Discoid Lupus Erythematosus Presenting With Disfiguring Acneiform Plaques: A Diagnostic Challenge.

ABSTRACT: Hypertrophic and acneiform forms are very rare variants of discoid lupus erythematosus (DLE), which can suppose a diagnostic and therapeutic challenge. We present a South American woman with facial disfiguring lesions of 7 years of evolution with clinical and histopathological characteristic of both hypertrophic and acneiform DLE. No criteria for systemic lupus erythematosus were present in the patient. To the best of our knowledge, no patients with concomitant hypertrophic and acneiform DLE have been previously reported in the literature.

Chloracne: a case series on cutaneous expression of CYP1A1 as diagnostic biomarker.

Chloracne, also known as metabolizing acquired dioxin-induced skin hamartomas (MADISH), is a rare disfiguring disease related to dioxin exposure. There is a paucity of literature on the clinical manifestations and pathogenesis of chloracne/MADISH. The aim of this study was to assess the clinical features of this very unusual acneiform eruption and to explore the pathogenesis of the disease. This was a retrospective, observational report study was conducted on five patients belonging to the same nuclear family (father, mother and three children) and a relative (father's brother) living in the same house. Histopathological, immunohistochemical, laboratory and toxicological analyses were performed for all patients. The results suggest that CYP1A1 in human skin is a diagnostic biomarker in chloracne, and was positive for all the patients in our sample. Tetrachlorodibenzo-p-dioxin is the most investigated dioxin responsible for chloracne; however, several other agonists, whether dioxin-like or not, can activate the aryl hydrocarbon receptor. To our knowledge, this Italian case series is the first study to suggest polychlorinated biphenyls as a possible cause of an overstimulation of aryl hydrocarbons causing the consequent acneiform eruption.

Immunosuppressant-induced cutaneous drug reactions in solid organ transplant recipients.

Solid organ transplant recipients (SOTRs) are susceptible to various cutaneous side effects as a consequence of long-term immunosuppressive therapy. Skin cancers and infections are well-studied complications that can cause death and/or allograft rejection. Other cutaneous drug reactions, such as inflammatory manifestations, have a high prevalence but are rarely studied. We analyzed these manifestations' prevalence and their association with immunosuppressants in transplant recipients from a Brazilian tertiary center. Among 532 SOTRs followed at our dermatology clinic, 60 (11.3%) developed some cutaneous adverse reactions to the immunosuppressants, with a median age at transplantation of 50.5 years and a median life span posttransplantation of seven years. Acneiform eruption was the most common drug reaction found (21 patients, 30.4%), followed by diffuse non-scarring alopecia (16 patients, 23.1%), lymphedema (10 patients, 14.5%), gingival hyperplasia (7 patients, 10.1%), hypertrichosis (6 patients, 8.7%) and sebaceous hyperplasia (9 patients, 13.1%). Adequate immunosuppression is an essential prerequisite for successful organ transplantation. In the immediate post-transplant period, significant immunosuppression is needed, but after that, the complications of excessive immunosuppression outweigh the risk of organ rejection. SORTs may present with a broad spectrum of inflammatory and cosmetic findings due to immunosuppressants that can impair life quality.

Wound Healing Treatments After Ablative Laser Skin Resurfacing: A Review.

Laser resurfacing has progressed since the 1980s to treat a variety of medical and aesthetic indications with ever-evolving safety parameters. While laser technology has evolved to provide a more favorable safety profile and decrease wound healing time, advances in post-procedure healing agents have also helped to mitigate adverse effects, such as persistent erythema, dyspigmentation, acneiform eruptions, dermatitis, infections, and scarring. We reviewed the evidence of growth factors, stem cells, silicone and silicone polymers, botanical based treatments, fatty acids, probiotics, and closed dressings on post-ablative laser skin resurfacing. All reviewed agents demonstrated some evidence in improving post-procedure outcomes, albeit mixed in many cases. Additionally, these studies contain small numbers of participants, vary in type, strength, and clinical indication for which the resurfacing laser was used, and have differing postprocedural evaluation protocols and assessments. This highlights a need for standardization of clinical studies and the importance of choosing an optimal postprocedural skincare plan depending on every unique clinical scenario. J Drugs Dermatol. 2020;19(11):1050-1055. doi:10.36849/JDD.2020.5386.

Eruptive milia and acneiform hyperkeratosis with comedones (pseudo-epidermal cysts) within tattoos.

