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Drugs in Context 2019Nail toxicities, such as paronychia and pyogenic granuloma-like lesions, are well-recognized side effects of epidermal growth factor receptor inhibitor (EGFR-I) therapy... (Review)
Review
Nail toxicities, such as paronychia and pyogenic granuloma-like lesions, are well-recognized side effects of epidermal growth factor receptor inhibitor (EGFR-I) therapy that can significantly impair patient's quality of life and compliance to anticancer treatment. Numerous therapeutic options are available, with variable rates of success. Recently, topical β-blockers have emerged as a novel, non-invasive treatment strategy. We tested the effectiveness of topical timolol 0.5% gel, twice daily, under occlusion for 30 days, on paronychia and periungual pyogenic granuloma-like lesions in 9 patients being treated with EGFR-I. We also reviewed the available literature on this topic, which is the use of topical β-blockers in the management of EGFR-I-induced nail toxicities. We assessed 25 lesions consistent with the diagnosis of EGFR-I-induced pyogenic granuloma-like lesions and paronychia (21 diagnosed as pyogenic granuloma-like, and four as paronychia). Thirteen of the 25 lesions achieved complete resolution, 9/25 reached at least improvement, and only 3/25 did not respond to the intervention. As for the review, four papers met the scope of our research. The results confirmed at least partial benefit in the majority of treated patients. Among current strategies, high-potency topical corticosteroids are a well-known treatment option especially for paronychia, targeting the inflammatory component of such lesions; nevertheless, the management of pyogenic granuloma-like lesion is often more complex and the success rate is variable. Nail plate avulsion and phenol chemical matricectomy are not highly effective and display some degree of invasiveness. Topical β-blockers seem to be promising alternatives, especially in fragile cancer patients who may be unsuitable candidates for an invasive procedure.
PubMed: 31798664
DOI: 10.7573/dic.212613 -
Current Oncology (Toronto, Ont.) Apr 2015Targeting the epidermal growth factor receptor (egfr) pathway has become standard practice for the treatment of advanced non-small-cell lung cancer. Compared with... (Review)
Review
Targeting the epidermal growth factor receptor (egfr) pathway has become standard practice for the treatment of advanced non-small-cell lung cancer. Compared with chemotherapy, egfr tyrosine kinase inhibitors (tkis) have been associated with improved efficacy in patients with an EGFR mutation. Together with the increase in efficacy comes an adverse event (ae) profile different from that of chemotherapy. That profile includes three of the most commonly occurring dermatologic aes: acneiform rash, stomatitis, and paronychia. Currently, no randomized clinical trials have evaluated the treatments for the dermatologic aes that patients experience when taking egfr tkis. Based on the expert opinion of the authors, some basic strategies have been developed to manage those key dermatologic aes. Those strategies have the potential to improve patient quality of life and compliance and to prevent inappropriate dose reductions.
PubMed: 25908911
DOI: 10.3747/co.22.2430 -
Dermatology Online Journal Jul 2009Patients affected by pemphigus vulgaris will occasionally present with associated and characteristic nail changes. This manuscript was prepared as a review of this... (Review)
Review
Patients affected by pemphigus vulgaris will occasionally present with associated and characteristic nail changes. This manuscript was prepared as a review of this unique presentation of pemphigus. Articles describing pemphigus vulgaris of the nail were compiled and reviewed and pertinent information was extracted to provide a concise analysis. The literature on this topic is still maturing. Publications to date suggest the incidence of nail and periungal involvement may correlate with the severity of mucocutaneous symptoms and the duration of the disease. The most common nail manifestations reported were acute or chronic paronychia and onychomadesis, and involvement of the fingernails. The nail changes may precede or develop concurrently with the mucocutaneous presentation. The diagnosis can be made by histologic identification and/or by the presence of IgG and C3 with direct immunoflourescence testing. Systemic treatment is required and highly effective; it includes a tailored combination of anti-inflammatory medications, immunosuppressive agents, and/or immunomodulatory treatments. This review aims to provide a better understanding of pemphigus vulgaris nail changes and guidance for clinical treatment. Unknown etiologies, predisposing factors, discrepancies evident in the literature, and limited research warrant further investigation of pemphigus vulgaris of the nail.
