RESUMO
The evidence on products for the prevention of radiodermatitis is limited. The primary objective was to analyse the effectiveness of the spray skin protectant 'non-burning barrier film' in the prevention of radiodermatitis with moist desquamation in patients with the anal canal and rectal cancer followed in nursing consultations compared to a standardised moisturiser based on Calendula officinalis and Aloe barbadensis. Single-blind randomised clinical trial. The study was performed in a hospital in Rio de Janeiro, Brazil, with 63 patients undergoing anal canal and rectal cancer treatment, randomised into one of the following two groups: an experimental group, which used a spray skin protectant and a control group, which used a moisturiser. Data were collected using an initial and subsequent evaluation form and were assessed using descriptive and inferential analyses. Participants who used the spray skin protectant had a lower chance of presenting radiodermatitis with moist desquamation and a longer time without this outcome when compared to the control group. The overall incidence of radiodermatitis was 100%, with 36.5% being severe. Furthermore, 17.5% of participants discontinued radiotherapy due to radiodermatitis. There were no differences between the groups regarding the severity of radiodermatitis and the number of patients who discontinued radiotherapy. The skin protectant was effective in preventing radiodermatitis with moist desquamation amongst patients with anal canal and rectal cancer.
Assuntos
Radiodermite , Neoplasias Retais , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Método Simples-Cego , Neoplasias Retais/complicações , Neoplasias Retais/radioterapia , Radiodermite/prevenção & controle , Radiodermite/tratamento farmacológico , Radiodermite/etiologia , Brasil , Aloe , Adulto , Emolientes/uso terapêutico , Emolientes/administração & dosagem , Neoplasias do Ânus , Calendula , Resultado do TratamentoRESUMO
BACKGROUND: Preterm infants are highly susceptible to infections, which significantly contribute to morbidity and mortality. This systematic review and meta-analysis investigated the effectiveness of topical emollient oil application in preventing infections among preterm infants. METHODS: A comprehensive search was conducted across multiple electronic databases (PubMed, Cochrane, Scopus, Clinical trials, Epistemonikos, HINARI and Global Index Medicus) and other sources. A total of 2185 articles were identified and screened for eligibility. The quality of included studies was assessed using the Cochrane Risk of Bias Tool for randomised controlled trials. Data analysis was performed using StataCrop MP V.17 software. Heterogeneity among the studies was evaluated using the I2 and Cochrane Q test statistics. Sensitivity and subgroup analyses were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist guided the presentation of the results. RESULTS: Of 2185 retrieved articles from initial searches, 11 met eligibility criteria and were included in the final analysis. A random effects meta-analysis revealed that infants who received massages with emollient oils had a 21% reduced risk of infection (risk ratio=0.79, 95% CI 0.64 to 0.97, I2=0.00%). Subgroup analyses indicated that preterm babies who received topical emollient oil massages with coconut oil, administered twice a day for more than 2 weeks, had a lower likelihood of acquiring an infection compared with their non-massaged counterparts. CONCLUSION: It is quite evident from this analysis that topical emollient oil application in preterm neonates is most likely effective in preventing infection. However, further studies, particularly from the African continent, are warranted to support universal recommendations.
Assuntos
Emolientes , Recém-Nascido Prematuro , Massagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Emolientes/administração & dosagem , Emolientes/uso terapêutico , Recém-Nascido , Massagem/métodos , Administração Tópica , Doenças do Prematuro/prevenção & controleRESUMO
BACKGROUND: Synthesizing current evidence on interventions to improve survival outcomes in preterm infants is crucial for informing programs and policies. The objective of this study is to investigate the impact of topical emollient oil application on the weight of preterm infants. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. To identify relevant studies, comprehensive searches were conducted across multiple databases, including PubMed, Cochrane, Scopus, Clinical trials, ProQuest Central, Epistemonikos, and gray literature sources. The inclusion criteria were based on the PICO (Population, Intervention, Comparison, and Outcomes) format. Study quality was assessed using the Cochrane risk of bias tool for randomized trials (RoB 2.0). Data analysis was performed using StataCrop MP V.17 software, which included evaluating heterogeneity, conducting subgroup analysis, sensitivity analysis, and meta-regression. The findings were reported in accordance with the PRISMA checklist, and the review was registered with PROSPERO (CRD42023413770). RESULTS: Out of the initial pool of 2734 articles, a total of 18 studies involving 1454 preterm neonates were included in the final analysis. Fourteen of these studies provided data that contributed to the calculation of the pooled difference in mean weight gain in preterm neonates. The random effects meta-analysis revealed a significant pooled difference in mean weight gain of 52.15 grams (95% CI: 45.96, 58.35), albeit with high heterogeneity (I2 > 93.24%, p 0.000). Subgroup analyses were conducted, revealing that preterm infants who received massages three times daily with either sunflower oil or coconut oil exhibited greater mean differences in weight gain. Meta-regression analysis indicated that the type of emollient oil, duration of therapy, and frequency of application significantly contributed to the observed heterogeneity. A sensitivity analysis was performed, excluding two outlier studies, resulting in a pooled mean weight difference of 78.57grams (95% CI: 52.46, 104.68). Among the nine studies that reported adverse events, only two mentioned occurrences of rash and accidental slippage in the intervention groups. CONCLUSION: The available evidence suggests that the application of topical emollient oil in preterm neonates is likely to be effective in promoting weight gain, with a moderate-to-high level of certainty. Based on these findings, it is recommended that local policymakers and health planners prioritize the routine use of emollient oils in newborn care for preterm infants. By incorporating emollient oils into standard care protocols, healthcare providers can provide additional support to promote optimal growth and development in preterm infants.