BACKGROUND: Milia are small, hard, white superficial epidermal cysts measuring a few millimetres that can occur during skin healing due to occlusion of pilosebaceous units. Milia rarely occur on tattoos. However, cases of allergic reactions with hyperkeratosis and open comedones have been described in the literature, sometimes under the term "epidermal cysts". PATIENTS AND METHODS: We saw three patients who developed milia, including a 32-year-old man with eruptive milia 10 weeks after getting a black, red and green tattoo on his upper arm. Topical tretinoin was applied. We encountered two further cases of eruptive milia on black/grey tattoos. A fourth patient presented a massive hyperkeratotic reaction with retention comedones on the red/pink area of a tattoo. DISCUSSION: The occurrence of milia and acneiform allergic reactions after tattooing is rare. We collated a total of 13 cases from the literature, of which 8 involved milia. This condition occurred within 3 months following tattooing, with no particular correlation with any given colour, and generally without any allergic reaction (except in one case). Reactions comprising excessive acneiform hyperkeratosis and open comedones were noted with pink and red inks and were a complication in a setting of allergic inflammatory reaction. However, the histopathology of these reactions is poorly described in the literature. It seems inappropriate to diagnose the condition as "epidermal cysts" since the lesions are not in fact simple cysts but rather retention lesions occurring during an inflammatory reaction and are thus different from post-traumatic milia.

Acneiform follicular mucinosis: an indolent follicular mucinosis variant unrelated to mycosis fungoides?

Follicular mucinosis (FM) can present as an acneiform eruption, and is usually a benign variant of primary FM unrelated to cutaneous T-cell lymphoma (CTCL). We report two cases of women in their twenties who presented with an acneiform rash on the face, arms and back. In both cases, pathological evaluation of the facial papules revealed predominantly mucinous degeneration of the follicular epithelium, with insufficient lymphocytic infiltration or atypia to diagnose mycosis fungoides. These cases are similar to previous reports of acneiform FM. As none of the reported cases progressed to CTCL, we consider that overdiagnosis and overtreatment should be avoided in acneiform FM, but recommend long-term follow-up.

The ginseng pimple: an inflammatory papule following ginseng consumption.

Ginseng is a popular herbal remedy derived from the plant roots of the Panax genus and has been used in traditional Asian medicine for thousands of years. In the United States, it has become increasingly popular and is taken for many conditions, including as an immune enhancer. Cutaneous adverse effects have been reported to occur following ginseng consumption, although detailed clinical descriptions are limited. A 60-year-old woman who repeatedly developed inflammatory papules following ginseng consumption is described and the characteristics of ginseng use in healthcare are reviewed.

Incidence of skin toxicity in squamous cell carcinoma of the head and neck treated with radiotherapy and cetuximab: A systematic review.

PURPOSE: Radiotherapy plus cetuximab is an effective combination therapy for locally advanced head and neck squamous cell carcinoma. The aim of our study was to determine the frequency of skin toxicity in patients receiving the combined treatment. RESULTS: Forty-eight studies were included in our analysis, for a total of 2152 patients. The mean rates of G3/G4 radiation dermatitis and acneiform rash were 32.5% (SD: 20.4; 95% CI: 28.5-36.5) and 13.4% (SD: 11.5; 95% CI: 11.2-15.6), respectively. The majority of studies referred to CTCAE scales for reporting both side effects (85.7% and 92.1%, respectively). Data on the management of skin toxicity were available in only 35.4% of the reviewed literature. CONCLUSIONS: severe radiation dermatitis is a frequent side effect induced by the combination of radiotherapy and cetuximab in head and neck cancer. The lack of predictive biomarkers of toxicity hampers the possibilty to design preventive measures on a personalized basis.

A Phase Ib Dose-Escalation Study of the Safety, Tolerability, and Pharmacokinetics of Cobimetinib and Duligotuzumab in Patients with Previously Treated Locally Advanced or Metastatic Cancers with Mutant KRAS.

LESSONS LEARNED: Cobimetinib and duligotuzumab were well tolerated as single agents and in combination with other agents.The cobimetinib and duligotuzumab combination was associated with increased toxicity, most notably gastrointestinal, and limited efficacy in the patient population tested. BACKGROUND: KRAS-mutant tumors possess abnormal mitogen-activated protein kinases (MAPK) pathway signaling, leading to dysregulated cell proliferation. Cobimetinib blocks MAPK signaling. The dual-action antibody duligotuzumab (MEHD7945A) inhibits ligand binding to both epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 3 (HER3). Blockade of EGFR/HER3 and inhibition of mitogen-activated protein kinase (MEK) in KRAS-mutant tumors may provide additive benefit. METHODS: Patients with KRAS-mutant solid tumors were eligible for this phase Ib dose-escalation study with a planned expansion phase. Duligotuzumab was given intravenously (IV) at 1,100 mg every 2 weeks (q2w), while cobimetinib was given orally in a standard 3 + 3 design to identify the recommended phase II dose (RP2D). The primary objective was to evaluate the safety and tolerability of this combination. RESULTS: Twenty-three patients were enrolled. Dose-limiting toxicities (DLTs) included grade 4 hypokalemia and grade 3 mucosal inflammation, asthenia, and dermatitis acneiform. Seventy percent of patients experienced grade 3 or worse adverse events (AEs). Five (22%) and 12 (52%) patients missed at least 1 dose of duligotuzumab and cobimetinib, respectively, and 9 (39%) patients required a cobimetinib dose reduction. Three (13%) patients discontinued due to an AE. Best response was limited to 9 patients with stable disease and 13 patients with progressive disease. CONCLUSION: Given the limited tolerability and efficacy of this combination, the study did not proceed to expansion stage and closed for enrollment.

