Skin Toxicities During Colorectal Cancer Chemotherapy: Incidence and Pearls of Treatment in Our Experience.

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.

Retrospective Analysis of Skin Toxicity in Patients under Anti-EGFR Tyrosine Kinase Inhibitors: Our Experience in Lung Cancer.

BACKGROUND: Tyrosine kinase inhibitors (TKIs) have been introduced for the treatment of lung cancer, improving progression-free survival, objective response rate, and quality of life. However, TKIs can lead to cutaneous toxicities, including papulopustular rash, xerosis, paronychia with/without pyogenic granulomas, scalp disorders, facial hair and/or eyelash growth. AIM: In this study, we describe retrospectively all cases of mucocutaneous side effects in patients with lung cancer under TKIs referring to our outpatient for the skin care of oncological patients. METHODS: We included patients referring from January 2016 to January 2018 affected by lung cancer and under TKIs. We collected data about the clinical exam, clinical photography, dermoscopy, histology and direct microscopic examination for each patient and we performed retrospectively descriptive analyses to assess whether a specific TKIs is linked significantly to particular cutaneous toxicity. RESULTS: The majority of skin toxicities were due to afatinib, and the most common skin reaction was rash. We selected 60 patients with skin reactions, treated by TKIs for lung cancer. The majority of skin toxicities were due to afatinib (47/102 adverse reactions) and erlotinib (39/102). The most common skin reaction was rash (63% of patients), followed by xerosis (30%) and granulomas (30%). There was no significant relationship between a specific type of cutaneous reaction and specific EGFRi except for granulomas, developed more frequently in patients under afatinib (p < 0.05). CONCLUSION: Most of our patients (63%) developed a cutaneous rash under TKIs. Most commonly afatinib was the drug involved, although it wasn't the most used EGFRi. Moreover, we noticed a significant correlation between afatinib therapy and appearance of granulomas.

Topical non-occlusive polymers in hand-foot syndrome.

BACKGROUND: Many cytotoxic and biological drugs are cause of severe dermatological side effects, such as hand-foot syndrome (HFS) and hand-foot skin reaction (HFSR). Oncologic patients with HFS or HFSR presents relevant symptoms that interferes with daily activities and with adherence to anticancer treatment. The HFRS control and treatment are important goals to enhance the quality of life of oncologic patients. The aim of this study was to assess the efficacy and tolerability of a b.i.d. (bis in die) topical administration of an anhydric ointment based on topical non-occlusive polymers (TNOP) in patients with HFS on current anticancer drug regiments. METHODS: A prospective, open, multicenter clinical study was conducted in oncologic patients with HFS attended two hospital-based Italian dermatological unit. A global-non-instrumental evaluation, based on different standardized tools (i.e., Sum Score System Index [SRRC] Score, Dermatology Life Qualiy Index [DLQI] and global efficacy) was conducted using measurements at baseline, at 4 and 8 weeks. Non-parametric test for two correlate samples, was used to assess changes in means of the different scores. The protocol was approved by ethical committee of both dermatology service pariticipating to the study. RESULTS: Twenty-one oncologic patients were enrolled. Thirteen (61.9%) of participants were female. The median age was 63 years (range: 37-73). Seventeen (80.9%) patients presenting a HFS associated to capecitabine, and four patients (19.1%) associated to docetaxel. At the enrollment, 33.3% (7/21) of patients showed at level of the hands a HFS of grade 2 and 9.5% (2/21) of grade 3. At level of the feet, 28.6% (6/21) showed a HFS of grade 2, and 17.4% (4/21) of grade 3. The SRRC scores were significantly decreased after 8 weeks of treatment compared to baseline, for both sites. In particular, SRRC score decreased from 4.38 to 1.67 (Z=-3.60, P=0.00) and from 4.48 to 1.43 (Z=-3.87, P=0.00) for hands and feet, respectively. A consistent significant improvement in the perceived QoL of patients was also observed. From baseline to visit 3, the total mean score of DLQI decreased from 10.62 to 4.57 (Δ=-57%, Z=-4.020, P=0.000). CONCLUSIONS: In a sample of oncologic patients with HFS, the b.i.d. administration of TNOP for eight weeks, induced a progressive and significant decrease of the SRRC Score and a relevant improvement in the perceived quality of life.