Assuntos
Emolientes , Recém-Nascido Prematuro , Humanos , Recém-Nascido , Emolientes/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Administração Tópica , Aumento de Peso/efeitos dos fármacosRESUMO
BACKGROUND: In the general population randomized controlled trial PreventADALL, frequent emollient bath additives from 2 weeks of age did not prevent atopic dermatitis, while the effect on skin barrier function throughout infancy is not established. OBJECTIVES: The primary aim of this exploratory substudy was to assess the effect of mineral-based oil baths on transepidermal water loss (TEWL) and dry skin through infancy, and secondarily to explore if filaggrin (FLG) mutations modified the effect. METHODS: Overall, 2153 infants were included and randomized to either the 'Skin intervention' (SI) group (n = 995) (oil bath 4 times weekly from 2 weeks through 8â months) or 'No skin intervention' (NSI) group (n = 1158), with TEWL measurements at 3, 6 and/or 12â months of age. Information on FLG mutation status was available for 1683 of these infants. Effects of the skin intervention on TEWL and dry skin through infancy were assessed by mixed-effects regression modelling. Background characteristics and protocol adherence were collected from electronic questionnaires, birth records and weekly diaries. RESULTS: The TEWL (95% confidence interval) was on average 0.42â g m-2 h-1 (0.13-0.70, P = 0.004) higher in the SI group compared with the NSI group through the first year of life, with significantly higher levels at 3â months [8.6 (8.3-9.0) vs. 7.6 (7.3-7.9)], but similar at 6 and 12â months. Dry skin was observed significantly more often in the NSI group compared with the SI group at 3â months (59% vs. 51%) and at 6â months of age (63% vs. 53%), while at 12â months of age, the difference was no longer significant. At 3â months, the TEWL of FLG mutation carriers was similar to the TEWL in the SI group. No interaction between SI and FLG mutation was found in the first year of life. CONCLUSIONS: Infants given frequent oil baths from 2 weeks of age had reduced skin barrier function through infancy compared with controls, largely attributed to higher TEWL at 3â months of age, while the skin at 3 and 6â months appeared less dry in infants subjected to the skin intervention.
Atopic dermatitis (AD) affects approximately 20% of children in industrialized countries. AD causes dry, itchy skin and can increase the chance of infections. This study was a substudy of the large Scandinavian PreventADALL trial, including 2394 infants, recruited from the general population between 2014 and 2016. Children in this trial were allocated randomly to receive either a skin intervention, food intervention, combined intervention, or no intervention. Children were examined at 3, 6 and 12â months of age. The examinations involved an investigation of the skin, to evaluate dry skin and skin barrier function by transepidermal water loss (TEWL) in the outer layers of the skin (higher TEWL suggests decreased skin barrier function). The skin intervention consisted of oil baths at least 4 times per week from 2 weeks of age through 8â months of age, and have previously not been shown to prevent AD by 1 and 3â years of age. We aimed to investigate whether frequent oil baths had any effect on TEWL and dry skin. We found that the skin intervention increased TEWL in the first year of life, especially at 3â months of age. Dry skin was less common in the skin intervention groups compared with the groups with no skin intervention. Infants with mutations in the gene coding for a skin barrier protein, called filaggrin, were associated with increased TEWL; however, in the skin intervention group, TEWL was similar among the infants with or without filaggrin mutations. Our findings suggest that oil baths several times per week from early infancy transiently decreases skin barrier function.
