The incidence of dermatitis following application of foam tape in healthy volunteers-A prospective trial.

BACKGROUND: Foam tape is commonly used in the emergency department as a dressing over chest tubes owing to its occlusive and compressible properties. There is a paucity of data regarding the incidence of significant cutaneous reactions to this material. We conducted a prospective trial to evaluate the incidence of dermatitis following application of foam tape to the upper arm of a cohort of healthy volunteers. METHODS: This was a prospective, interventional trial. We enrolled a cohort of consenting, healthy physicians, nurses, and ancillary staff at a teaching facility who did not have known hypersensitivity to foam tape. Study investigators applied a 2 × 2 inch piece of 3 M microfoam adhesive to the medial aspect of each subject's upper arm. The contralateral arm served as a reference for comparison. The adhesive remained in place for 48 h and the study authors assessed patients utilizing the previously validated Cutaneous Irritancy Scoring System (CISS). Categorical variables analyzed by chi-square, continuous variables with t-tests. RESULTS: There were 40 subjects in the study group; 52% female, mean age 40±7 years, 55% non-White race. 10/40 (25%; 95%CI[14%, 41%]) of subjects had erythema; 9/40 (22%) had an erythema score of 1 and 1/40 (2.5%) had a score of 2. With respect to edema, 2/40 (5%; 95% CI[1%,18%]); 1/40(2.5%) had an edema score of 1, and 1/40(2.5%) had a score of 2. There were 9/40 subjects with an irritancy score > 0; (22%; 95%CI[12%,38%]); 7/40(18%) had an irritancy score of 1, and 2/4(5.0%) had a score of 2. In terms of the severity score, 10/40 (25%; 95%CI[14%, 41%]) had a score > 0; 9/40(22%) had a score of 1, and 1/40(2.5%) had a score of 2. Overall, 10/40 (25%; 95%CI[14%, 41%]) of subjects had at least one positive measure of a reaction of any kind. Subjects' age, gender and race were not found to be statistically significantly associated with the incidence of erythema, edema, or irritancy. In addition, these characteristics were not statistically significantly associated with severity score > 0. The p values for all the above bivariate analyses were > 0.05. CONCLUSIONS: Cutaneous reactions occurred in 25% of healthy volunteers after the application of foam tape to the arm. Patient characteristics were not associated with risk of a skin reaction. CLINICAL TRIALS REGISTRATION: #NCT06059417.

Correlating facial skin parameters with age and gender in population of Shaanxi Province, China.

OBJECTIVE: This study was designed to comprehensively evaluate the changes in facial skin biophysical parameters with age, as well the influence of gender differences in populations of Shaanxi Province, China. METHODS: Fourteen skin parameters, including stratum corneum hydration (SCH), transdermal water loss (TEWL), erythema, melanin, R0, R2, R5, R7, F4, gloss, skin surface pH, skin erythema index (a*), wrinkle length, and sebum, were measured by noninvasive instruments in 481 volunteers from Shaanxi Province. Spearman correlation analysis was performed to analyze the relationship between skin parameters and age. Additionally, skin parameters were analyzed for different age groups and different genders. RESULTS: The results of the study showed a linear decrease in skin surface pH and sebum content with age, and the skin elasticity parameters R0, R2, R5, and R7 decreased significantly at the age of 54-65 years. Wrinkle length showed a linear and increase with age. R5 showed a weak negative correlation with age, R2, R7, and sebum content showed a moderate negative correlation, while wrinkle length showed a strong positive correlation. Considering the effect of gender on skin parameters, the results showed that SCH and gloss were lower in men than in women, while TEWL, erythema, melanin, wrinkle length, and sebum were higher than in women. However, there was no difference in skin elasticity between them. CONCLUSION: The facial skin parameters, especially for the wrinkle length, exhibited the strong correlation relationship with ages in Shaanxi Province. Meanwhile, most skin parameters show significant differences with gender, which can provide a reference for future research and development in the field of cosmetics.

CANTO skin: Evaluation of skin toxicity risk factors in patients treated for breast cancer.

