Permanent Alopecia in Breast Cancer Patients: Role of Taxanes and Endocrine Therapies.

Permanent chemotherapy-induced alopecia (PCIA) has been described following high-dose chemotherapy regimens for allogeneic bone marrow transplants; however, reports of PCIA in breast cancer patients are increasing. Many prior reports involve treatment with taxanes, but the role of endocrine therapies has not been well defined. Permanent alopecia in breast cancer patients appears to be a potential adverse effect of taxanes and endocrine therapies. Although the cytotoxic effects of taxanes may lead to permanent hair loss, the influence of endocrine therapies on the remaining follicles may affect the pattern of hair loss. Further characterization of these cases may elucidate risk factors for developing permanent alopecia, allowing for more appropriate risk stratification and counseling. We describe 3 patients with breast cancer who experienced PCIA following chemotherapy with taxanes.

Safe and effective treatment of atopic dermatitis using dupilumab over 23 months in a patient with HIV.

In 2017, the Food and Drug Administration approved dupilumab for patients with moderate to severe atopic dermatitis (AD) refractory to topical therapies; however, clinical trials specifically excluded patients with human immunodeficiency virus (HIV). Here, we describe the effective and uncomplicated treatment of AD with dupilumab over a 23-month period in a patient with HIV. Throughout the treatment duration, the patient demonstrated marked improvement in AD severity, while maintaining stable CD4 T cell counts and viral load. These results suggest that dupilumab represents a safe and effective treatment option for AD in patients with HIV.

A case of atezolizumab-induced photodistributed bullous pemphigoid.

Immunotherapy has revolutionized cancer therapy in recent years but is associated with unique immunologically mediated adverse effects. Immunotherapy-induced bullous pemphigoid (BP) is an uncommon but established reaction that portends significant management implications as in most instances systemic treatment is required. We report a case of immunotherapy-associated BP in a marked photodistribution, highlighting the diverse clinical presentations of this eruption.

Non-pruritic bullous scabies in an immunosuppressed pediatric patient.

Bullous scabies is an uncommon subtype of scabies that frequently mimics other blistering skin diseases. Nocturnal pruritus is a hallmark symptom of bullous scabies. We report an unusual case of bullous scabies presenting in the absence of pruritus in an immunosuppressed pediatric patient. It is critical that clinicians consider the diagnosis of bullous scabies in any patient with bullae, irrespective of pruritus symptoms.

Sweet's Syndrome Presenting in Concordance with Acute Coronary Syndrome.

Acute febrile neutrophilic dermatosis (Sweet's syndrome) is typically characterized by an acute onset of erythematous papules, plaques, and nodules in a febrile patient. This dermatosis is classically accompanied by leukocytosis and neutrophilia, and has had reported associations with various underlying etiologies including drug reactions, malignancies, infections, autoimmune disorders, and inflammatory bowel diseases. However, most cases of acute febrile neutrophilic dermatosis are idiopathic. We present a unique case of Sweet's syndrome in a patient with concurrent acute myocardial infarction.

Peroxyl radical mediated oxidative DNA base damage: implications for lipid peroxidation induced mutagenesis.

Endogenous DNA damage induced by lipid peroxidation is believed to play a critical role in carcinogenesis. Lipid peroxidation generates free radical intermediates (primarily peroxyl radicals, ROO(*)) and electrophilic aldehydes as the principal genotoxicants. Although detailed information is available on the role of aldehyde base adducts in mutagenesis and carcinogenesis, the contribution of peroxyl radical mediated DNA base damage is less well understood. In the present study we have mapped oxidative base damage induced by peroxyl radicals in the supF tRNA gene and correlated this information with peroxidation-induced mutations in several human fibroblast cell lines. Nearly identical patterns of oxidative base damage were obtained from reaction of DNA with either peroxidizing arachidonic acid (20:4omega6) or peroxyl radicals generated by thermolysis of ABIP in the presence of oxygen. Oxidative base damage primarily occurred at G and C. Transversions at GC base pairs in the supF gene were the major base substitution detected in all cell lines. Peroxyl radical induced tandem mutations were also observed. Many mutation hot spots coincided with sites of mapped oxidative lesions, although in some cases hot spots occurred adjacent to the damaged base. Evidence is presented for the involvement of 8-oxodG in the oxidation of DNA by ROO(*). These results are used to interpret some key features of previously published mutation spectra induced by lipid peroxidation in human cells.