Assuntos
Banhos , Dermatite Atópica , Emolientes , Proteínas Filagrinas , Proteínas de Filamentos Intermediários , Mutação , Perda Insensível de Água , Humanos , Perda Insensível de Água/efeitos dos fármacos , Banhos/métodos , Lactente , Feminino , Dermatite Atópica/prevenção & controle , Dermatite Atópica/genética , Masculino , Emolientes/administração & dosagem , Proteínas de Filamentos Intermediários/genética , Recém-Nascido , Óleo Mineral/administração & dosagem , Cuidado do Lactente/métodos , Higiene da Pele/métodos , Pele/efeitos dos fármacosRESUMO
Pruritus is the sensation of itching; it can be caused by dermatologic and systemic conditions. An exposure history may reveal symptom triggers. A thorough skin examination, including visualization of the finger webs, anogenital region, nails, and scalp, is essential. Primary skin lesions indicate diseased skin, and secondary lesions are reactive and result from skin manipulation, such as scratching. An initial evaluation for systemic causes may include a complete blood count with differential, creatinine and blood urea nitrogen levels, liver function tests, iron studies, fasting glucose or A1C level, and a thyroid-stimulating hormone test. Additional testing, including erythrocyte sedimentation rate, HIV screening, hepatitis serologies, and chest radiography, may also be appropriate based on the history and physical examination. In the absence of primary skin lesions, physicians should consider evaluation for malignancy in older patients with chronic generalized pruritus. General management includes trigger avoidance, liberal emollient use, limiting water exposure, and administration of oral antihistamines and topical corticosteroids. If the evaluation for multiple etiologies of pruritus is ambiguous, clinicians may consider psychogenic etiologies and consultation with a specialist.
Assuntos
Prurido/diagnóstico , Prurido/terapia , Administração Tópica , Corticosteroides/administração & dosagem , Idoso , Contagem de Células Sanguíneas/métodos , Sedimentação Sanguínea , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Dermatite Atópica/complicações , Emolientes/administração & dosagem , Antagonistas dos Receptores Histamínicos/administração & dosagem , Humanos , Exame Físico/métodos , Prurido/etiologia , Radiografia/métodos , Encaminhamento e Consulta , Couro Cabeludo/patologia , Pele/patologia , Dermatopatias/diagnóstico , Tinha/complicaçõesRESUMO
BACKGROUND: Port-wine stain (PWS) is a congenital vascular malformation affecting 0.3–0.5% of normal population. These characteristic lesions arise due to the interplay of vascular, neural, and genetic factors. Treatment options include lasers, cosmetic tattooing, electrotherapy, cryosurgery, derma-abrasion, and skin grafting; however, none of these treatment alternatives appears to be satisfactory and is unable to provide consistent, satisfactory responses or even complete cures. Currently, laser is the treatment of choice, as it is comparatively safe and more effective than other procedures. The most commonly used modality is pulsed dye laser (PDL). The literature research includes peer-reviewed articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) to January 2020 and reference lists of respective articles. Only articles published in English language were included. J Drugs Dermatol. 20(5): doi:10.36849/JDD.5005.
Assuntos
Técnicas Cosméticas/tendências , Dermatologia/métodos , Lasers de Corante/uso terapêutico , Mancha Vinho do Porto/terapia , Administração Cutânea , Inibidores da Angiogênese/administração & dosagem , Ensaios Clínicos como Assunto , Terapia Combinada/métodos , Técnicas Cosméticas/instrumentação , Cosméticos/administração & dosagem , Criocirurgia/métodos , Criocirurgia/tendências , Dermabrasão/métodos , Dermabrasão/tendências , Dermatologia/tendências , Terapia por Estimulação Elétrica/métodos , Terapia por Estimulação Elétrica/tendências , Emolientes/administração & dosagem , Humanos , Satisfação do Paciente , Mancha Vinho do Porto/psicologia , Qualidade de Vida , Pele/efeitos dos fármacos , Pele/efeitos da radiação , Tatuagem/tendências , Resultado do TratamentoRESUMO
The human skin, particularly the stratum corneum, serves as a protective barrier against exogenous factors, including ultraviolet radiation (UVR) and pathogen invasions. The impact of UVR on skin cancer and photoaging has been extensively studied. However, the direct impact of UVR on skin barrier integrity under clinical settings remains poorly explored. Due to their benefits in reducing inflammation and promoting skin barrier repair, ceramide-containing formulations can provide added photoprotection benefits. In this study, the efficacy of a ceramide-containing sunscreen and moisturizer were evaluated in preventing UV-induced skin surface barrier changes. Expert grading, instrumental, and tape-stripping assessments demonstrated that UVR induced erythema and hyperpigmentation and caused changes in skin cells surface morphological organization and maturation. Treatment with a ceramide-containing sunscreen and moisturizing cream routine reduced erythema and hyperpigmentation, improved skin hydration, and maintained normal superficial skin cells morphology and turnover after UVR. Our results indicate that barrier-enforcing lipids formulations can provide additional benefits in patient’s daily routine by strengthening the barrier and improving skin health overall against chronic sun exposure. J Drugs Dermatol. 20(4 Suppl):s29-35. doi:10.36849/JDD.S589E.
