Secukinumab Therapy for Netherton Syndrome.

Importance: Netherton syndrome (NS) is a rare, severe genetic disorder of cornification with high morbidity. Treatment for NS has been notoriously difficult. Recent studies showed an upregulated helper T cell (TH) 17/interleukin 23 (IL-23) pathway in NS, suggesting the possibility of treatment strategies that target IL-17. Objective: To evaluate the clinical response of NS to treatment with the IL-17 antagonist secukinumab. Design, Setting, and Participants: This case series study reports the experience of compassionate use therapy with secukinumab in 4 patients with severe NS, including 2 children, from December 1, 2018, to December 1, 2019, with 3 patients still undergoing treatment at the time of final analysis. Data were analyzed from December 1, 2018, to December 1, 2019. Main Outcomes and Measures: Expression of IL-17 in the skin was evaluated by immunohistochemical analysis, and serum cytokine concentrations were measured using a commercially available assay. Treatment response was assessed using the Ichthyosis Area and Severity Index (IASI) total score, including measures of erythema and scaling, the Dermatology Life Quality Index (DLQI), and the 5-D itch scale. Results: In all 4 patients (age range, 9-27 years; 3 male and 1 female), immunostaining with an IL-17A antibody showed an increased number of positive cells in lesional skin. Cytokine assessment in serum samples revealed increased levels of CCL20. Treatment duration with secukinumab was 3 to 12 months at the time of this report. After 3 months of therapy, IASI scores were reduced by 44% to 88%, DLQI scores were reduced by 40% to 76%, and 5-D itch scale scores were reduced by 27% to 62%. This outcome was sustained at the 6-month follow-up. Two patients with an erythrodermic phenotype showed marked improvement of all parameters. A refractory palmoplantar eczematous eruption occurred in 2 patients, and a candidal nail infection developed in 2 patients. No severe adverse events were reported. Conclusions and Relevance: This initial case series reporting the use of anti-IL-17 therapy in NS demonstrated marked cutaneous improvement, particularly in 2 pediatric patients with erythrodermic phenotypes. Further studies are needed to evaluate the long-term benefit of this potential treatment modality.

Onychocryptosis and asymptomatic external urethritis as complications of oral isotretinoin therapy.

This case report presents a patient who, while undergoing oral isotretinoin therapy for acne vulgaris, developed onychocryptosis and asymptomatic external urethritis. These uncommon adverse events are not well-documented in medical literature. While his urethritis spontaneously resolved, his onychocryptosis symptoms necessitated surgical intervention. This report illustrates both cosmetic and functional adverse effects of isotretinoin and provides insight into the progression of these reactions over time.

Onicomicosis subungueal proximal en paciente tratado con inhibidores del factor de necrosis tumoral alfa / Proximal subungual onychomycosis in a patient treated with tumor necrosis factor alpha blockers

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Elconixis por isotretinoína / Isotretinoin-induced elkonyxis

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Cumulative arsenic exposure is associated with fungal infections: Two cohort studies based on southwestern and northeastern basins in Taiwan.

Long-term arsenic exposure results in atherosclerosis and cancers, along with aberrant immune responses. Animal-based and epidemiological studies indicate that arsenic exposure increases susceptibility to viral and bacterial infections. This study aimed to assess whether arsenic exposure is associated with the development of fungal infection, which is substantially attributed to as a cause of aberrant immunity. Based on two well-established cohorts from two basins in southwestern (SW; high arsenic area) and northeastern (NE; low arsenic area) Taiwan (n=297 and 2738, respectively), the arsenic exposure in well water was estimated using HPLC-ICP-MS. Fungal infections were defined via clinical and mycological assessments (PCR of fungal 18S rRNA) of nail samples. Individuals in SW cohort with cumulative arsenic exposure >10,000µg/L∗years had a higher risk of developing fungal infections (OR=1.57, 95% CI=1.08-1.92) after adjusting for diabetes and occupation. In NE cohort, female sex, alcohol consumption, and chronic kidney diseases were associated with toenail infections. In contrast, fingernail infections (OR=1.33, 95% CI=1.05-1.68) were highly associated with arsenic exposure in a dose-dependent manner. We are the first to report palmar and plantar hyperkeratosis upon low arsenic exposure in 3.9% and 6.7% individuals, respectively. This is the first large-scale study showing arsenic exposure is associated with fungal infections in a dose-dependent manner.