Skin reaction is a common toxicity during oncology management, especially followed during the radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients treated for an early breast cancer (BC). We evaluated 8561 patients during their overall management for a BC. We focus on specific skin toxicities: erythema, fibrosis, telangiectasia and changes of skin colour. These toxicities were assessed at the baseline defined as 0-3-6 (M0), 12 (M12), 36 (M36) and 60 (M60) months. The prevalence of toxicities of interest varied over time, so at M0, 30.4% of patients had erythema while 17.7% of patients had fibrosis. At M60, the prevalence of erythema was 2%, while fibrosis remained stable at about 19%. After adjustments, at M0, there was a significant association between the onset of cutaneous erythema and obesity, the presence of axillary dissection, the type of surgery and the tumour phenotype RH+/HER2+. Concerning fibrosis, a significant association was found, at M12, with the age of the patient, obesity, Charlson score and type of surgery. Concerning the modification of skin colour at M12, we find a link between the age of the patient, obesity, tobacco consumption and alcohol consumption. The prevention of this toxicity is a major issue for the quality of life. Our results allow us to understand the risk of developing skin toxicity in a patient, depending on her intrinsic, tumour or therapeutic characteristics and to implement adapted means of prevention and monitoring.

Hand-foot syndrome induced by chemotherapy drug: Case series study and literature review.

INTRODUCTION: Chemotherapy drugs can be responsible of several side effects such as hand-foot syndrome (HFS). This syndrome is also called "palmar-plantar erythrodysesthesia" and "acral erythema." Without proper management, it can deteriorate the quality of life of a patient, leading to temporary or definitive stop of chemotherapy. AIM OF THIS STUDY: To identify the epidemiological and clinical characteristics of patients, the risk factors for occurrence and worsening of this syndrome, and the drugs most likely to be responsible of HFS. METHODS: Our study was retrospective, including 42 patients with HFS secondary to a chemotherapy drug. These cases were notified to the National Center of Pharmacovigilance over 7 years. The severity of HFS has been classified according to the NCI-CTCAE v4.0 classification. RESULTS: Our population was composed of 40 women and 2 men. The mean age was 51 years. Docetaxel was the main drug associated with this adverse effect. Hands were involved in all cases and were sometimes associated with other skin surfaces apart from feet. Erythema of the hands and/or feet was present in all patients; it was associated with edema in more than half of the cases. The distribution of different grades according to the NCI-CTCAE classification among the patients was almost equal: 28% Grade 1, 36% Grade 2, and 36% Grade 3. HFS occurred mainly after the first course of chemotherapy with a mean period of 3-4 days. The regression of HFS occurred more rapidly for Grade 1 and Grade 2 compared with Grade 3, especially when assisted by symptomatic treatment. The recurrence rate of HFS for those patients with decreased doses, spacing of cures, and/or symptomatic and prophylaxis treatment was 25%. CONCLUSION: An early detection of HFS, associated with preventive measures, enables patients to continue the chemotherapy.

CANTO-RT: Skin toxicities evaluation of a multicentre large prospective cohort of irradiated patients for early-stage breast cancer.

Skin damage is the most common and most important toxicity during and after radiation therapy (RT). Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients irradiated for an early breast cancer. CANTO is a prospective clinical cohort study of 10 150 patients with stage I-III BC treated from 2012 to 2017 in 26 cancer centres. In our study, we used CANTO-RT, a subcohort of CANTO, including 3480 patients who received RT. We are focus on specific skin toxicities: erythema, fibrosis, telangiectasia and cutaneous pigmentation. The prevalence of toxicities of interest varied over time, so at baseline for early toxicity Month (M) 0-3-6, 41.1% of patients had erythema while 24.8% of patients had fibrosis. At M12 and M36, the prevalence of erythema decreased, respectively, while fibrosis remains stable. The prevalence of telangiectasia increases from 1% to 7.1% from M0-3-6 to M36. After adjustments, we showed an association between the occurrence of skin erythema and obesity; the type of surgery; the presence of axillary dissection; the use of taxane-based CT and the 3D vs IMRT irradiation technique. Regarding fibrosis, an association is found, at M0-3-6, with age at diagnosis, obesity, tobacco and the use of boost. Only obesity and the type of surgery received by the patient remained statistically significant at M12 and M36. In our study we identified several risk factors for acute and late skin reactions. The use of a boost was mainly related to the occurrence of fibrosis while the use of IMRT-type technique decreased the occurrence of skin erythema.

Health risks of extended exposure to low-level UV radiation - An analysis of ground-based and satellite-derived data.