Assuntos
Ceramidas/administração & dosagem , Eritema/prevenção & controle , Hiperpigmentação/prevenção & controle , Raios Ultravioleta/efeitos adversos , Adolescente , Adulto , Emolientes/administração & dosagem , Emolientes/química , Eritema/diagnóstico , Eritema/etiologia , Eritema/patologia , Feminino , Voluntários Saudáveis , Humanos , Hiperpigmentação/diagnóstico , Hiperpigmentação/etiologia , Hiperpigmentação/patologia , Masculino , Pessoa de Meia-Idade , Fotografação , Pele/diagnóstico por imagem , Pele/efeitos dos fármacos , Pele/efeitos da radiação , Envelhecimento da Pele/efeitos dos fármacos , Envelhecimento da Pele/efeitos da radiação , Protetores Solares/administração & dosagem , Protetores Solares/química , Resultado do Tratamento , Perda Insensível de Água/efeitos dos fármacos , Perda Insensível de Água/efeitos da radiação , Adulto JovemRESUMO
Verrucous epidermal nevi (VEN) are benign congenital hamartomas consisting of keratinocytes. Histological examination mostly exhibits hyperkeratosis, acanthosis, papillomatosis and, rarely, the features of epidermolytic hyperkeratosis (EHK). We report a case of a 6-year-old boy who presented at Aga Khan University Hospital, Karachi, Pakistan with bilaterally symmetrical linear epidermal nevi following Blaschko's lines and showing epidermolytic hyperkeratosis on histology. The patient was treated with topical keratolytics and emolients which led to considerable improvement. To the best of the authors' knowledge, this is the first report of VEN from Pakistan.
Assuntos
Emolientes/uso terapêutico , Hiperceratose Epidermolítica/tratamento farmacológico , Ceratolíticos/uso terapêutico , Nevo Sebáceo de Jadassohn/tratamento farmacológico , Administração Tópica , Criança , Emolientes/administração & dosagem , Hamartoma , Humanos , Ceratolíticos/administração & dosagem , Masculino , Mosaicismo , Nevo , PaquistãoRESUMO
Since the first shedder test was formulated almost 20 years ago, a plethora of different test strategies has emerged. The amount of data generated so far is considerable. However, because of the limited reproducibility of its results, the reliability of the shedder concept is frequently questioned. This study provides a literature overview of applied shedder tests that capture the diversity of the concept. It is pointed out to what extent different classification criteria, workflows, and trace evaluation can impair the classification outcome. The robustness of shedder status was assessed by applying a promising approach established by Fonneløp et al. (Forensic Sci Int Genet 29:48-60, 21). Data provide similar results to those in recent studies but also ambiguous shedder classifications. The applied shedder test was adapted based on our own as well as the reviewed data. With novel classification parameters, promising results were achieved. This study reveals uncertainties and inconsistencies of the shedder concept. Recommendations for harmonization and transparency are proposed. Implementation of the recommendations may result in an increased impact on casework and transfer studies, including activity-level assessments. Furthermore, this study shows that moisturizers affect participants' shedder status as well as DNA transfer. The impact appears to remain relevant even 60 min post ointment application but depends greatly on the type of moisturizer applied.
Assuntos
DNA/análise , DNA/isolamento & purificação , Emolientes/administração & dosagem , Pele/química , Tato , Líquidos Corporais/química , Células Epiteliais/química , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Fluxo de TrabalhoAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Dermatologia/métodos , Papiloma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Administração Cutânea , Administração Oral , Antibacterianos/administração & dosagem , Antifúngicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Dermatologia/normas , Emolientes/administração & dosagem , Ácido Fusídico/administração & dosagem , Glucocorticoides/administração & dosagem , Humanos , Guias de Prática Clínica como Assunto , Retinoides/administração & dosagem , Resultado do TratamentoRESUMO
BACKGROUND: Patients with sensitive skin find topical retinoid use for anti-aging purposes challenging due to irritation. Bakuchiol, a meroterpene from the Psoralea corylifolia seed, has retinol functionality through retinol-like regulation of gene expression. OBJECTIVE: This research examined the tolerability, efficacy, and barrier effects of a nature-based bakuchiol-containing cleanser and moisturizer in subjects with sensitive skin. METHODS: 60 female subjects Fitzpatrick skin types I–V age 40–65 years with sensitive mild to moderate photodamaged skin were enrolled in this 4 week study. A sensitive skin panel was constructed: 1/3 eczema/atopic dermatitis, 1/3 rosacea, 1/3 cosmetic intolerance syndrome. Subjects used a nature-based cleanser and moisturizer twice daily and underwent transepidermal water loss (TEWL), corneometry, tolerability assessments, and efficacy assessments at baseline, 5–10 minutes post-application, and week 4. RESULTS: The skin care products were well tolerated and efficacious (P<0.001) in terms of investigator assessed improvement in visual smoothness, tactile smoothness, clarity, radiance, overall appearance, and global anti-aging. Cheek corneometry measurements demonstrated a statistically significant 16% increase in skin moisture content (P<0.001). CONCLUSION: A bakuchiol nature-based anti-aging moisturizer is well tolerated and effective in individuals with sensitive skin.J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5522.