Topics: Adult; Anti-Inflammatory Agents; Candidiasis, Cutaneous; Diagnosis, Differential; Female; Fluorescent Antibody Technique, Direct; Humans; Immunologic Factors; Immunosuppressive Agents; Male; Middle Aged; Nail Diseases; Paronychia; Pemphigus; Prognosis; Staphylococcal Infections
PubMed: 19903430
DOI: No ID Found -
Medicine Oct 2022The development of targeted therapy has improved treatment outcomes for patients with non-small cell lung cancer (NSCLC). However, paronychia, a common adverse effect of...
The development of targeted therapy has improved treatment outcomes for patients with non-small cell lung cancer (NSCLC). However, paronychia, a common adverse effect of targeted therapy, remains burdensome. Although conservative treatments for paronychia have been well reported in the literature, studies on the efficacy of surgical partial matricectomy for paronychia, are scarce. This study aimed to evaluate the effect of surgical partial matricectomy in targeted therapy-induced paronychia in patients with NSCLC. This retrospective cohort study included 11 patients with a total of 18 lesions on the big toes. Data on lung cancer stages, types and duration of targeted therapy, onset of paronychia, pain scale scores, conservative treatments, course of matricectomy, paronychia-free interval after matricectomy, and wound condition were collected from medical records. The Wilcoxon signed-rank test was used for analysis. The mean pain scale score after matricectomy was significantly lower than that after conservative treatments (1.00 ± 0.00 vs 2.94 ± 0.87; P < .001) and before treatment (1.00 ± 0.00 vs 3.06 ± 0.80; P < .001). The mean duration of matricectomy was significantly shorter than that of conservative treatments (3.22 ± 1.00 vs 56.56 ± 52.29 weeks; P < .001). Surgical partial matricectomy is an effective and enduring intervention for targeted therapy-related paronychia. It provides a shorter course of treatment, reduced pain, and improved appearance of the healed wound. Furthermore, surgical partial matricectomy could result in a better quality of life during targeted therapy than that of conservative treatments.
Topics: Humans; Retrospective Studies; Carcinoma, Non-Small-Cell Lung; Quality of Life; Lung Neoplasms; Paronychia; Pain
PubMed: 36281135
DOI: 10.1097/MD.0000000000031208 -
Skin Appendage Disorders Nov 2022Paronychia is the most common hand infection. Prior paronychia studies were limited by small patient numbers. We conducted a national-level analysis over two decades,...
INTRODUCTION
Paronychia is the most common hand infection. Prior paronychia studies were limited by small patient numbers. We conducted a national-level analysis over two decades, analyzing demographics, etiologies, and trends in paronychia cases.
METHODS
We conducted a retrospective analysis of paronychia cases in the 1999-2018 National Electronic Injury Surveillance System database. Sex, race, age, and cause were recorded and compared using χ, ANOVA, and tests. Multivariable linear regression analysis assessed changes in age, weight, and sex over time.
RESULTS
We analyzed a total of 2,512 cases, with an average age of 27.6 ± 20.6 years, 45.5% females, and 25.6% white and 28.6% black patients. In multivariable linear regression, both age and weight significantly increased over time. Manicuring was the most common etiology (30.9%), increasing in incidence over time and with a higher frequency in adults ( < 0.0001) and females ( < 0.0001). There was a significant decrease in pediatric paronychia cases over time, particularly in 0- to 4-year-olds. Possible limitations include missed paronychia cases or additional non-paronychia cases due to improper coding, infrequent race reporting, and inability to analyze treatments or distinguish between paronychia subtypes.
CONCLUSIONS
Paronychia cases were associated with increased age and weight over time with different presentations by age. Manicuring represents the largest growing paronychia etiology.
PubMed: 36407642
DOI: 10.1159/000525032 -
Skin Therapy Letter Jan 2011Epidermal growth factor receptor (EGFR) inhibitors are an increasingly important treatment option for metastasized cancer in patients. In addition to the pivotal role of... (Review)
Review
Epidermal growth factor receptor (EGFR) inhibitors are an increasingly important treatment option for metastasized cancer in patients. In addition to the pivotal role of EGFR in the development and progression of malignant tumors, EGFR is also important for proliferation and differentiation of the human epidermis and hair follicles. As a consequence, cutaneous side-effects are frequently observed during cancer therapy with EGFR inhibitors. During the first few weeks of treatment, acneiform eruptions are the earliest common side-effect. Xerosis and fissures are complications appearing in later treatment phases. Paronychia and alterations in hair growth are less common and generally seen after a longer period of treatment. We present an overview of the various cutaneous side-effects associated with EGFR inhibition and discuss their respective therapeutic options.
