review
BACKGROUND
Hand-foot syndrome (HFS) and nail changes are frequent adverse events of anticancer therapies.
OBJECTIVES
To provide a review of current evidence in HFS and nail disorders associated with medical tumor treatment.
MATERIALS AND METHODS
Basis is the current German S3 guideline "Supportive therapy in oncologic patients" and literature on this topic published since the guideline was finalized.
RESULTS
Two variants of HFS are distinguished: a chemotherapy-associated and a kinase-inhibitor-associated variant. In the first form, painful erythema, blisters and ulceration can occur, also in other areas with a high number of sweat glands such as axillary and inguinal regions. Thus, the secretion of toxic substances through sweat glands is a proposed pathogenetic mechanism. For the second form, which results in callus-like painful thickening of the horny layer on areas of mechanic pressure, a vascular mechanism is proposed. For prophylaxis of HFS, avoidance of mechanical stress, regular cleaning of predisposed areas, and also urea- and diclofenac-containing ointments are recommended; in case of infusions (taxanes, doxorubicine), cooling of hands and feet during infusion is recommended. In case of manifest HFS, dose reduction or prolongation of intervals of the associated treatment are recommended. Nail changes often develop under therapy with chemotherapeutic agents but also under treatment with agents such as checkpoint inhibitors or under targeted therapy. Different components of the nail unit may be involved such as the nail matrix, nail bed, nail plate, hyponychium, lunula and proximal and lateral nail folds.
CONCLUSION
This work gives insight into the pathophysiology of HFS and nail disorders that develop under systemic oncologic treatments and gives recommendations for prophylaxis and treatment.
Topics: Humans; Hand-Foot Syndrome; Antineoplastic Agents; Nail Diseases; Practice Guidelines as Topic; Drug Eruptions; Neoplasms
PubMed: 38802652
DOI: 10.1007/s00105-024-05351-6 -
Frontiers in Oncology 2024While typically low-risk, cutaneous squamous cell carcinoma (cSCC) can infrequently progress to metastatic disease with in-transit lesions, localized to the dermis or...
While typically low-risk, cutaneous squamous cell carcinoma (cSCC) can infrequently progress to metastatic disease with in-transit lesions, localized to the dermis or subcutaneous tissue between the primary tumor and draining regional lymph nodes. These lesions are associated with poor prognostic values, including decreased survival rates and increased risk of recurrence. We present the case of a 75-year-old male with cSCC and in-transit metastases on his scalp treated with the immune checkpoint inhibitor (ICI) pembrolizumab in conjunction with diphencyprone (DPCP), a topical hapten that induces a delayed-type hypersensitivity reaction in the skin. The patient was enrolled in a clinical trial (NCT05481658) that involved the twice-weekly application of DPCP 0.04% ointment to four of the in-transit metastases on his frontal scalp, concurrent with pembrolizumab 300 mg administered every three weeks. Following effective sensitization and a twelve-week treatment course, complete clearance of all lesions, DPCP-treated and non-DPCP treated, was achieved, with no adverse events. The immunologic profiles of the post-treatment biopsies were analyzed by TaqMan Low Density Array quantitative real-time polymerase chain reaction to measure immune marker gene expression. Relative to the non-DPCP-treated lesion, the DPCP-treated lesion demonstrated increased pro-inflammatory genetic markers and T-cell activation. This case represents the first reported instance of in-transit metastases of cSCC successfully treated with DPCP and an ICI. It highlights the potential safety and efficacy of DPCP with systemic immunotherapy for the management of in-transit metastases of cSCC in patients for whom surgery and radiation may be contraindicated.
PubMed: 38800408
DOI: 10.3389/fonc.2024.1294331 -
Postepy Dermatologii I Alergologii Apr 2024Vitiligo is an immune-related skin disease. Cytokines regulate immune response and inflammation and are involved in the pathogenesis of vitiligo.
INTRODUCTION
Vitiligo is an immune-related skin disease. Cytokines regulate immune response and inflammation and are involved in the pathogenesis of vitiligo.
AIM
To assess the serum levels of pro-inflammatory cytokines pre- and post- systemic glucocorticoid treatment in patients with active vitiligo.
MATERIAL AND METHODS
We measured serum cytokine levels using the enzyme-linked immunosorbent assay in 31 patients with active vitiligo before and after treatment. All patients received systemic glucocorticoid (compound betamethasone injection) in combination with topical halometasone cream and tacrolimus ointment for 3 months. Twenty healthy controls were also examined. The cytokines measured included TNF-α, IL-1β, IL-6, IFN-γ, IL-2, IL-17, IL-10, IL-8, and CXCL10.
