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BMJ Open Apr 2024Hand-foot syndrome, also known as palmar-plantar erythrodysesthesia (PPE), is a complication caused by chemotherapy. Clinically, it manifests as erythema and oedema on...
INTRODUCTION
Hand-foot syndrome, also known as palmar-plantar erythrodysesthesia (PPE), is a complication caused by chemotherapy. Clinically, it manifests as erythema and oedema on the palms of the hands and feet, dry and scaly skin, accompanied by a sensation of tightness and pain. Extreme cases have blisters and ulcerations that may require hospitalisation and/or pause in cancer treatment. It can also be accompanied by paraesthesia. Considering the characteristics, photobiomodulation (PBM) may reduce the PPE effects. The objective of this protocol will be to evaluate the efficacy of PBM in reducing PPE induced by capecitabine and 5-fluorouracil chemotherapy.
METHODS AND ANALYSIS
This will be a randomised controlled, double-blind, double-centre clinical trial (Centro Asistencial del Sindicato Médico del Uruguay and Instituto Nacional del Cáncer from Uruguay). The sample population (40 individuals) will be divided into two groups: group 1 will receive moisturising cream plus PBM treatment and group 2 moisturising cream plus PBM sham treatment, at the ratio of 1:1. PBM will be performed at 630 nm two times per week in palmoplantar areas of the hands and feet (4 J/cm), for 4 weeks. The PPE degree and the data referring to the chemotherapy treatment plan will be measured, prior to the start of treatment in the middle and at the end of it. Quality of life questionnaires will be applied at the beginning of the trial and at the end of treatment. The data will be analysed based on the intention-to-treat analysis and α<0.05 will be considered statistically significant.
ETHICS AND DISSEMINATION
The protocol was approved by the Research Ethics Committee of Universidad Católica del Uruguay (220316b), of Centro Asistencial del Sindicato Médico del Uruguay (221989) and of Instituto Nacional del Cáncer (2023-04). The recruitment has already started (March 2023).
PROTOCOL VERSION
V.2, 27 October 2023.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov Registry (NCT05337423).
Topics: Humans; Double-Blind Method; Hand-Foot Syndrome; Low-Level Light Therapy; Randomized Controlled Trials as Topic; Fluorouracil; Quality of Life; Capecitabine; Multicenter Studies as Topic
PubMed: 38657999
DOI: 10.1136/bmjopen-2023-081459 -
The Journal of International Medical... Apr 2024Psoriasis is a chronic inflammatory skin disease. It is associated with many autoimmune diseases such as rheumatoid arthritis, Crohn's disease and thyroid diseases....
Psoriasis is a chronic inflammatory skin disease. It is associated with many autoimmune diseases such as rheumatoid arthritis, Crohn's disease and thyroid diseases. Graves' disease (GD) is a common organ-specific autoimmune disease characterized by diffuse goitre and thyrotoxicosis. Management of psoriasis patients with GD is challenging. This current report presents the case of a 34-year-old female patient with refractory psoriasis with GD who was hospitalized for drug eruption and then experienced new-onset erythema and scaling following treatment with adalimumab and secukinumab. Despite the sequential move to phototherapy, tofacitinib and ustekinumab, the erythema and scaling continued unabated and exacerbated. Finally, switching to guselkumab resulted in the psoriasis lesions significantly improving. These findings suggest that guselkumab might be an effective treatment option for refractory psoriasis combined with GD.
Topics: Humans; Psoriasis; Female; Adult; Graves Disease; Antibodies, Monoclonal, Humanized; Treatment Outcome
PubMed: 38656269
DOI: 10.1177/03000605241239856 -
Cureus Mar 2024Both the skin and neuronal systems originate from the ectoderm. In patients hospitalized for neurosurgery, their skin may be affected by genetic and environmental...
BACKGROUND
Both the skin and neuronal systems originate from the ectoderm. In patients hospitalized for neurosurgery, their skin may be affected by genetic and environmental factors.
OBJECTIVE
This study researched disease relationships by evaluating the profile of hospitalized neurosurgery patients who consulted with dermatology in a tertiary clinic (Neurosurgery Clinic, Ankara Training and Research Hospital, Ankara).
METHODS
This study included hospitalized neurosurgery patients who consulted with dermatology. Age, gender, type of hospitalization, neurosurgical diseases, and dermatology diseases were selected as study variables. The medical health records of the patients were retrospectively scanned and analyzed.
RESULTS
A total of 172 consultations were analyzed. The mean age of patients was 44.7 years old ranging from 1 year to 99 years old. The percentage of male patients was 54.7%; 25.5% of the patients were hospitalized for cerebral vascular diseases, 30.2% for spinal diseases, 22.1% for tumors, 12.2% for infections, and 1.2% for other neurosurgical diseases. The most commonly diagnosed dermatological disease in patients was drug eruptions (18.6%), followed by seborrheic dermatitis (16.2%) and contact dermatitis (14.5%).
CONCLUSION
According to this study, the most commonly diagnosed dermatological diseases in neurosurgery inpatients were drug eruption, contact dermatitis, and seborrheic dermatitis. The results of this study may be helpful in terms of neurosurgical training planning and treatment management.