This study aims to indicate the importance of revising current health recommendations concerning the duration of exposure and individual sensitivity of the skin to solar ultraviolet (UV) radiation. For this purpose, a 16-year data series (2005-2020) of erythemal radiant exposure (Her) and UV index (UVI) for Serbia was analyzed. The UV-related risk was estimated for lighter skin (skin phototypes I-IV) under prolonged exposure on days when maximum UVI was below the recommended protection threshold (UVIlow days, for UVI < 3). Risk assessment was performed for seasonal exposure using satellite-derived data (OMUVBd product) previously validated by ground-based measurements in Novi Sad. The assessment of harmful effects included an analysis of the relation between the daily maximum UVI and the corresponding daily Her, the occurrence of UVIlow days, the exceedance of minimal erythema dose (MED), and the minimum duration of exposure to induce erythema (tMED) for all lighter skin phototypes. It was found that the share of UVIlow days in the total number of days in Serbia increases with the latitude, with the highest percentage in winter (up to 69.454%) and the lowest in summer (up to 3.468%). The results show that the daily Her frequently exceeded the harmful threshold for lighter skin phototypes I-IV (on average by 91.521, 84.923, 70.556, and 56.515%, respectively) on UVIlow days. It was found that prolonged exposure on days with a maximum of UVI = 2 poses a significant risk of erythema for all lighter skin phototypes, even for a duration of 3 h in the middle of the day, as well as medium risk for UVI = 1, and an absence of risk for UVI = 0. The results suggest that health recommendations should be revised, especially in the mid-latitudes, where the share of UVIlow days is large, and in areas where the population is predominantly lighter-skinned.

No molecular detection of tick-borne pathogens in the blood of patients with erythema migrans in Belgium.

BACKGROUND: A number of tick-borne pathogens circulate in the Belgian tick population in addition to the causative agent of Lyme borreliosis. However, so far, only a few patients with tick-borne diseases other than Lyme borreliosis have been reported in Belgium. The aim of this study was to investigate the occurrence of other human tick-borne infections in Belgium and their possible clinical manifestation. METHODS: Patients with fever (> 37.5 °C) after a tick bite or those with erythema migrans (EM) were included in the study. EDTA-blood samples were screened for the presence of DNA from Borrelia burgdorferi sensu lato, Borrelia miyamotoi, Anaplasma phagocytophilum, Neoehrlichia mikurensis, spotted fever group rickettsiae (genus Rickettsia), Babesia spp., Bartonella spp., Spiroplasma ixodetis and tick-borne encephalitis virus, using multiplex PCR methods. A questionnaire on, among others, demographics and clinical symptoms, was also filled in. RESULTS: Over a period of 3 years, 119 patients with EM and 14 patients with fever after a recent tick bite were enrolled in the study. Three samples initially tested positive for N. mikurensis by quantitative PCR (qPCR), but the results could not be confirmed by other PCR methods, and repetition of the DNA extraction procedure and qPCR test was not successful. The qPCR test results for the other tick-borne pathogens were negative. CONCLUSIONS: In general, only a few patients with fever after a tick bite could be identified. Although no tick-borne pathogens were detected, their occurrence cannot be excluded based on the limited number of patients and the limitations inherent to current methodologies. This study underscores the possibility of false-positive PCR results and the necessity for the development of multiple independent tools for the sensitive and specific detection of emerging tick-borne pathogens.

Eczema, facial erythema, and seborrheic dermatitis symptoms among young adults in China in relation to ambient air pollution, climate, and home environment.

A questionnaire survey on dermal symptoms and home environment was performed in eight Chinese cities (40 279 participants). Data on city level temperature, precipitation, PM10 , NO2, and gross domestic product (GDP) per capita were collected. In total, 2.2% had eczema, 2.4% facial erythema (FE) and 2.6% seborrheic dermatitis symptoms (SD). Higher temperature was associated with eczema (OR = 1.09). Higher GDP per capita was related to less SD. Higher PM10 was related to SD. Suburban living was protective for eczema (OR = 0.77) (vs. urban). Living in old buildings (built before 1991) was related to eczema (OR = 1.42). Living near heavily trafficked roads was related to FE (OR = 1.33) and SD (OR = 1.35). Having new furniture was related to all symptoms (OR = 1.26-1.47). Burning mosquito coils (OR = 1.37-1.57) and incense (OR = 1.33-1.37) were associated with eczema, FE, or SD. Presence of cockroaches and rats/mice was associated with FE or SD (OR = 1.31-1.40). Using air conditioner, daily cleaning and frequently exposing bedding to sunshine were protective (OR = 0.60-0.83). In conclusion, higher temperature, higher PM10 , urban living, living near heavily trafficked roads, old buildings, new furniture, burning mosquito coils and incense, and presence of cockroaches/rats/mice increased the risk of eczema, FE, or SD. Higher GDP, air conditioner, daily cleaning, and exposing bedding to sunshine were protective.