Topics: Acneiform Eruptions; Administration, Oral; Adrenal Cortex Hormones; Anti-Infective Agents, Local; Cephalosporins; ErbB Receptors; Fluoroquinolones; Humans; Hyperpigmentation; Neoplasms; Paronychia; Protein Kinase Inhibitors; Retinoids; Telangiectasis
PubMed: 21293833
DOI: No ID Found -
Cureus Sep 2023Background and objective Nail disorders encompass a wide spectrum of conditions, spanning congenital, developmental, infectious, neoplastic, degenerative,...
Background and objective Nail disorders encompass a wide spectrum of conditions, spanning congenital, developmental, infectious, neoplastic, degenerative, dermatological, and systemic diseases. A comprehensive exploration of their clinical manifestations, incidence, and associations is crucial for precise diagnosis and effective management. Methods This observational cross-sectional study conducted at B.J. Medical College and Civil Hospital, Ahmedabad involved 300 consecutive patients with nail changes from July 2017 to June 2019 reporting diverse dermatological and systemic conditions. The inclusion criteria involved patients of both genders and all age groups displaying nail changes associated with dermatological and systemic diseases. Data collection entailed a comprehensive clinical history, systemic and dermatological examinations, nail assessment using Dermoscope (DermLite 3, 10x), and supplementary tests. Analyses were performed on Microsoft Excel 2007 software. The study was approved by the Institute Ethics Committee. Results Among the 300 cases, females had a higher prevalence of nail involvement (57%), with a female-to-male ratio of 1.3:1. The most affected age group was 21-40 years, with 6-10 nails typically affected. Notably, housewives showed a higher prevalence. The most frequent nail condition was onychomycosis (24.33%) followed by psoriatic nail changes (20%). Less frequent nail changes involved eczema (5.7%), paronychia (5%), drug-induced (4.3%), lichen planus (3.7%), trauma-induced (3%), twenty nail dystrophy (2.33%), Darier's disease (2%), pemphigus vulgaris (2%), alopecia areata (1.67%), median Heller dystrophy (1.33%), atopic dermatitis (1%), epidermolysis bullosa (1%), racquet nail (1%), leprosy (1%), pityriasis rubra pilaris (0.67%), vitiligo (0.67%), secondary syphilis (0.67%), pachyonychia congenita (0.67%), as well as a case each of total leukonychia, subungual warts, Koenen tumor, and periungual fibroma(0.33%). Systemic autoimmune connective tissue disorders (CTD) accounted for 9%; the most common nail finding observed was nail fold erythema (48.1%) followed by nail fold telangiectasis (44.4%). In systemic sclerosis (SS), the most common finding was nail fold telangiectasia, and in systemic lupus erythematosus (SLE), the most common was nail fold erythema. Scleroderma capillary pattern on nail fold capillaroscopy was found in seven patients with SS, two patients with dermatomyositis, and only one patient with SLE. Nail changes observed in systemic diseases include onychomycosis in diabetes mellitus and chronic renal failure patients, splinter hemorrhages in ischemic heart disease and hypertension, longitudinal melanonychia in HIV, and koilonychia and platynychia in iron deficiency anemia. Other systemic diseases, such as Addison's disease and renal failure, also exhibited various nail changes. Conclusions Beyond their cosmetic importance, nails hold a vital pathologic role. Proficiency in nail terminology and classification is key for skillful evaluation. Understanding normal and abnormal nail variants, along with their disease associations, benefits diagnosis and tailored management. Nails, often overlooked but accessible, serve as a window into patients' general health and should be an integral part of thorough examinations. This study highlights an intricate clinical panorama of nail disorders, highlighting their significant role in both dermatological and systemic contexts.
PubMed: 37701161
DOI: 10.7759/cureus.45007 -
Investigational New Drugs Feb 2023Potential novel strategies for adverse event (AE) management of osimertinib therapy, including therapeutic drug monitoring and the use of biomarkers, have not yet been... (Observational Study)
Observational Study
Population Pharmacokinetics, Pharmacogenomics, and Adverse Events of Osimertinib and its Two Active Metabolites, AZ5104 and AZ7550, in Japanese Patients with Advanced Non-small Cell Lung Cancer: a Prospective Observational Study.
