[Drug reactions caused by chemotherapy agents]. / Arzneimittelreaktionen bei antineoplastischen Substanzen.

In recent years, several new classes of compounds have successfully been established in the treatment of cancer. They selectively inhibit disturbed signaling pathways or induce anti-tumor immune responses. These novel targeted cancer drugs show a favorable safety profile compared to conventional chemotherapeutic agents. The most important side effects of these anticancer agents include cutaneous reactions and occur in a time-dependant manner and show class-specific patterns. In this review article, we compare the cutaneous side effects of epidermal growth factor inhibitors (EGFRI), multikinase inhibitors (MKI), BRAF inhibitors (BRAFI), mTor inhibitors (mTorI) and immune checkpoint inhibitors and discuss severity-adapted management strategies.

[Successful treatment of granulomatous rosacea with dapsone]. / Erfolgreiche Therapie einer granulomatösen Rosazea mit Dapson.

Granulomatous rosacea is an uncommon variant of rosacea. It is characterized by disseminated, red-brown papules and nodules especially in periocular and centrofacial locations. This form of rosacea causes considerable distress among patients because of the inflammatory facial lesions and represents a therapeutic challenge. A 62-year old man with granulomatous rosacea failed to improve with systemic doxycycline. Systemic isotretinoin and corticosteroids produced only a temporary reduction in cutaneous findings. Finally, systemic treatment with dapsone resulted in remission of the skin lesions and long-term stabilization.

[Paraneoplastic palmoplantar hyperkeratosis. Minor form of acrokeratosis neoplastica Bazex?]. / Paraneoplastische palmoplantare Hyperkeratose. Minorform der Acrokeratosis paraneoplastica Bazex?

Acrokeratosis paraneoplastica Bazex is a rare, obligate paraneoplasia initially presenting with palmoplantar hyperkeratosis. Later stages show acral psoriasiform lesions on other parts of the body. Common associated malignancies are laryngeal cancer and other tumors of the head or neck region or neck lymph node metastases. A 49-year-old woman presented with palmoplantar hyperkeratoses for 4 months; in addition she had a squamous cell carcinoma of the larynx. We diagnosed a minor form of acrokeratosis paraneoplastica Bazex. Some authors consider this as a separate entity, but the well- known course argues against this hypothesis. We report a case and review the literature.

[New tyrosine kinase and EGFR inhibitors in cancer therapy. Cardiac and skin toxicity as relevant side effects. Part B: Skin]. / Neue Tyrosinkinase- und EGFR-Inhibitoren in der Tumortherapie. Herz und Haut als wichtige Schädigungsorgane. Teil B: Haut.

Recently, inhibitors of the epidermal growth factor receptor (EGFR) and multikinase inhibitors have been successfully established in the therapy of various solid tumors. EGFR inhibitors and multikinase inhibitors are specific and selective agents that intervene with the dysfunctional regulatory processes of malignant cells. This results in a favorable safety profile and range of side effects, especially in comparison to conventional chemotherapy. The various cutaneous adverse drug reactions are considered substance class effects and are the most frequent side effects of these targeted therapies. Therapy with EGFR inhibitors is associated with acneiform rash, painful paronychia, xerosis cutis, acral fissures, hair changes, and pruritus. Treatment with tyrosin kinase inhibitors may cause hand-foot syndrome, various types of drug rash, hair loss, xerosis cutis, and pruritus. These side effects may be stigmatizing and place a huge burden on the patient's quality of life. Treatment is a challenge and best performed in interdisciplinary cooperation of dermatologists and oncologists.

[Multiple Sister Mary Joseph's nodules in a patient with gastric cancer]. / Multiple "Sister Mary Joseph's nodules" bei einem Patienten mit Magenkarzinom.

HISTORY AND CLINICAL FINDINGS: A 52-year-old patient presented with a 6-months history of painful, progressive erythematous periumbilical papules and nodules. Seven months previously, an advanced stage of an adenocarcinoma of the stomach with peritoneal carcinosis and malignant ascites had been diagnosed. INVESTIGATIONS: Clinical examination showed ten firm, painful, umbilicated, erythematous, polygonal papules and nodules (size up to 7 mm), partly covered with central hemorrhagic crusts or scales. The histological examination revealed epithelial cell clusters infiltrating the dermis and forming tubular structures. The prominent nuclei varied in size, some were vacuolated. Signet ring structures were visible in the tumor. Immunohistochemical staining revealed MNF116 expressing tumor cells, consistent with a moderately differentiated adenocarcinoma. DIAGNOSIS: Multiple Sister Mary Joseph's nodules - periumbilical skin metastases from gastric carcinoma. TREATMENT AND COURSE: The previous palliative chemotherapy with capecitabine will be expanded by irinotecan after completion of local iradiation of an esophageal stenosis. The patient declined additional local therapeutic options such as excision or electric chemotherapy. CONCLUSION: Sister Mary Joseph's nodule is a rare, umbilical cutaneous metastatic tumor originating from advanced metastatic intraabdominal or intrapelvic malignancies. Our case is remarkable because of the number of the umbilical and periumbilical, but otherwise characteristic nodules. Sister Mary Joseph's nodules are associated with a dismal prognosis. As they may precede cancer diagnosis, histological investigation of suspect umbilical nodules should be performed.

Cutaneous side-effects of EGFR inhibitors and their management.

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.