Erythema ab igne in pediatric patients remote schooling during the COVID-19 pandemic: A case series.

Erythema ab igne is an uncommon dermatosis characterized by erythematous or hyperpigmented reticular patches that appear after prolonged localized heat exposure. We present three cases of erythema ab igne in pediatric patients who presented in March and April of 2021 and share a history of space heater usage while engaging in remote schooling during the COVID-19 pandemic.

Delayed skin reaction after mRNA-1273 vaccine against SARS-CoV-2: a rare clinical reaction.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is associated with a wide clinical spectrum of skin manifestations, including urticarial, vesicular, vasculitic and chilblain-like lesions. Recently, delayed skin reactions have been reported in 1% individuals following mRNA vaccination against SARS-CoV-2. The exact pathophysiology and the risk factors still remain unclear. PATIENTS AND METHODS: 6821 employees and patients were vaccinated at our institutions between February and June 2021. Every patient received two doses of the mRNA-1273 vaccine in our hospitals, and reported back in case of any side effects which were collected in our hospital managed database. RESULTS: Eleven of 6821 vaccinated patients (0.16%) developed delayed skin reactions after either the first or second dose of the mRNA-1273 vaccine against SARS-CoV-2. Eight of 11 patients (73%) developed a rash after the first dose, while in 3/11 (27%), the rash occurred after the second dose. More females (9/11) were affected. Four of 11 patients required antihistamines, with two needing additional topical steroids. All the cutaneous manifestations resolved within 14 days. None of the skin reactions after the first dose of the vaccine prevented the administration of the second dose. There were no long-term cutaneous sequelae in any of the affected individuals. CONCLUSION: Our data suggests that skin reactions after the use of mRNA-1273 vaccine against SARS-CoV-2 are possible, but rare. Further studies need to be done to understand the pathophysiology of these lesions.

[Epidemiological profile of dermatomyositis and polymyositis: a study conducted in the Department of Rheumatology in Marrakech]. / Profil épidémiologique de la dermatomyosite et de la polymyosite: expérience du service de rhumatologie de Marrakech.

Dermatomyositis (DM) and polymyositis (PM) are rare but serious conditions. The purpose of this study was to investigate, by a review of hospital cases, their epidemiological, clinical and evolutionary profile. We conducted a retrospective study over a 15-year period, between January 2004 and December 2019. All cases with possible or definite diagnosis according to Bohan and Peter's criteria were retained. A total of 14 patients were enrolled (8 DM and 6 PM), with an average age of 48.7 years. Sex ratio was 13F/ 1H. General signs were reported in 71% of cases. Motor deficit affected the girdle muscles in 71% of cases; 85.7% of patients had arthralgia and 14% arthritis. Erythema and periorbital edema were the predominant skin signs. Patients' assessment showed increased sedimentation rate in all cases and increased muscle enzymes in 80% of cases. Antinuclear antibodies were positive in 63% of cases. Muscle biopsy objectified inflammatory myositis in 75% of cases. Heart disease was reported in 14% of cases and lung disease in 21%. Cancer was found in 21.4% of cases. All patients received corticosteroid therapy. Improvement was reported in 88% of patients, with a relapse in 4 patients. In our context, DM is more frequent than PM, with a clear female predominance. Pulmonary disease is a heavy complication. Its association with cancers occurs commonly, hence the need for a systematic cancer screening at diagnosis and follow-up.

Tolerability and Efficacy of Clindamycin/Tretinoin versus Adapalene/Benzoyl Peroxide in the Treatment of Acne Vulgaris.