BACKGROUND
Potential novel strategies for adverse event (AE) management of osimertinib therapy, including therapeutic drug monitoring and the use of biomarkers, have not yet been fully investigated. This study aimed to evaluate (1) the relationship between exposure to osimertinib, especially its active metabolites (AZ5104 and AZ7550), and AEs, and (2) the relationship between germline polymorphisms and AEs.
METHODS
We conducted a prospective, longitudinal observational study of 53 patients with advanced non-small cell lung cancer receiving osimertinib therapy from February 2019 to April 2022. A population pharmacokinetic model was developed to estimate the area under the serum concentration-time curve from 0 to 24 h (AUC) of osimertinib and its metabolites. Germline polymorphisms were analyzed using TaqMan® SNP genotyping and CycleavePCR® assays.
RESULTS
There was a significant association between the AUC of AZ7550 and grade ≥ 2 paronychia (p = 0.043) or anorexia (p = 0.011) and between that of osimertinib or AZ5104 and grade ≥ 2 diarrhea (p = 0.026 and p = 0.049, respectively). Furthermore, the AUC of AZ5104 was significantly associated with any grade ≥ 2 AEs (p = 0.046). EGFR rs2293348 and rs4947492 were associated with severe AEs (p = 0.019 and p = 0.050, respectively), and ABCG2 rs2231137 and ABCB1 rs1128503 were associated with grade ≥ 2 AEs (p = 0.008 and p = 0.038, respectively).
CONCLUSION
Higher exposures to osimertinib, AZ5104, and AZ7550 and polymorphisms in EGFR, ABCG2, and ABCB1 were related to higher severity of AEs; therefore, monitoring these may be beneficial for osimertinib AE management.
Topics: Humans; Aniline Compounds; Carcinoma, Non-Small-Cell Lung; East Asian People; ErbB Receptors; Lung Neoplasms; Mutation; Pharmacogenetics; Prospective Studies; Protein Kinase Inhibitors; ATP Binding Cassette Transporter, Subfamily B, Member 2; ATP Binding Cassette Transporter, Subfamily B
PubMed: 36637703
DOI: 10.1007/s10637-023-01328-9 -
Dermatology Online Journal Jan 2021Paronychia is usually caused by bacterial infections. Herpetic whitlow is an acute infection of the fingers or toes caused by herpes simplex viruses and it typically...
Paronychia is usually caused by bacterial infections. Herpetic whitlow is an acute infection of the fingers or toes caused by herpes simplex viruses and it typically presents with vesicles. We report the case of a 78-year-old woman with gingivostomatitis and atypical paronychia in several fingers without blisters.
Topics: Aged; Antiviral Agents; Female; Fingers; Gingivitis; Hand Dermatoses; Herpes Simplex; Humans; Paronychia; Stomatitis; Valacyclovir
PubMed: 33560799
DOI: No ID Found -
Frontiers in Cellular and Infection... 2021The commensal microbiome influences skin immunity, but its function in toenail health remains unclear. Paronychia is one of the most common inflammatory toenail...
The commensal microbiome influences skin immunity, but its function in toenail health remains unclear. Paronychia is one of the most common inflammatory toenail diseases, but antibiotic treatment is seldom effective in clinical cases. In this study, we performed sequencing to investigate the characteristics of microbes associated with paronychia in order to identify the key microorganisms involved in inflammation. Seventy dermic samples were collected from patients with paronychia and the differences in dermic microbiota were analyzed in patients with different inflammation severities. Distinct clustering of dermal microbiota was observed in the dermis with different inflammation severities. A higher relative abundance of anaerobic microorganisms such as , , and was observed in severe paronychia, whereas disappeared with disease progression. Co-occurring network analysis suggested that the disturbance of the dermic microbiome and attenuation of antagonism by against anaerobic pathogens may aggravate inflammation in paronychia. Functional analysis showed that dermic microbiome disturbance may worsen microbial metabolism and tissue repair in the skin. In conclusion, we revealed that an increased abundance of anaerobic microorganisms and loss of in the dermis may promote paronychia progression and microbiological imbalance may aggravate inflammation in patients with paronychia.
Topics: Humans; Inflammation; Microbiota; Nails; Paronychia; RNA, Ribosomal, 16S
PubMed: 34926325
DOI: 10.3389/fcimb.2021.781927