Ocorrência de espécies fúngicas isoladas a partir de mãos e unhas de trabalhadores / Occurrence fungal species isolated from hands and nails of workers

Contexto: A infecção fúngica que acomete as mãos, além de funcionar como porta de entrada para infecções, também pode causar dor, desconforto, limitação física e ocupacional. As pesquisas de microrganismos nas mãos de trabalhadores e as recomendações relacionadas à higiene adequada das mãos valorizam mais o risco de contaminação de alimentos e objetos e a transmissão de infecções a terceiros, desconsiderando muitas vezes a importância de manter a saúde das mãos dos profissionais. É importante conhecer a legislação e as orientações pertinentes que regulamentam as atividades profissionais e os aspectos relacionados ao desempenho profissional para promover medidas de proteção e prevenção de agravos à saúde do trabalhador e no estabelecimento de nexo que possa existir com dermatose ocupacional. Objetivo: Pesquisar sobre estudos de espécies fúngicas isoladas a partir das mãos de manipuladores de alimentos e profissionais da área de saúde, comparar com espécies isoladas em outras populações, destacar as dermatoses cutâneas por agentes biológicos e mais especificamente por fungos dermatófitos e Candida, abordar aspectos relacionados à segurança, saúde e medicina do trabalho. Métodos: Revisão de literatura de artigos publicados nos bancos de dados da CAPES, sítio da biblioteca virtual em saúde, SciELO e pesquisas em livros específicos. Conclusões: Evidenciou-se diferenças na detecção de fungos nas mãos de trabalhadores, em manipuladores de alimentos os percentuais variaram de 26,3 a 63,4% e em profissionais de saúde a variação foi desde 6,7 até 93%; predominaram espécies de Candida. Observou-se, em outras populações, menor percentual de positividade dos exames laboratoriais e predomínio de dermatófitos.

Context: The fungal infection that affects the hands, in addition to functioning as a gateway for infection, can also cause pain, discomfort, physical and occupational limitations. Research of microorganisms in the hands of workers and recommendations related to proper hand hygiene value the risk of contamination of food and objects and transmission to third parties infections, often disregarding the importance of maintaining the health of the hands of professionals. It is important to know the relevant legislation and guidelines governing their professional activities and aspects related to the performance to promote protection and prevention of harm to workers? health and the nexus of business that might exist with occupational dermatosis. Objective: To analyse studies of fungal species isolated from the hands of food handlers and health professionals, to compare them to species from other populations, highlighting the skin dermatoses by biological agents and more specifically by dermatophytes and Candida, and to address aspects related to safety, health and occupational medicine. Methods: Literature review of articles published in the CAPES, Biblioteca Virtual em Saúde website, and SciELO databases and also from specific books. Conclusions: Differences were identified in the detection of fungi in the hands of workers; in the food handlers the percentage ranged from 26.3 to 63.4%; and in health professionals the range was from 6.7% to 93%, with a prevalence of Candida species. It was observed, in other populations, lower percentage of positive laboratory tests and prevalence of dermatophytes.

Onycholysis associated with paclitaxel.

Chemotherapeutic agents are known to cause a myriad of cutaneous side effects that the dermatologist is often called upon to identify and treat. The taxoid drug paclitaxel is commonly used in oncology. To date, there have been few adverse dermatologic effects reported secondary to paclitaxel use. This is in contrast to the related drug docetaxel. We report a case in which paclitaxel caused onycholysis and nail loss in a patient being treated for lung cancer. To our knowledge, this finding has not previously been reported in the American dermatologic literature, though it has been reported in association with docetaxel use. It is important for clinicians to recognize that onycholysis can be associated with paclitaxel. Prompt recognition may prevent the unnecessary use of antibiotics or antifungal medications. Discontinuation of paclitaxel chemotherapy generally is not required, and regrowth of nails can be expected following completion of therapy.