RESUMEN
PURPOSE: Common side effects of taxane chemotherapy are nail toxicity and peripheral neuropathy (CIPN) causing severe impact on the quality of life. Different methods of cryotherapy to prevent these side effects have been tested. We investigated the use of machine-controlled cooling of hands and feet to reduce nail toxicity and CIPN in patients receiving taxane chemotherapy. METHODS: Patients receiving Docetaxel (planned dose ≥ 300 mg/m2) or Paclitaxel (planned dose ≥ 720 mg/m2 - ) in the adjuvant or palliative setting of different cancers were included. The dominant hand and foot were cooled to approximately 10 °C using the Hilotherapy machine. The contralateral hand and foot were used as intrapatient comparison. The primary endpoint was the occurrence of any CIPN due to paclitaxel or nail toxicity due to Docetaxel. Both the intention to treat population (ITT) and the per protocol population (PPP) were analyzed. RESULTS: A total of 69 patients, 21 treated with Docetaxel and 48 with Paclitaxel, were included at our centre between 08/2020 and 08/2022. Nail toxicity due to Docetaxel was overall not significantly improved by cooling in the ITT or PPP but a significant benefit across visits was found for the ITT. CIPN due to Paclitaxel was numerically better in the ITT and significantly better in the PPP. A significant benefit of cooling on CIPN occurrence across visits was found for the ITT and the PPP. Cooling was very well tolerated. CONCLUSION: Cooling of hands and feet has a clinically meaningful impact on reducing occurrence of CIPN and nail toxicity on treatment with taxanes. Effects are more significant over time and are dose dependent. TRIAL REGISTRATION NUMBER: 2020-00381. Date of registration. 24th February 2020.
Asunto(s)
Docetaxel , Enfermedades de la Uña , Paclitaxel , Enfermedades del Sistema Nervioso Periférico , Humanos , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Masculino , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/prevención & control , Anciano , Docetaxel/administración & dosificación , Docetaxel/efectos adversos , Paclitaxel/administración & dosificación , Paclitaxel/efectos adversos , Enfermedades de la Uña/terapia , Enfermedades de la Uña/inducido químicamente , Neoplasias/tratamiento farmacológico , Adulto , Taxoides/efectos adversos , Taxoides/administración & dosificación , Antineoplásicos/efectos adversos , Antineoplásicos/administración & dosificación , Crioterapia/métodos , Calidad de VidaRESUMEN
Pyogenic granuloma (PG) is a benign vascular neoformation, presenting as a painful red nodule on the skin, mucosa or nail apparatus. It is usually related to local complications such as bleedings and superinfections. The etiology of PG remains still unclear, and several triggers can lead to its formation. In case of multiple lesions, systemic conditions and drugs remain the main causes. Antineoplastic treatments, retinoids, antiretrovirals, hormones and anticonvulsants are frequently implicated in PG formation. In literature, PG has been rarely described in the course of biological treatment due to rheumatological disease. The present case report describes the development of polydactolous PGs in a 21-year-old woman with juvenile systemic lupus erythematosus (jSLE) during treatment with belimumab, a monoclonal antibody directed against BlyS. The clinical presentation, in particular the timing and the multiplicity of the lesions, and the improvement after belimumab discontinuation allowed us to consider PG as drug-induced. This case highlights the importance of considering PG as a potential complication of rheumatologic treatments.
Asunto(s)
Anticuerpos Monoclonales Humanizados , Granuloma Piogénico , Inmunosupresores , Humanos , Femenino , Granuloma Piogénico/inducido químicamente , Anticuerpos Monoclonales Humanizados/efectos adversos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Adulto Joven , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/tratamiento farmacológicoRESUMEN
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.