RESULTS
The serum levels of TNF-α, IL-1β, IL-6, IFN-γ, IL-2, IL-17, IL-8, and CXCL10 were significantly higher, and levels of IL-10 were lower in vitiligo patients compared to controls. Additionally, serum IFN-γ ( = 0.378; = 0.036), IL-17 ( = 0.426; = 0.017), and CXCL10 ( = 0.514; = 0.003) showed a positive correlation with affected body surface area in vitiligo patients. After 3 months of systemic glucocorticoid treatment, the levels of IL-1β, IFN-γ, IL-2, IL-17, and CXCL10 in responders were significantly decreased and nearly restored to normal levels. The IL-10 level was also increased in response to treatment. In contrast, the non-responder group had persistently high IL-6, IL-17, IL-8, and CXCL10 levels, and negligible changes in TNF-α, IL-1β, IFN-γ, IL-2, and IL-10.
CONCLUSIONS
Our study indicated that the levels of inflammatory cytokines were significantly ameliorated in the glucocorticoid responder group. Altered cell-mediated immunity may contribute to the resistance in vitiligo. The cytokines such as TNF-α, IL-1β, IFN-γ and IL-2 could serve as therapeutic targets for managing glucocorticoid-resistant vitiligo.
PubMed: 38784928
DOI: 10.5114/ada.2024.138672 -
Expert Review of Anti-infective Therapy Jun 2024Neonatal ocular prophylaxis with 0.5% erythromycin ophthalmic ointment is mandated by law in many U.S. states despite its lack of efficacy in preventing chlamydial... (Review)
Review
INTRODUCTION
Neonatal ocular prophylaxis with 0.5% erythromycin ophthalmic ointment is mandated by law in many U.S. states despite its lack of efficacy in preventing chlamydial ophthalmia and the low incidence of gonococcal ophthalmia today. The current shortage of 0.5% erythromycin ophthalmic ointment is bringing into question what alternatives exist for neonatal ocular prophylaxis for the prevention of gonococcal ophthalmia. Providers in states with mandates are concerned with the implications of administering intramuscular ceftriaxone to every newborn. Azithromycin eye drops are being considered as an alternative.
AREAS COVERED
This article discusses 1% azithromycin eye drops as an alternative to 0.5% erythromycin ophthalmic ointment. Clinical experience, side effects, resistance, logistics, pharmacokinetics, and pharmacodynamics are considered.
EXPERT OPINION
Azithromycin eye drops are not an appropriate alternative to 0.5% erythromycin ophthalmic ointment for ocular prophylaxis. Prenatal screening and treatment of pregnant women is the most effective way to prevent neonatal ophthalmia. Mandates for universal prophylaxis should be withdrawn to avoid unnecessary medication administration, healthcare costs, and potential harm.
Topics: Humans; Azithromycin; Ophthalmic Solutions; Anti-Bacterial Agents; United States; Gonorrhea; Infant, Newborn; Female; Ophthalmia Neonatorum; Pregnancy; Erythromycin; Antibiotic Prophylaxis; Neisseria gonorrhoeae
PubMed: 38781483
DOI: 10.1080/14787210.2024.2359725 -
Italian Journal of Dermatology and... May 2024
PubMed: 38780908
DOI: 10.23736/S2784-8671.24.07726-0 -
International Journal of Medicinal... 2024Podaxis pistillaris, an abundant gasteroid mushroom, has become an important biological element in arid and semiarid communities worldwide. This mushroom possesses... (Review)
Review
Podaxis pistillaris, an abundant gasteroid mushroom, has become an important biological element in arid and semiarid communities worldwide. This mushroom possesses cosmetic, edible, and medicinal attributes, playing a crucial role in communities in countries such as Australia, India, Saudi Arabia, Yemen, and Mexico. Proximate studies highlight the nutritional richness of P. pistillaris, characterized by high protein content and essential bioelements such as K, P, and Mg. Furthermore, P. pistillaris is integral to the traditional medicine of indigenous communities in America, Asia, and Africa, where it is revered for its purported wound-healing, anti-inflammatory, and coagulant properties. In the case of Mexico, the Seri community uses and markets P. pistillaris in various forms, including ointments and, within the region, its spores. Chemical analysis of this species reveals notable compounds, including epicorazines A-C exhibiting antimicrobial properties, along with polysaccharides such as β-glucans, and a recently identified ergosterol derivative named podaxisterol. Despite its importance, the chemical characterization and assessment of the biological activity of its compounds have been largely understudied. Consequently, there are currently no wound-healing products on the market derived from fungi, as the majority originate from plant sources. This work aims to present the essential aspects of P. pistillaris's ethnobiological use, medicinal properties, bioactive compounds, and biotechnological applications. In addition, it underscores the overlooked status of P. pistillaris among fungi inhabiting arid areas, emphasizing its potential as a valuable subject for further research.
Topics: Medicine, Traditional; Humans; Desert Climate
PubMed: 38780419
DOI: 10.1615/IntJMedMushrooms.2024052892 -
Journal of Multidisciplinary Healthcare 2024This study aimed to investigate the maintenance effect of two puncture methods using non-coring needles in children with totally implantable venous access device (TIVAD).
PURPOSE
This study aimed to investigate the maintenance effect of two puncture methods using non-coring needles in children with totally implantable venous access device (TIVAD).