Assuntos
Cosmecêuticos/administração & dosagem , Emolientes/administração & dosagem , Fenóis/administração & dosagem , Envelhecimento da Pele/efeitos dos fármacos , Pele/imunologia , Administração Tópica , Adulto , Idoso , Bochecha , Cosmecêuticos/efeitos adversos , Dermatite Atópica/complicações , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/imunologia , Emolientes/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Fenóis/efeitos adversos , Rosácea/complicações , Rosácea/tratamento farmacológico , Rosácea/imunologia , Pele/efeitos dos fármacos , Pele/efeitos da radiação , Envelhecimento da Pele/efeitos da radiação , Higiene da Pele/efeitos adversos , Higiene da Pele/métodos , Luz Solar/efeitos adversos , Perda Insensível de Água/efeitos dos fármacos , Perda Insensível de Água/imunologiaRESUMO
INTRODUCTION: Transient acantholytic dermatosis has been frequently reported in patients with malignancies. While paraneoplastic cases have rarely been reported, most eruptions occur in the setting of chemotherapeutic agents. Management is based on limited data and primarily with topical steroids and topical emollients. A subset of patients exhibits recalcitrant disease and require alternate therapeutic approachesMethods: This systematic review consisted of identifying records in PubMed using the medical subject headings (MeSH) terms “chemotherapy” AND “Grover”, “chemotherapy” AND “Grover’s”, “cancer” AND “Grover”, “cancer” AND “Grover’s”, “malignancy” AND “Grover”, “malignancy” AND “Grover’s”, as well as a free text search for “Grover” OR “Grover’s” OR “Grover disease” OR “Grovers disease” OR “Grover’s disease” OR “transient acantholytic dermatosis” OR “transient acantholytic” to identify case reports, case series, systematic reviews, review articles, meta-analyses, clinical trials, brief commentaries, and original articles. The titles and abstracts of all results were reviewed. Full texts of relevant results were then read in their entirety and applicability was determined. RESULTS: Overall, Grover disease has rarely been reported in the setting of malignancy. When it occurs, it is generally in the setting of chemotherapy use. Chemotherapy-associated Grover disease is reported most frequently in association with cytotoxic chemotherapies, followed by small molecule inhibitors. The first line treatment for this complication is the use of topical agents. When these provide inadequate relief, alternate therapies have been rarely reported, with novel treatments proposed based on the type of chemotherapy agent and its mechanism of action. CONCLUSIONS: Chemotherapy-associated Grover disease is an uncommon complication of cancer treatment. While most cases of chemotherapy-associated Grover disease can be treated with topical steroids and topical emollients, certain cases require a more specialized approach. This could include adjuvant adjuvant therapies, or novel treatments that are directly related to the mechanism of action of the chemotherapy involved. J Drugs Dermatol. 2020;19(11):1056-1064. doi:10.36849/JDD.2020.5648.