Efficacy and tolerability of a spray product containing hydroxypropyl chitosan, climbazole and piroctone olamine, applied twice weekly for the treatment of the pitiriasis versicolor.

BACKGROUND: The aim of this study was to demonstrate the effectiveness of a product containing hydroxypropyl chitosan, climbazole and piroctone olamine, by monitoring the adherence and the penetration of the molecules in the skin. Confocal microscopy led us to show the persistence of the active compound for a long time in the stratum corneum, thanks to the presence of hydroxypropyl chitosan. This evidence suggests a new protocol of application (a biweekly application, rather than daily). METHODS: Thirty patients (17 males, 13 females; average age 20.8 years) were selected from 3 dermatological centers: the Dermatological Clinic of "Federico II" University of Naples; the Dermatological outpatient clinic of Bologna private hospital "Villa Nigrisoli"; the Section of Cutaneous Appendages of the European Dermatological Institute of Milan. The study protocol entailed application of a topical spray product 2 evenings a week for 2 months. Confocal microscopy, dermoscopy and photographic documentation were performed at the moment of diagnosis (T0), 12 hours after the first application (T1), after 7 days (T2), after 1 month (T3) and after 2 months (T4). RESULTS: The improvements of clinical symptoms were documented by dermoscopy and digital photos. Confocal microscopy shows the persistence of the product in the stratum corneum, at different times of observations. CONCLUSIONS: A biweekly application of a product containing hydroxypropyl chitosan, climbazole and piroctone olamine shows a clinical significative improvement, evaluated through digital photographs and dermoscopic images, with complete resolution at T4 in 100% of cases.

Efficacy and tolerability of a topical gel containing 3% hydrogen peroxide, 1.5% salicylic acid and 4% D-panthenol in the treatment of mild-moderate acne.

BACKGROUND: The aim of this paper was to evaluate efficacy and tolerability of a topical gel (ACNAID TM gel medical device) containing 3% hydrogen peroxide (HPO), 1.5% salicylic acid (SA) and 4% D-panthenol (D-p) in the treatment of mild-moderate acne, comparing it with a previous formulation (ACNAID TM gel Cosmetic) containing 4% HPO, 0.5% SA, 4% D-p. METHODS: Twenty patients of both sex with mild-moderate acne have been selected. The topical gel was applied twice a day for 60 days. Evaluations included: Global Acne Grading System (GAGS); lesions count; photographic assessment; a questionnaire to assess the tolerability. The results have been compared with those obtained in a previous study conducted with the formulation containing 4% HPO, 0.5% SA, 4% D-p. RESULTS: The GAGS score showed a reduction of 43% from T0 to T1 and of 61% from T0 to T2. Count of lesions: comedones reduction of 62% from T0 to T1 and of 95% from T0 to T2; papules reduction of 49% from T0 to T1 and of 68% from T0 to T2; pustules reduction of 75% from T0 to T1 and of 100% from T0 to T2. Digital images showed a significant reduction of acne lesions. At T2 the tolerability of the topical product was excellent according to 83% of patients and good according to 17% of patients. CONCLUSIONS: The topical gel has demonstrated to be effective and safe for treatment of mild to moderate acne. No patients reported side effects. These results are superior to those obtained in the previous study.

Acneiform Rash Induced by EGFR Inhibitors: Review of the Literature and New Insights.

Acneiform rash is the most common side effect of epidermal growth factor receptor (EGFR) inhibitors (EGFRis), and it occurs in 50-100% of patients. This condition can affect the quality of life of these patients and can sometimes lead to a discontinuation of the antineoplastic therapy. Several recent prospective studies have addressed and evaluated different interventions to mitigate or reduce the severity of EGFRis-associated skin rash. With this aim, we have established a dermocosmetological outpatient clinic for cancer patients at the Department of Clinical Medicine and Surgery, University of Naples Federico II in collaboration with the Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami. An interdisciplinary network of physicians can improve the quality of life of the cancer patients, focusing on such important aspects as dermocosmetological skin care, but also on the evaluation of new therapeutic and diagnostic algorithms in order to make further progress in the field of prevention. In this review, we summarize the state of the art of the epidemiology, pathogenesis, and treatment of EGFRis acneiform rash, and we describe our outpatient clinical experience.