METHODS
The 110 children who received TIVAD implantation for short bowel syndrome and solid tumors in our department from 2021.12 to 2022.12 were selected as the study subjects. Blinded method was used and divided into experimental group and control group according to random number table The experimental group underwent painless surround puncture method to place the needles and compound lidocaine ointment for topical anesthesia, while the control group underwent traditional puncture method to complete this operation. The effects of the two puncture methods on pain, catheter seal fluid volume, and catheter occlusion rate were evaluated using the Facial Pain Scale Revised, Behavioral Assessment Scale, and in vitro digital subtraction angiography test.
RESULTS
In the control group, the degree of puncture pain was mild in 5 patients, moderate in 19 patients, and severe in 28 patients; the amount of catheter sealing solution was 9.32 ± 1.32 mL, and the catheter occlusion rate was 25.00%. In the experimental group, the degree of puncture pain was mild in 16 patients, moderate in 22 patients, and severe in 16 patients; the amount of sealing solution was 7.66 ± 1.08 mL, and the blocking rate was 9.26%. The total pain score in the experimental group was lower than that in the control group (5.23±6.17 VS 7.89±2.38). The difference between the two groups had statistical significance < 0.05).
CONCLUSION
The use of the painless surround puncture method can effectively reduce the pain experienced by children during puncture, decrease the volume of catheter sealing fluid, reduce the rate of catheter blockage, provide a valuable basis for enhancing the maintenance effect of TIVAD in clinical practice for children.
PubMed: 38774624
DOI: 10.2147/JMDH.S459786 -
Regional Anesthesia and Pain Medicine Jun 2024A vaginal delivery may be associated with acute postpartum pain, particularly after perineal trauma. However, pain management in this setting remains poorly explored. (Review)
Review
BACKGROUND
A vaginal delivery may be associated with acute postpartum pain, particularly after perineal trauma. However, pain management in this setting remains poorly explored.
OBJECTIVE
The aim of this systematic review was to evaluate the literature and to develop recommendations for pain management after a vaginal delivery with perineal trauma.
EVIDENCE REVIEW
MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and systematic reviews assessing pain after a vaginal delivery with perineal tears or episiotomy until March 2023. Cochrane Covidence quality assessment generic tool and the RoB Vis 2 tool were used to grade the quality of evidence.
FINDINGS
Overall, 79 studies (69 RCTs and 10 systematic reviews and meta-analyses) of good quality of evidence were included. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment. Epidural morphine (≤2 mg) is recommended among women with labor epidural analgesia and severe perineal tears, with adequate respiratory monitoring. Local anesthetic infiltration, topical local anesthetic, ointment application, and pudendal nerve block are not recommended due to insufficient or lack of evidence. Ice or chemical cold packs are recommended for postpartum pain first-line treatment due to their simplicity of use. Transcutaneous nerve stimulation and acupuncture are recommended as adjuvants. When a perineal suture is indicated, a continuous suture compared with an interrupted suture for the repair of episiotomy or second-degree perineal tears is recommended for the outcome of pain. For women with first-degree or second-degree perineal tears, no suturing or glue compared with suturing is recommended for the outcome of pain.
CONCLUSIONS
Postpartum pain management after a vaginal delivery with perineal trauma should include acetaminophen, NSAIDs, and ice or chemical cold packs. Epidural morphine should be reserved for severe perineal tears. A surgical repair technique should depend on perineal tear severity.
PubMed: 38772634
DOI: 10.1136/rapm-2024-105478 -
Journal of the American Academy of... May 2024
JAAD Game Changers: "An investigator-initiated, double-blind, vehicle-controlled pilot study: Assessment for tachyphylaxis to topically occluded halobetasol 0.05% ointment in the treatment of psoriasis".
PubMed: 38768861
DOI: 10.1016/j.jaad.2024.05.033 -
International Journal of Pharmaceutical... 2024Pyometra is a common disease in intact female canines characterized by an infection of the uterus. If it is not treated immediately, it could result in various...
Pyometra is a common disease in intact female canines characterized by an infection of the uterus. If it is not treated immediately, it could result in various complications such as fistulous tract development, sepsis, hemorrhage, uveitis, conjunctivitis, pyelonephritis, urinary tract infection, and myocarditis. In this case report, we highlight the benefits of the application of a topical ointment on wound healing after ovariohysterectomy in canine Pyometra. Following surgical intervention, the dog developed necrosis in her nipples and lost a portion of her mammary tissues. A large cyst formed and later ruptured, leaving the animal with a large wound. The vet applied a topical ointment, AlpaWash, to the affected area and prescribed antibiotic, analgesic, and antiinflammatory drugs to help manage the condition. The vet reported complete healing of the wounds within one month from the commencement of the treatment regimen.
Topics: Animals; Female; Dogs; Pyometra; Wound Healing; Hysterectomy; Dog Diseases; Ovariectomy; Ointments; Surgical Wound
PubMed: 38768506
DOI: No ID Found