Frecuencia, severidad y ubicación de erupciones acneiformes en hombres y mujeres tras una cirugía ortognática: estudio descriptivo longitudinal / Frequency, severity and location of acneiform eruptions in men and women after orthognathic surgery: longitudinal descriptive study

Describir la frecuencia de erupciones acneiformes y/o exacerbaciones de un acné previo tras una cirugía ortognática. La muestra consta de 57 pacientes (n=57) de ambos sexos, sometidos a una cirugía ortognática, los cuales fueron evaluados en: el preoperatorio (0-7 días previos); en distintas etapas de la cirugía; postoperatorio inmediato (7 ­ 15 días post cirugía) y postoperatorio mediato (30 ­ 40 días postquirúrgicos). En todos los controles clínicos mencionados se determinó la presencia/ausencia, ubicación, severidad y diagnóstico de las erupciones acneiformes. El 52,6 % de los pacientes sometidos a cirugía ortognática presentaron erupciones acneiformes, siendo mayores en las mujeres en comparación con los hombres. La severidad de las erupciones acneiformes es mayor en el postoperatorio inmediato en comparación al preoperatorio y postoperatorio mediato. La ubicación más frecuente del acné corresponde a la región frontal, tanto en el preoperatorio (22,8 %) como en el postoperatorio inmediato (31,6 %). En el postoperatorio mediato la zona más frecuente es la geniana (39 %). La frecuencia de acné post cirugía ortognática es elevada, siendo mayor en mujeres que en hombres. La severidad de este acné es mayor en el postoperatorio inmediato. La región frontal corresponde a la zona más frecuente de aparición de las erupciones acneiformes en el postoperatorio inmediato y la zona geniana en el postoperatorio mediato. El diagnóstico de estas erupciones acneiformes corresponde a un acné esteroidal, por lo que se puede sugerir un posible plan de tratamiento, con el fin de mejorar el postoperatorio de las pacientes y evitar, en lo posible, futuras manifestaciones en nuevas pacientes sometidas a este tipo de cirugía.

Describe the frequency of acneiform eruptions and / or exacerbations of a previous acne after orthognathic surgery. The sample consisted of 57 patients (n = 57) of both genders, undergoing orthognathic surgery, who were evaluated with a follow-up of 2 postoperative months, at different stages of surgery; Preoperative (0-7 days), immediate postoperative (7-15 days) and mediate postoperative (30-40 days). The presence / absence, location, severity and diagnosis of acneiform eruptions were determined in all clinical controls. The frequency of acneiform eruptions corresponds to 52.6 % of patients undergoing orthognathic surgery, being higher in women compared to men in relation to the presence of acneiform eruptions and / or exacerbations of a previous acne after the intervention. The severity of acneiform eruptions is greater in the immediate postoperative period compared to the preoperative and mediate postoperative period. The most frequent location to be found in the facial region is in the frontal area, both in the preoperative (22.8 %) and in the immediate postoperative period (31.6 %). In the postoperative period, the most frequent is the genial area (39 %). The appearance of acneiform eruptions corresponds to steroidal acne. The frequency of acne post orthognathic surgery is high, being higher in women than in men. The severity of this acne is greater in the immediate postoperative period. The frontal region corresponds to the most frequent area of onset of acneiform eruptions in the immediate postoperative period and the genial area in the postoperative period. The diagnosis of these acneiform eruptions corresponds to a steroidal acne, so it is possible to suggest a possible treatment plan, in order to improve the postoperative of the patients and to avoid, as far as possible, future manifestations in new patients undergoing this type of surgery.

Review and Management of Acneiform Eruptions in Patients with Immune Disorders.

Immune disorders are associated with acne or acneiform lesions secondary to the occurrence of acne vulgaris or acneiform eruptions arising as a result of immunosuppressive medication or infection. In this review, we aim to provide an overview of acne and acneiform eruptions that can arise in the immunosuppressed host. Tips for differentiating between various acneiform entities are discussed, as well as a brief overview of treatment considerations.