EMPACT syndrome associated with phenobarbital.

Intracranial malignancies can be complicated by seizure activity, and anticonvulsants such as phenytoin are usually administered to prevent this neurological kind of complication. Cranial radiation therapy is instead the treatment of choice when the tumor is unresectable. Anyway, the combination of phenytoin and cranial radiation therapy can lead to a rare and severe mucocutaneous complication called EMPACT syndrome. It is composed of "erythema (E) multiforme (M) associated with phenytoin (P) and (A) cranial radiation (C) therapy (T)." Herein, we report 2 cases of EMPACT syndrome related to the use of phenobarbital instead of phenytoin as usually described in literature.

Trichomegaly of the eyelashes during therapy with epidermal growth factor receptor inhibitors: report of 3 cases.

A wide spectrum of skin toxicities has been described in patients receiving epidermal growth factor receptor (EGFR), inhibitors, including papulopustular rash, xerosis and fissures, pruritus, mucositis, paronychia, and hair changes.Trichomegaly of the eyelashes is a rare adverse effect of EGFR inhibitor therapy and is characterized by a paradoxical overgrowth of eyelashes. We present 3 cases of trichomegaly occurred during EGFR inhibitor therapy.

Chemotherapy and skin reactions.

BACKGROUND: New chemotherapic agents and new protocols in oncology have led to an increasing survival rate in patients affected by tumors. However, this increased use has been accompanied by a growth in the incidence of cutaneous side effects and a worsening of patients' quality of life. Appropriate management of skin toxicity associated with chemotherapic agents is therefore necessary for suitable drug administration and to improve quality of life and clinical outcomes. METHODS: We have clinically examined 100 patients affected by cancer, determining type, frequency, treatment, and evolution of side effects related to chemotherapy. RESULTS: The prevalent cutaneous side effects in patients undergoing chemotherapy are skin rash, xerosis, pruritus, paronychia, hair abnormality, and mucositis. The clinical cases are reported in detail. CONCLUSION: Oncological therapies have become more selective and have low systemic toxicity because of their high specificity, but cutaneous side effects are common and may worsen the quality of life of these patients.

Quality of life and contact dermatitis: a disease-specific questionnaire.

BACKGROUND: Contact dermatitis (CD) is a chronic disease with a significant impact on quality of life (QoL). There have been relatively few reports in the literature on specific QoL outcomes for patients suffering from CD. OBJECTIVES: To develop a new instrument specifically designed to measure QoL in CD and to investigate which disease features could strongly influence QoL. METHODS: Three hundred seventy-two patients affected by CD were administered a 20-item questionnaire, which comprised some questions taken and modified from the Dermatology Life Quality Index and the Skindex 16. Six more items were added. Univariate analysis and a chi-square test were performed. RESULTS: Females reported lower QoL scores than males. Three aspects (itching, discomfort, and difficulty in daily activities) were strongly associated with a poor QoL; even if patients who experienced difficulty in using their hands at work had a poor QoL, the statistical significance was very low. CONCLUSION: A CD-specific questionnaire can be used to understand a priori the impact on psychological behaviour of the patient and can lead to specific choices, such as the appropriate therapy to be used, the evaluation of treatment efficacy, the choice of preventive devices, and the comparison with QoL of other dermatoses.

Spitz nevus: follow-up study of 8 cases of childhood starburst type and proposal for management.

Spitz nevus is an uncommon, benign melanocytic neoplasm that shares many clinical and histological features with melanoma. It presents clinical ambiguity that makes the diagnosis and management of the patient difficult. We present our experience in the management of Spitz nevus by rigorous dermoscopic long-term follow-up of 8 Spitz nevi in patients younger than 12 years. Dermoscopic images, acquired every 6 months, show evolution and modifications of these lesions. The aim of this paper is to better understand the long-term modifications of nevi with starburst pattern to avoid surgical excision of these lesions in the pediatric age group.

Nicolau syndrome following intramuscular diclofenac injection: a case report.

Nicolau syndrome (NS) is a rare complication of intramuscular injection of various drugs which clinically presents with extensive necrosis of skin, subcutaneous and even muscle tissue. We describe a case of NS following intramuscular injection of diclofenac.