Acne vulgaris is the most common dermatological disorder worldwide, causing significant physical and psychological morbidity. Topical combination therapy has shown superior efficacy compared to monotherapy, especially when combined with retinoids. Few studies have directly compared combined formulations. This evaluator-blinded pilot study compared the efficacy and tolerability of two marketed topical combination acne gels, clindamycin 1%-tretinoin 0.025% (CT) and benzoyl peroxide 2.5%-adapalene 0.1% (BA) in 20 patients with mild to moderate acne vulgaris. Gels were applied daily on opposite sides of the face for 21 days. The primary outcome was difference in transepidermal water loss (TEWL) at the end of treatment. Secondary endpoints were skin moisture content measurement, Investigators' Global Assessment, subject self-assessments (SSA) of burning/stinging, itching, erythema, and dryness/scaling, and Comparative Participant Satisfaction Questionnaire (CPSQ). Efficacy was assessed by inflammatory and non- inflammatory acne efflorescences counts. TEWL increased significantly for both CT and BA (+57.74%, P=0.002; +58.77%, P<0.001); skin moisture content significantly decreased only for BA (-16.47%, P=0.02). Only BA showed a significant increase in erythema and dryness/scaling (P=0.027 and P=0.014) and in SSA burning/stinging (P=0.04). Patient satisfaction evaluation also reflected the strong BA irritation. Although CT and BA both reduced acne lesions (P<0.001) and more patients preferred to continue with CT, subject perception of acne improvement was higher for BA. These findings suggest that CT and BA have similar efficacy in the treatment of mild to moderate papulopustular acne. However, CT was better tolerated than BA by both medical and subject evaluation. CT is an effective and tolerated treatment option.J Drugs Dermatol. 2021;20(3):295-301. doi:10.36849/JDD.2021.5641.

Oral mucosal and skin lesions observed in the first 48 hr in newborns.

BACKGROUND: Newborn period is a definition used for the first 4 weeks of life and it has some different characteristics compared with adult skin. AIMS: In this study, we tried to define the pathological and physiological skin manifestations and demographic data observed in newborns PATIENTS/METHODS: In this study, newborns born between 2018 and 2019 were evaluated prospectively. Along with demographic findings, temporary neonatal skin manifestations, congenital spots, benign neonatal pustulosis, congenital anomalies and other lesions were statistically evaluated. RESULTS: A total of 2109 newborns, consisting of 1157 (54.9%) boys and 952 (45.1%) girls, were enrolled in the study. 94% of the newborns evaluated had at least one skin lesion. The most common skin manifestations in the study were Epstein pearls at a rate of 49.4%. This was followed by salmon patch (38.4%), Mongolian spot (20.1%), edema in the eyelids (15.5%), lanugo (15.4%), and erythema toxicum neonatarum (11.6%), respectively. CONCLUSION: Several studies on dermatological findings observed in newborns have been conducted in many different countries around the world. In this study, we tried to identify many temporary and pathological skin manifestations and congenital anomalies observed in the first 48 h in newborns.

Cellulitis.

Cellulitis is a common infection of the skin and subcutaneous tissue caused predominantly by gram-positive organisms. Risk factors include prior episodes of cellulitis, cutaneous lesions, tinea pedis, and chronic edema. Cellulitis is a clinical diagnosis and presents with localized skin erythema, edema, warmth, and tenderness. Uncomplicated cellulitis can be managed in the outpatient setting with oral antibiotics. Imaging often is not required but can be helpful. Recurrent cellulitis is common and predisposing conditions should be assessed for and treated at the time of initial diagnosis. For patients with frequent recurrences despite management of underlying conditions, antimicrobial prophylaxis can be effective.

Facial and neck erythema associated with dupilumab treatment: A systematic review.

BACKGROUND: Neither dupilumab-associated facial erythema nor neck erythema was reported in phase 3 clinical trials for the treatment of atopic dermatitis, but there have been a number of reports of patients developing this adverse event in clinical practice. OBJECTIVE: To outline all cases of reported dupilumab-associated facial or neck erythema to better characterize this adverse event, and identify potential etiologies and management strategies. METHODS: A search was conducted on EMBASE and PubMed databases. Two independent reviewers identified relevant studies for inclusion and performed data extraction. RESULTS: A total of 101 patients from 16 studies were reported to have dupilumab-associated facial or neck erythema. A total of 52 of 101 patients (52%) had baseline atopic dermatitis facial or neck involvement and 45 of 101 (45%) reported different cutaneous symptoms from preexisting atopic dermatitis, possibly suggesting a different etiology. Suggested etiologies included rosacea, allergic contact dermatitis, and head and neck dermatitis. Most commonly used treatments included topical corticosteroids, topical calcineurin inhibitors, and antifungal agents. In the 57 patients with data on the course of the adverse events, improvement was observed in 29, clearance in 4, no response in 16, and worsening in 8. A total of 11 of 101 patients (11%) discontinued dupilumab owing to this adverse event. LIMITATIONS: Limited diagnostic testing, nonstandardized data collection and reporting across studies, and reliance on retrospective case reports and case series. CONCLUSION: Some patients receiving dupilumab develop facial or neck erythema that differs from their usual atopic dermatitis symptoms. Prompt identification and empiric treatment may minimize distress and potential discontinuation of dupilumab owing to this adverse event.