Assuntos
Acantólise/induzido quimicamente , Antineoplásicos/efeitos adversos , Ictiose/induzido quimicamente , Neoplasias/tratamento farmacológico , Pele/patologia , Acantólise/diagnóstico , Acantólise/tratamento farmacológico , Acantólise/imunologia , Administração Cutânea , Antineoplásicos/administração & dosagem , Emolientes/administração & dosagem , Glucocorticoides/administração & dosagem , Humanos , Ictiose/diagnóstico , Ictiose/tratamento farmacológico , Ictiose/imunologia , Pele/efeitos dos fármacos , Pele/imunologiaRESUMO
The development of Bruton's tyrosine kinase (BTK) inhibitors represents a major breakthrough in the treatment of chronic lymphocytic leukemia and other B cell malignancies. The first-generation inhibitor ibrutinib works by covalent irreversible binding to BTK, a non-receptor tyrosine kinase of the TEC (transient erythroblastopenia of childhood) family that plays a critical role in the B-cell receptor signaling pathway. It also induces an 'off-target' inhibition of a range of other kinases including (but not limited to) epidermal growth factor receptor (EGFR), SRC, and other kinases of the TEC family (interleukin-2-inducible T-cell kinase [ITK], Tec, BMX). Dermatological toxicities are among the most common toxicities of ibrutinib, but remain of mild to moderate intensity in most cases and are readily manageable. Their incidence is highest during the first year of treatment and declines over time. In addition, it has been postulated that ibrutinib-related dermatologic adverse events are mediated by the direct binding to both BTK and other 'off-target' kinases. Bruising, ecchymoses, and petechiae represent the most characteristic dermatologic adverse events. Nail and hair changes are also common, as skin infections (opportunistic infections including herpes simplex and herpes zoster virus reactivations, and Staphylococcus aureus superinfection), folliculitis, and other types of rashes. Panniculitis, aphthous-like ulcerations with stomatitis, neutrophilic dermatosis, peripheral edema, and skin cracking can also occur. Next-generation BTK inhibitors, acalabrutinib and zanubrutinib, have been designed to optimize BTK inhibition and minimize off-target inhibition of alternative kinases (Tec, ITK, EGFR, SRC-family kinases). These drugs have been recently FDA-approved for relapsed or refractory mantle cell lymphoma. Although the overall incidence of their toxicities is expected to be more limited, acalubrutinib and zanubrutinib are associated with a range of dermatologic toxic effects that appear to be similar to those previously described with ibrutinib, including bruising and ecchymoses, panniculitis, human herpesvirus infections, cellulitis, and skin rash. In particular, both drugs induce skin bleeding events in more than 30% of patients treated. However, the available dermatological data are still rather limited and will have to be consolidated prospectively. This review article analyses the wide spectrum of dermatological toxicities that can be encountered with first- and second-generation BTK inhibitors. Finally, recommendations for appropriate treatment as well as a synthesis algorithm for management are also proposed.
Assuntos
Tirosina Quinase da Agamaglobulinemia/antagonistas & inibidores , Toxidermias/epidemiologia , Equimose/epidemiologia , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Adenina/efeitos adversos , Adenina/análogos & derivados , Administração Cutânea , Tirosina Quinase da Agamaglobulinemia/metabolismo , Benzamidas/efeitos adversos , Biópsia , Toxidermias/diagnóstico , Toxidermias/imunologia , Toxidermias/terapia , Equimose/diagnóstico , Equimose/imunologia , Equimose/terapia , Emolientes/administração & dosagem , Humanos , Incidência , Necrose/diagnóstico , Necrose/epidemiologia , Necrose/imunologia , Necrose/terapia , Educação de Pacientes como Assunto , Piperidinas/efeitos adversos , Pirazinas/efeitos adversos , Pirazóis/efeitos adversos , Pirimidinas/efeitos adversos , Receptores de Antígenos de Linfócitos B/metabolismo , Índice de Gravidade de Doença , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/imunologia , Pele/efeitos dos fármacos , Pele/imunologia , Pele/patologia , Higiene da Pele/métodosRESUMO
INTRODUCTION: Medical treatment of advanced colorectal cancer is effective in prolonging the survival of patients. The aim of this study was to describe the most common skin toxicities that occur in those patients, analyzing the association between the type of reaction and the different chemotherapeutic drugs; and to evaluate the importance of an outpatient dermatologic service to improve quality of life. PATIENTS AND METHODS: Seventy-two patients with skin reactions from advanced colorectal cancer chemotherapy were included. Each patient underwent physical examination and digital photographic imaging, and completed a quality-of-life questionnaire (Dermatology Life Quality Index [DLQI]). RESULTS: Papulopustular rash was the most common side effect observed. It was statistically associated with EGFRi + irinotecan, EGFRi + FOLFOX, and EGFRi. Xerosis occurred in 50% of patients during EGFRi therapy. Periungual pyogenic granuloma-like lesions occurred in 30% of patients during EGFRi therapy. Our data underline a statistically significant association between capecitabine, FOLFOX + EGFRi, FOLFIFI + EGFRi, and hand-foot syndrome (P < .001). Because none of patients treated with EGFRi alone developed this kind of reaction, we suppose that it is associated with the use of 5-fluorouracil. Fifty percent of patients receiving anti-epidermal growth factor receptor (EGFR) therapy developed trichomegaly. These data underline a statistically significant association between these reactions and this specific drug. CONCLUSION: A dermatologic visit is useful, both for the correct diagnosis of and for the adequate therapy of chemotherapy side effects. The prevention and treatment of these toxicities are important, not only to improve quality of life but also to avoid unnecessary dose reduction or interruption, which can have a negative effect on treatment outcome.