PubMed: 38646246
DOI: 10.7759/cureus.56633 -
JAAD Case Reports May 2024
PubMed: 38645799
DOI: 10.1016/j.jdcr.2024.03.006 -
Acta Dermato-venereologica Apr 2024
Topics: Humans; Drug Eruptions; Antibodies, Monoclonal, Humanized
PubMed: 38643361
DOI: 10.2340/actadv.v104.37804 -
Clinical Immunology (Orlando, Fla.) Jun 2024As the number of vaccinated individuals has increased, there have been increasing reports of cutaneous hypersensitivity reactions. The main COVID-19 vaccines... (Review)
Review
As the number of vaccinated individuals has increased, there have been increasing reports of cutaneous hypersensitivity reactions. The main COVID-19 vaccines administered include messenger ribonucleic acid vaccines, non-replicating viral vector vaccines, inactivated whole-virus vaccines, and protein-based vaccines. These vaccines contain active components such as polyethylene glycol, polysorbate 80, aluminum, tromethamine, and disodium edetate dihydrate. Recent advances in understanding the coordination of inflammatory responses by specific subsets of lymphocytes have led to a new classification based on immune response patterns. We categorize these responses into four patterns: T helper (Th)1-, Th2-, Th17/22-, and Treg-polarized cutaneous inflammation after stimulation of COVID-19 vaccines. Although the association between COVID-19 vaccination and these cutaneous adverse reactions remains controversial, the occurrence of rare dermatoses and their short intervals suggest a possible relationship. Despite the potential adverse reactions, the administration of COVID-19 vaccines is crucial in the ongoing battle against severe acute respiratory syndrome coronavirus 2.
Topics: Humans; COVID-19 Vaccines; SARS-CoV-2; COVID-19; Drug Eruptions
PubMed: 38642783
DOI: 10.1016/j.clim.2024.110220 -
The Journal of International Medical... Apr 2024Pregabalin is the first-line treatment for neuropathic pain. Cases of cutaneous hypersensitivity reactions caused by pregabalin generally occur within 2 weeks of...
Pregabalin is the first-line treatment for neuropathic pain. Cases of cutaneous hypersensitivity reactions caused by pregabalin generally occur within 2 weeks of initiating medication. We report a rare case of a delayed cutaneous hypersensitivity reaction caused by pregabalin, which was confirmed by a drug provocation test. A 72-year-old man with severe herpes zoster neuralgia developed maculopapular drug eruption covering 80% to 90% of his total body surface area after 40 days of combined multidrug analgesia. A drug provocation test for pregabalin was positive. The time interval between initiating medication and the onset of the patient's rash was the longest and he also had the largest area of skin affected compared with patients with a similar condition in previous related reports. Remaining vigilant for possible adverse cutaneous hypersensitivity reactions during treatment is important because of the long-term course of pregabalin treatment for neuropathic pain.
Topics: Male; Humans; Aged; Pregabalin; Analgesics; Skin; Neuralgia; Administration, Cutaneous; Dermatitis, Atopic
PubMed: 38635889
DOI: 10.1177/03000605241245004 -
JAAD Case Reports May 2024
PubMed: 38633887
DOI: 10.1016/j.jdcr.2024.02.025 -
Journal of Cardiothoracic Surgery Apr 2024Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome is a severe adverse drug reaction marked by delayed hypersensitivity reactions causing skin and...
BACKGROUND
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome is a severe adverse drug reaction marked by delayed hypersensitivity reactions causing skin and systemic complications. DRESS diagnosis is challenging due to the variety of clinical presentations and symptom overlap with other conditions. The perioperative period in these patients requires precise pharmacological strategies to prevent complications associated with this syndrome. The treatment of DRESS induced by unfractionated heparin during cardiopulmonary bypass (CPB) surgery presents some challenges that must be considered when selecting an anticoagulant to avoid side effects. In this case, bivalirudin, a direct thrombin inhibitor, is indicated as an alternative to heparin in patients undergoing CPB. However, in contrast to heparin/protamine, there is no direct reversal agent for bivalirudin.
CASE PRESENTATION
We report the case of an 11-year-old male diagnosed with native aortic valve endocarditis and thrombosis in his left lower extremity. During valvular replacement surgery, systemic unfractionated heparin was administered. Postoperatively, the patient developed fever, eosinophilia and pruritic rash. Warm shock and elevated alanine transaminase (ALT) and aspartate transaminase (AST) levels followed, leading to the diagnosis of DRESS syndrome. Treatment with methylprednisolone resulted in complete resolution of symptoms. Seven years later, the patient was readmitted due to insufficient anticoagulation and a thrombus in the prosthetic aortic valve, presenting a recurrent DRESS episode due to the administration of unfractionated heparin, which was later replaced with low-molecular-weight heparin during hospitalization. Treatment with corticosteroids and antihistamines was initiated, resulting in the resolution of this episode. Ultimately, the patient required the Ross procedure. During this intervention the anticoagulation strategy was modified, unfractionated heparin was replaced with bivalirudin during the procedure and fondaparinux was administered during the postoperative period. This resulted in stable transaminases levels and no eosinophilia.
CONCLUSION
The severity of DRESS Syndrome underscores the importance of early recognition, heightened monitoring, and a comprehensive approach tailored to each patient's needs. This particular case highlights the significance of this approach and may have a substantial clinical impact since it provides alternatives to heparin, such as bivalirudin and fondaparinux, in the anticoagulation strategy of CPB for patients who have a hypersensibility reaction to this medication; thus, enhancing clinical outcomes by minimizing risks linked to adverse drug reactions.
Topics: Male; Humans; Child; Heparin; Fondaparinux; Drug Hypersensitivity Syndrome; Anticoagulants; Hirudins; Eosinophilia; Peptide Fragments; Anesthetics; Recombinant Proteins
PubMed: 38632589
DOI: 10.1186/s13019-024-02722-x