Epidemiology, Clinical Features, and Management of Texas Coral Snake (Micrurus tener) Envenomations Reported to the North American Snakebite Registry.

INTRODUCTION: Few of the 5000-8000 snakebites reported to poison control centers annually in the USA are attributed to coral snakes. This study describes Texas coral snake envenomations reported to the North American Snakebite Registry. METHODS: All Texas coral snake envenomation cases reported to the registry were identified for the period from January 1, 2015, through December 31, 2019. Data reviewed for this study included details regarding the snake encounter, patient demographics, signs and symptoms, treatment, and outcomes. Descriptive statistics were used to report results. RESULTS: Ten men and four nonpregnant women reported coral snake bites. The median patient age was 15.5 (range 5-72 years). There were 12 upper extremity bites and two bites to the lower extremity. The most common symptoms reported were paresthesias and pain. All subjects had paresthesias, often described as an "electric" sensation. Seven patients described them as painful. The most common clinical findings were erythema and swelling. No patient developed tissue damage, hematotoxicity, rhabdomyolysis, hypotension, weakness, or respiratory symptoms. Thirteen subjects were treated with opioids. Six patients were treated with antiemetics: three prophylactically and two for opioid-induced nausea. One patient developed nausea and non-bloody, nonbilious emesis within 1 hour of the bite, prior to receiving opioids. No patients were treated with antivenom. Antibiotics were not administered to any patient, and no infections were reported. CONCLUSIONS: Envenomations from M. tener in Southeast Texas are characterized by painful paresthesias. Mild swelling and erythema are common. Neurotoxicity necessitating antivenom or mechanical ventilation did not occur.

Epidemiology and pathological progression of erythematous lip lesions in captive sun bears (Helarctos malayanus).

This study investigates the occurrence of erythematous lip lesions in a captive sun bear population in Cambodia, including the progression of cheilitis to squamous cell carcinoma, and the presence of Ursid gammaherpesvirus 1. Visual assessment conducted in 2015 and 2016 recorded the prevalence and severity of lesions. Opportunistic sampling for disease testing was conducted on a subset of 39 sun bears, with histopathological examination of lip and tongue biopsies and PCR testing of oral swabs and tissue biopsies collected during health examinations. Lip lesions were similarly prevalent in 2015 (66.0%) and 2016 (68.3%). Degradation of lip lesion severity was seen between 2015 and 2016, and the odds of having lip lesions, having more severe lip lesions, and having lip lesion degradation over time, all increased with age. Cheilitis was found in all lip lesion biopsies, with histological confirmation of squamous cell carcinoma in 64.5% of cases. Single biopsies frequently showed progression from dysplasia to neoplasia. Eighteen of 31 sun bears (58.1%) had at least one sample positive for Ursid gammaherpesvirus 1. The virus was detected in sun bears with and without lip lesions, however due to case selection being strongly biased towards those showing lip lesions it was not possible to test for association between Ursid gammaherpesvirus 1 and lip squamous cell carcinoma. Given gammaherpesviruses can play a role in cancer development under certain conditions in other species, we believe further investigation into Ursid gammaherpesvirus 1 as one of a number of possible co-factors in the progression of lip lesions to squamous cell carcinoma is warranted. This study highlights the progressively neoplastic nature of this lip lesion syndrome in sun bears which has consequences for captive and re-release management. Similarly, the detection of Ursid gammaherpesvirus 1 should be considered in pre-release risk analyses, at least until data is available on the prevalence of the virus in wild sun bears.

Tirbanibulin Ointment 1% as a Novel Treatment for Actinic Keratosis: Phase 1 and 2 Results.