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Antineoplásicos , Síndrome Mano-Pie , Enfermedades de la Uña , Humanos , Síndrome Mano-Pie/etiología , Antineoplásicos/efectos adversos , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/patología , Enfermedades de la Uña/terapia , Guías de Práctica Clínica como Asunto , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/patología , Erupciones por Medicamentos/terapia , Neoplasias/tratamiento farmacológicoAsunto(s)
Artritis Psoriásica , Enfermedades de la Uña , Psoriasis , Humanos , Artritis Psoriásica/tratamiento farmacológico , Artritis Psoriásica/epidemiología , Artritis Psoriásica/complicaciones , Estudios Transversales , Psoriasis/tratamiento farmacológico , Psoriasis/complicaciones , Psoriasis/epidemiología , Enfermedades de la Uña/epidemiología , Enfermedades de la Uña/inducido químicamente , Masculino , Femenino , Prevalencia , Persona de Mediana Edad , Adulto , Productos Biológicos/uso terapéutico , Productos Biológicos/efectos adversos , AncianoAsunto(s)
Enfermedades de la Uña , Psoriasis , Humanos , Cuero Cabelludo/patología , Uñas/patología , Psoriasis/inducido químicamente , Psoriasis/tratamiento farmacológico , Psoriasis/patología , Anticuerpos Monoclonales Humanizados/efectos adversos , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/tratamiento farmacológicoAsunto(s)
Fumar Cigarrillos , Enfermedades de la Uña , Uñas , Humanos , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/etiología , Fumar Cigarrillos/efectos adversos , Uñas/patología , Trastornos de la Pigmentación/inducido químicamente , Trastornos de la Pigmentación/etiología , Masculino , Femenino , AdultoRESUMEN
INTRODUCTION: Terbinafine has been a cornerstone in dermatophyte infection treatment. Despite its global efficacy, the emergence of terbinafine resistance raises concerns, requiring ongoing vigilance. AREAS COVERED: This paper focuses on evaluating the efficacy and safety of terbinafine in treating dermatophyte toenail infections. Continuous and pulse therapies, with a 24-week continuous regimen and a higher dosage of 500 mg/day have demonstrated superior efficacy to the FDA approved regimen of 250 mg/day x 12 weeks. Pulse therapies, though showing comparable effectiveness, present debates with regards to their efficacy as conflicting findings have been reported. Safety concerns encompass hepatotoxicity, gastrointestinal, cutaneous, neurologic, hematologic and immune adverse-effects, and possible drug interactions, suggesting the need for ongoing monitoring. EXPERT OPINION: Terbinafine efficacy depends on dosage, duration, and resistance patterns. Continuous therapy for 24 weeks and a dosage of 500 mg/day may enhance outcomes, but safety considerations and resistance necessitate individualized approaches. Alternatives, including topical agents and alternative antifungals, are to be considered for resistant cases. Understanding the interplay between treatment parameters, adverse effects, and resistance mechanisms is critical for optimizing therapeutic efficacy while mitigating resistance risks. Patient education and adherence are vital for early detection and management of adverse effects and resistance, contributing to tailored and effective treatments.
Asunto(s)
Arthrodermataceae , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Dermatosis del Pie , Enfermedades de la Uña , Onicomicosis , Humanos , Terbinafina/efectos adversos , Onicomicosis/tratamiento farmacológico , Itraconazol/efectos adversos , Naftalenos/efectos adversos , Dermatosis del Pie/inducido químicamente , Dermatosis del Pie/tratamiento farmacológico , Antifúngicos/efectos adversos , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Dermatitis Alérgica por Contacto , Dermatitis Profesional , Enfermedades de la Uña , Humanos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Resinas Epoxi/efectos adversos , Parestesia , Dermatitis Profesional/etiología , Enfermedades de la Uña/inducido químicamente , Pruebas del ParcheAsunto(s)
Cosméticos , Dermatitis Alérgica por Contacto , Enfermedades de la Uña , Psoriasis , Humanos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/diagnóstico , Uñas , Psoriasis/diagnóstico , Psoriasis/etiología , Cosméticos/efectos adversosRESUMEN
Blue nail discoloration is a distinctive clinical presentation, and diagnosis is challenging given the broad differential diagnosis. A comprehensive review of the literature describing blue discoloration of one or multiple nails was performed using the PubMed, Embase, Scopus, and Web of Science databases. A total of 245 publications were included and grouped based on involvement of a single nail (monodactylic) or multiple nails (polydactylic). Monodactylic blue discoloration was associated with tumors or benign nevi, most commonly glomus tumors, followed by blue nevi and less commonly melanomas. Polydactylic blue discoloration was frequently associated with medications (such as minocycline, zidovudine, and hydroxyurea), toxic and exogenous exposures (such as silver), and other medical conditions (such as HIV/AIDS and systemic lupus erythematous). Patients presenting with blue nail discoloration warrant a thorough history, physical examination, and workup to rule out malignancy, systemic disease, or toxic exposure. We present diagnostic algorithms for monodactylic and polydactylic blue nail discoloration to guide workup and treatment plans.