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais/tratamento farmacológico , Toxidermias/epidemiologia , Administração Cutânea , Idoso , Antibacterianos/administração & dosagem , Toxidermias/diagnóstico , Toxidermias/tratamento farmacológico , Toxidermias/etiologia , Emolientes/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Antagonistas dos Receptores Histamínicos/administração & dosagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Índice de Gravidade de Doença , Inquéritos e Questionários/estatística & dados numéricosAssuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/estatística & dados numéricos , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Uso de Medicamentos/estatística & dados numéricos , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Tópica , Antibioticoprofilaxia/métodos , Biópsia/efeitos adversos , Dermatologistas/estatística & dados numéricos , Resistência Microbiana a Medicamentos , Emolientes/administração & dosagem , Humanos , Vaselina/administração & dosagem , Pele/patologia , Dermatopatias/diagnóstico , Dermatopatias/patologia , Dermatopatias/cirurgia , Infecção da Ferida Cirúrgica/etiologiaRESUMO
Grover disease (GD) is a benign eruption that causes a papulovesicular rash on the trunk and proximal extremities. It often resolves spontaneously but can follow a more chronic and fluctuating course that may last several years. Although the etiology remains unknown, several associated triggers have been identified including heat and sweating, cool and dry air, renal failure, malignancy, and the initiation of several drugs. Since the disease tends to resolve on its own, management is aimed at disease prevention and symptomatic relief. First-line therapy includes topical steroids and vitamin D analogues with adjuvant antihistamines. In more severe cases that are refractory to less aggressive therapy, systemic corticosteroids, retinoids, and phototherapy may lead to successful resolution. Novel therapies are few and have little evidence but involve innovative use of light therapy and immune modulators. Herein, we review the literature and new trends of GD with a focus on established and novel treatments.
Assuntos
Acantólise/classificação , Acantólise/tratamento farmacológico , Ictiose/classificação , Ictiose/tratamento farmacológico , Acantólise/diagnóstico , Acantólise/etiologia , Administração Cutânea , Administração Oral , Doença de Darier/diagnóstico , Dermoscopia , Diagnóstico Diferencial , Quimioterapia Combinada/métodos , Emolientes/administração & dosagem , Glucocorticoides/administração & dosagem , Antagonistas dos Receptores Histamínicos/administração & dosagem , Humanos , Hiperpigmentação/diagnóstico , Ictiose/diagnóstico , Ictiose/etiologia , Pênfigo/diagnóstico , Pênfigo Familiar Benigno/diagnóstico , Fotoquimioterapia/métodos , Retinoides/administração & dosagem , Pele/diagnóstico por imagem , Pele/efeitos dos fármacos , Pele/patologia , Dermatopatias Genéticas/diagnóstico , Dermatopatias Papuloescamosas/diagnóstico , Vitamina D/administração & dosagemRESUMO
BACKGROUND: Xerosis is common among patients with Kaposi's sarcoma (KS). The aim of our study was to evaluate the efficacy of a detergent containing dihydroavenanthramide D 5% combined with a moisturizer containing 1% of menthol for the treatment of chronic pruritus associated with xerosis in elderly KS patients. METHODS: We conducted a prospective, open-label, intra-individual, right/left comparative study. During the 4-week treatment study, patients used the test products on the right lower limb, and a basic skin cleanser plus basic cream on their left lower limb, in a predefined protocol. A 10 cm visual analogue scale (VAS), the hydration index (HI) of the stratum corneum and the overall dry skin score (ODSS) were used to assess pruritus and xerosis severity on admission, at 2 and 4 weeks. RESULTS: Thirty patients (24 males, 6 females, mean age: 76.6±6.8 years) were enrolled. At the end of 4 weeks, the mean pruritus VAS score declined from 4.2±2.2 to 1.7±1.4 on the right side, and from 4.2±2.2 to 2.3±1.5 on the left side. The HI score increased from 25.6±15.0 to 46.1±12.3 on the right side, and from 26.0±15.2 to 35.4±12.6 on the left side. Differences between the right and left limbs were significant for VAS score (P=0.0064), HI (P<0.0001) and ODSS values (P=0.0049). There was no adverse reaction to the test products. CONCLUSIONS: Daily use of a detergent containing dihydroavenanthramide D 5% combined with a moisturizer containing 1% of menthol improves chronic pruritus associated with xerosis in elderly adults with KS.
