ABSTRACT
Sorafenib is an oral multikinase inhibitor approved by the United States Food and Drug Administration for the treatment of advanced hepatocellular and renal cell carcinoma. Cases of sorafenib-induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome have been reported in the literature. DRESS syndrome is a potentially fatal, drug-induced hypersensitivity reaction that occurs 2-8 weeks after drug exposure. DRESS syndrome presents with generalized morbilliform eruption, facial edema, eosinophilia, and end-organ damage. We present the first reported case of sorafenib toxicity mimicking DRESS syndrome in a patient with metastatic adrenocortical carcinoma presenting with fever, morbilliform rash, and transaminitis in the absence of eosinophilia three days following initiation of sorafenib therapy. It is critical that clinicians are equipped to accurately diagnose DRESS syndrome due to its high mortality rate and the morbidity associated with prolonged steroid therapy. J Drugs Dermatol. 2019;18(5):468-469.
Subject(s)
Adrenal Cortex Neoplasms/drug therapy , Adrenocortical Carcinoma/drug therapy , Antineoplastic Agents/toxicity , Drug-Related Side Effects and Adverse Reactions/diagnosis , Sorafenib/toxicity , Adrenal Cortex Neoplasms/pathology , Adrenocortical Carcinoma/secondary , Diagnosis, Differential , Drug Hypersensitivity Syndrome/diagnosis , Female , Humans , Middle Aged , Neoplasm MetastasisSubject(s)
Scalp Dermatoses , Skin Diseases, Genetic , Humans , Bibliometrics , Cellulitis/drug therapyABSTRACT
BACKGROUND: Bullous pemphigoid (BP) responds to a variety of immunosuppressive agents and usually controls, but does not cure, the disease. Omalizumab, Food and Drug Administration-approved for asthma, selectively suppresses the activity of IgE, an important immunoglobulin in the pathogenesis of BP. OBJECTIVE: We wished to determine if systemic omalizumab would have a therapeutic effect in patients with BP. METHODS: We treated 6 patients with BP using omalizumab and followed up their disease for up to 42 months. RESULTS: Although variable, 5 of the 6 patients with BP received therapeutic benefit from systemic omalizumab (the sixth terminated treatment because of intercurrent illness) with less use of other immunosuppressants, inhibition of new bullae, less pruritus, and dramatic decreases in eosinophil counts. None of the patients had untoward side effects from omalizumab. LIMITATIONS: This was an open, uncontrolled study. CONCLUSIONS: Omalizumab neutralizes the activity of IgE in patients with BP and improves the control of their disease activity.
Subject(s)
Anti-Allergic Agents/therapeutic use , Antibodies, Anti-Idiotypic/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Pemphigoid, Bullous/drug therapy , Aged , Aged, 80 and over , Anti-Allergic Agents/pharmacology , Antibodies, Anti-Idiotypic/pharmacology , Antibodies, Monoclonal, Humanized/pharmacology , Female , Humans , Immunoglobulin E/drug effects , Immunoglobulin E/immunology , Omalizumab , Pemphigoid, Bullous/immunologyABSTRACT
BACKGROUND: Dissecting cellulitis of the scalp (DCS) is a chronic inflammatory skin condition characterized by abscesses, nodules, fistulas, and scarring alopecia. Management of this oftentimes debilitating dermatosis can be challenging due to its recalcitrant nature. There is limited data regarding the efficacy of treatment options for DCS. OBJECTIVE: The aim of this study was to conduct a systematic review of the literature to explore the efficacy and safety of reported DCS treatments. METHODS: In October 2022, MEDLINE and EMBASE databases were searched for articles on treatments for DCS. Studies that contained outcome efficacy data for DCS treatments were included. Reviews, conference abstracts, meta-analyses, commentaries, non-relevant articles, and articles with no full-text available were excluded. Data extraction was performed by two independent reviewers. RESULTS: A total of 110 relevant articles with 417 patients were identified. A majority of studies (86.4%) were case reports or series. Treatment options included systemic antibiotics, oral retinoids, biologics, procedural treatments, combination agents, and topical treatments. Oral retinoids and photodynamic therapy were the most extensively studied medical and procedural interventions, respectively. CONCLUSION: Overall, randomized controlled trials are needed to evaluate various treatment regimens for DCS and provide patients with a robust, evidence-based approach to therapy.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Drug Hypersensitivity Syndrome/etiology , Vancomycin/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Child , Drug Hypersensitivity Syndrome/epidemiology , Female , Humans , Los Angeles , Male , Middle Aged , Retrospective Studies , Young AdultSubject(s)
Dermatology/statistics & numerical data , Primary Health Care/statistics & numerical data , Referral and Consultation/statistics & numerical data , Skin Diseases/diagnosis , Skin Diseases/therapy , Telemedicine , Adult , Dermatology/methods , Female , Health Services Accessibility , Humans , Los Angeles , Male , Medically Underserved Area , Middle Aged , Office Visits/statistics & numerical data , Photography , Retrospective StudiesABSTRACT
Patient satisfaction often is used as a proxy for quality of care, with physicians evaluated and reimbursed based on patient satisfaction scores. As a specialty, dermatology is lagging in quality improvement studies. To fill this gap, we conducted a prospective study of targeted interventions administered at outpatient dermatology clinics to determine if they resulted in statistically significant increases in patient satisfaction measures, particularly among Spanish-speaking patients. This study, along with the existing body of research, suggests the need for continued work to maximize patient satisfaction in dermatology.
Subject(s)
Dermatology/standards , Outcome Assessment, Health Care , Patient Satisfaction , Skin Diseases/therapy , Adolescent , California , Ethnicity , Female , Health Services Accessibility , Humans , Male , Middle Aged , Outpatients , Prospective Studies , Quality Improvement , Surveys and Questionnaires , Young AdultABSTRACT
Patient satisfaction has become an important measure of quality under the Patient Protection and Affordable Care Act. In this study, we assessed and analyzed patient satisfaction, nonattendance rates, and cycle times in an outpatient dermatology clinic. This study provides a snapshot of patient satisfaction in an urban dermatology clinic. Under the Patient Protection and Affordable Care Act, providers will be challenged to increase access to care and to validate quality of care through patient satisfaction.