Asunto(s)
Enfermedades de la Uña , Uñas Malformadas , Humanos , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/patología , Uñas/patología , Diagnóstico Diferencial , AlgoritmosRESUMEN
BACKGROUND: Nail changes are among the most common dermatological adverse events in paclitaxel-receiving patients. Although effective, low-temperature prophylactic cryotherapy is discomforting and a potential cause of side effects, resulting in low patients' adherence. PATIENTS AND METHODS: A phase II single-arm study evaluating mild cryotherapy for the reduction of 12-week, grade 2 nail toxicity was conducted on 67 taxane-naïve breast cancer patients (age 18-74 years) undergoing weekly adjuvant chemotherapy with paclitaxel. Instant-ice packs were fixed over the fingers and toes for a total of 70 minutes during paclitaxel infusion at a temperature between -5 °C and +5 °C. Nail toxicity was evaluated weekly (CTCAE vs 4.03), including grade 2 (ie, onycholysis, subungual hematoma, onychomadesis) and grade 1 nail toxicities. RESULTS: Twelve patients experienced grade 2 nail toxicities (17.9%, 95% confidence interval [CI] 9.6%-29.2%; median time to onset: 56 days): onycholysis was the most frequent grade 2 toxicity (13.4%), followed by subungual hematoma (9.0%) and onychomadesis (1.5%). Grade 1 toxicity occurred in 33 patients (63.5%, 95% CI 49.0%-76.4%) with nail discoloration representing by far the most frequent toxicity (59.6%). Seventeen patients (25.4%) reported no nail toxicity. 62.7% of patients reported no pain and 22.4% suffered moderate pain. No patient experienced severe pain or others adverse effects. CONCLUSIONS: Instant-ice pack is a feasible prophylactic intervention for nail toxicity, well tolerated by patients and with limited impact on routine workload. It could be considered for patients refusing (or interrupting) cryotherapy, and it can be implemented when frozen gloves management is not feasible.
Asunto(s)
Neoplasias de la Mama , Enfermedades de la Uña , Onicólisis , Adolescente , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Adulto Joven , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/inducido químicamente , Crioterapia/métodos , Hielo , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/prevención & control , Onicólisis/inducido químicamente , Onicólisis/prevención & control , PaclitaxelRESUMEN
The aim of this retrospective study of patients affected by plaque psoriasis who underwent tildrakizumab therapy was to describe and compare the response of the nail psoriasis and the plaque psoriasis elsewhere in the body. Eight patients treated with tildrakizumab, 4 males and 4 females with a mean age of 61 years affected by psoriasis (mean baseline-PASI:13) with nail involvement (mean baseline mNAPSI: 51.9), were followed for at least 20 weeks. At week 4, the mean PASI was 6.6 (49% improvement), and the mean mNAPSI was 30.8 (40.6% improvement). At week 20, the mean PASI was 2.1 (84% improvement), and the mean mNAPSI was 5.1 (90% improvement). The fast improvement of the nail psoriasis in the 8 patients was unexpected, considering the fact that Tildrakizumab is a molecule that in RCTs (reSURFACE-1 and 2) studies has proved to be efficacious against plaque psoriasis but not strikingly fast, requiring at least 20 weeks to achieve the best PASI-improvements in most patients. Evidence regarding nail improvement during tildrakizumab are scarce. Studies including a higher number of patients are required in order to confirm our observation of the fast improvement of nail psoriasis during Tildrakizumab. J Drugs Dermatol. 2022;21(8):914-916. doi:10.36849/JDD.6828.