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Prurido/tratamento farmacológico , Sarcoma de Kaposi/complicações , Dermatopatias/tratamento farmacológico , ortoaminobenzoatos/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Detergentes/administração & dosagem , Emolientes/administração & dosagem , Feminino , Humanos , Masculino , Mentol/administração & dosagem , Estudos Prospectivos , Prurido/etiologia , Sarcoma de Kaposi/tratamento farmacológico , Dermatopatias/etiologia , Resultado do TratamentoRESUMO
BACKGROUND: Preterm constitutes a major part of neonatal mortality, particularly in India. Due to dermal immaturity, preterm neonates are susceptible to various complications like infection, hypothermia, etc. Emollient application is a traditional practice in our subcontinent. AIMS: To find out the efficacy of coconut oil application for skin maturity, prevention of sepsis, hypothermia and apnea, its effect on long-term neurodevelopment and adverse effect of it, if any. MATERIAL AND METHODS: A randomized controlled trial was conducted in the rural field practice area of Department of Community Medicine, Burdwan Medical College from March 2014 to August 2018. Preterm born in the study period was divided into Group A (received virgin coconut oil application) and Group B (received body massage without any application). Neonatal skin condition was assessed on 7th, 14th, 21st and 28th day of life. Neurodevelopmental status was assessed on 3rd, 6th and 12th months. RESULTS: A total of 2294 preterm were included in the study. Groups A and B consisted of 1146 and 1148 preterm infants, consecutively. Mean gestational age of the study population was 31.9 ± 3.4 weeks and 50.4% were male. Mean weight loss in first few days was less in group A but mean weight gain per day was higher in group B. Lesser incidences of hypothermia and apnea, and better skin maturity and neurodevelopmental outcome were noted in group A. No significant adverse effect was noted with coconut oil application. CONCLUSION: Use of coconut oil helps in dermal maturity and better neurodevelopmental outcome. Further studies are warranted for universal recommendation.
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Apneia/prevenção & controle , Óleo de Coco/administração & dosagem , Emolientes/administração & dosagem , Hipotermia/prevenção & controle , Recém-Nascido Prematuro , Sepse/prevenção & controle , Pele/efeitos dos fármacos , Administração Cutânea , Óleo de Coco/uso terapêutico , Emolientes/uso terapêutico , Feminino , Humanos , Cuidado do Lactente/métodos , Recém-Nascido , Masculino , Avaliação de Resultados em Cuidados de Saúde , População RuralAssuntos
Pustulose Exantematosa Aguda Generalizada , Ciprofloxacina/efeitos adversos , Glucocorticoides/administração & dosagem , Mupirocina/administração & dosagem , Soluções Oftálmicas , Pele/patologia , Pustulose Exantematosa Aguda Generalizada/diagnóstico , Pustulose Exantematosa Aguda Generalizada/etiologia , Pustulose Exantematosa Aguda Generalizada/fisiopatologia , Pustulose Exantematosa Aguda Generalizada/terapia , Administração Tópica , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Biópsia/métodos , Ciprofloxacina/administração & dosagem , Conjuntivite Bacteriana/tratamento farmacológico , Diagnóstico Diferencial , Substituição de Medicamentos , Emolientes/administração & dosagem , Humanos , Masculino , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/efeitos adversos , Resultado do Tratamento , Suspensão de TratamentoRESUMO
INTRODUCTION: Diabetes mellitus (DM) associated skin changes, which may be the first sign of DM in undiagnosed patients. Frequently these patients present with dry skin, which may benefit from the use of gentle cleansers and moisturizers. A review paper was developed to explore DM-associated skin changes and possible benefits of cleanser and moisturizer use. METHODS: For this purpose, an expert panel of physicians involved in the care of patients with DM selected information from literature searches coupled with expert opinions and experience of the panel. RESULTS: A defective skin barrier predisposes the skin to water loss leading to dryness, hyperkeratosis and inflammation. Skin changes that may benefit from the use of gentle cleansers and moisturizers are, amongst others, diabetic foot syndrome, ichthyosiform skin changes, xerosis, and keratosis pilaris. Adherence to treatment is a considerable challenge making education essential, especially about the need to keep skin clean and what skin care to use. Specifically designed diabetic skin care that contains anti-aging ingredients, urea, and essential ceramides, has demonstrated benefits for dry/itchy skin. CONCLUSIONS: Skin disorders are common complications among either diabetic patients with patients with DM and may lead to serious adverse events. Evidence suggests that daily application of optimal skin care using gentle cleansers and moisturizers is one of the measures that may help improve skin barrier dysfunction, preventing complications by providing early-stage treatment of patients with diabetes. J Drugs Dermatol. 2019;18(12):1211-1217.