BACKGROUND: Current field-directed treatments of actinic keratosis (AK), a pre-malignant condition, are often limited by severe local reactions and/or complex treatment. Tirbanibulin, a novel potent anti-proliferative synthetic agent that inhibits tubulin polymerization and Src kinase signalling, is being developed as a convenient, safe, and effective field treatment of actinic keratosis. HYPOTHESIS: A short course of tirbanibulin ointment 1% safely reduces AK lesions. METHODS: In the Phase 1 study, 4 treatment cohorts with forearm lesions received tirbanibulin ointment 1% over 25 or 100 cm2 once daily for 3 or 5 days and were evaluated through day 45. In the Phase 2 study, 2 treatment cohorts with face or scalp lesions received tirbanibulin ointment 1% once daily for 3 or 5 days over 25 cm2 and were evaluated through day 57. Lesion reductions, clearance rates, safety, and pharmacokinetics were assessed. RESULTS: Forearm AK lesions were reduced by day 45 in all Phase 1 cohorts (N=30). Complete AK clearance at day 57 for face/scalp AK lesions in Phase 2 cohorts (N=168) was demonstrated in 43% and 32% of participants of the 5-day and 3-day cohorts, respectively. Adverse reactions were mainly transient mild local erythema and flaking/scaling, pruritus, and pain. Tirbanibulin plasma concentrations were low or undetectable. CONCLUSION: Tirbanibulin ointment 1% was well tolerated and active in AK reduction. Based on activity, the 5-day regimen was selected for Phase 3 development. Clinicaltrials.gov: NCT02337205; NCT02838628 J Drugs Dermatol. 2020;19(11):1093-1100. doi:10.36849/JDD.2020.5576THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

Erysipelas-like erythema in children with familial Mediterranean fever.

OBJECTIVES: Erysipelas-like erythema (ELE) is a well-known pathognomonic skin lesion associated with familial Mediterranean fever (FMF). The aim of this study was to describe the clinical and demographic features and phenotypic differences between paediatric FMF patients with and without ELE. METHODS: We retrospectively collected the medical charts of paediatric patients who had been diagnosed with FMF and followed by the Paediatric Rheumatology Department of Gazi University, Turkey, from 2006 to 2016. RESULTS: Among 782 FMF patients, 59 (33 males and 26 females; median age, 11.1±5.1) were found to have ELE. More patients had arthritis in the ELE group than in the other group (p=0.011). Arthritis occurred in the ankle (77.4%), knee (19.3%) and hip (3.2%) joints. The coexistence of arthritis and ELE was seen in 12 (20.3%) patients. All ELE plaques were located on the lower legs and dorsum of the feet. Eleven patients (18.6%) presented with ELE as the initial symptom and were diagnosed with FMF, and 48 (81.4%) patients experienced ELE attacks while receiving colchicine therapy. The median dose of colchicine at last visit, PRAS activity score and M694V homozygous mutation status were significantly higher in the ELE group than in the other group (p=0.041, p=0.001 and p=0.023, respectively). CONCLUSIONS: ELE is an uncommon but important feature of FMF. In patients with ELE, arthritis is more frequently encountered, and M694V homozygous mutation is more frequently found. FMF patients with ELE have more severe disease activity, and they use higher doses of colchicine in relation to this severe disease course.

Complication of vasopressor infusion through peripheral venous catheter: A systematic review and meta-analysis.

BACKGROUND: Vasopressors are mainstay treatment for patients in shock and are usually infused through central venous catheters (CVCs). However, CVCs are associated with risk of infection or delay from the needs of confirmation of placement. Infusing vasopressor through peripheral venous catheter (PIVs) could be an alternative in the Emergency Departments (ED) but data regarding complications is inconclusive. We performed a random-effects meta-analysis to assess literature involving prevalence of complications from infusing vasopressors via PIVs. METHODS: We searched PubMed, EMBASE and Scopus databases from beginnings to 02/02/2020 to identify relevant randomized control trials, cohort, case-control studies. We excluded case reports. Authors assessed studies' quality with Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Kappa score was used to assess interrater agreement. Outcome was complications as direct results from infusing vasopressors through PIVs. RESULTS: We identified 325 articles and included 9 studies after reviewing 16 full text articles. Our analysis included 1835 patients whose mean age was 63 (Standard Deviation 12) years and 48% was female. There were 122 (7%) complications, of which 117 (96%) were minor. The meta-analysis with random effects showed the pooled prevalence of complications as 0.086 (95%CI 0.031-0.21). Studies reporting infusion safety guidelines had significantly lower prevalence of complications (0.029, 95%CI 0.018-0.045), compared to those not reporting a safety guideline (0.12, 95%CI 0.038-0.30, p = 0.024). CONCLUSION: There was low prevalence of complications as a direct result from infusing vasopressors through PIVs. Studies with safety guidelines were associated with significantly lower prevalence of complications. Further studies are needed to confirm our observations.