Efficacy and Safety of Precision Cryotherapy to Treat Seborrheic Dermatitis of the Scalp.

BACKGROUND: Recently, a new cryotherapy device that precisely controls skin temperature was developed. Precision cryotherapy (PC) can be a safe and alternative treatment modality for immune-related skin diseases that are difficult to treat by conventional cryotherapy because of serious adverse events. OBJECTIVE: To evaluate the efficacy and safety of PC in scalp seborrheic dermatitis (SD). METHODS: A single-arm, prospective trial was designed. Twenty-four patients with SD underwent 3 PC interventions 2 weeks apart. At the baseline, Week 6, and Week 8, overall improvements in Physician Global Assessment (PGA) and clinical severity scores were assessed. At each visit, the erythema index (EI) and transepidermal water loss were evaluated. The patients scored 9 subjective symptoms using a visual analog scale (VAS). RESULTS: The itch VAS score decreased by 50.4% at Week 8. Blinded investigators reported improvement of PGA scores from 2.86 ± 0.62 to 1.66 ± 0.61 and clinical severity scores from 4.55 ± 1.30 to 2.45 ± 1.37. The average EI decreased by 19.6% at Week 8 ( p < .05). CONCLUSION: This study not only demonstrated the efficacy and safety of PC in scalp SD but it also revealed insights for PC being a promising treatment modality in immune-related skin diseases.

Hiperplasias sebáceas eruptivas por ciclosporina en paciente trasplantado renal / Eruptive sebaceous hyperplasias secondary to ciclosporin in a renal transplant patient

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Prospective Case Series of Cutaneous Adverse Effects Associated With Dabrafenib and Trametinib.

BACKGROUND: Dabrafenib, a novel selective small-molecule inhibitor of BRAF, has been shown to increase overall survival in patients with unresectable metastatic melanoma harboring the BRAF V600E mutation. The development of resistance has led to combination therapy with selective MEK inhibitor trametinib. Compared with vemurafenib, dabrafenib is a more recent BRAF inhibitor approved by the Food and Drug Administration in May 2013 for metastatic melanoma; fewer data are available in the current literature regarding cutaneous toxicity. OBJECTIVES: We sought to present additional cutaneous side effects of dabrafenib and trametinib and follow their evolution and management. METHODS: We carried out a prospective study of 14 patients treated with dabrafenib alone or with trametinib. Patients were followed every 4 weeks, and we collected detailed cutaneous symptoms, photos, and biopsy specimens. RESULTS: All patients presented with at least 1 adverse skin reaction. The mean duration of treatment was 24 weeks. The most common adverse effect was papillomas (7/14), followed by palmoplantar hyperkeratosis (5/14), alopecia (5/14), and seborrheic dermatitis-like eruption (2/14). Three patients who received trametinib developed an acneiform eruption (3/5). One patient developed a keratoacanthoma-like squamous cell carcinoma. Side effects presented as early as 2 weeks after starting therapy, with a mean time of onset of 9 weeks. CONCLUSION: Selective BRAF inhibitor dabrafenib and MEK inhibitor trametinib are associated with multiple skin adverse effects. Given their recent approval and the potential for malignant lesions to develop on treatment, awareness of potential adverse effects and their management is necessary.

Skin lesions in patients treated with imatinib mesylate: a 5-year prospective study.

Imatinib mesylate (IM) represents the first-line treatment of patients with chronic myeloid leukemia (CLM) or gastrointestinal stromal tumor (GIST). It presents several side effects. However, less than 10% are nonhematologic including nausea, vomiting, diarrhea, muscle cramps, and cutaneous reactions. The aim of our study was to identify data regarding IM cutaneous adverse effects (AEs) to improve the clinical diagnosis and management of the more frequent side effects. Skin examination should be done before and during IM treatment so that AEs can be diagnosed and treated early with less impact on chemotherapy treatments and on the quality of life of the patient.

Hand-foot syndrome and seborrheic dermatitis-like eruption induced by erlotinib.

Erlotinib is an epidermal growth factor receptor tyrosine kinase inhibitor that is responsible for several cutaneous side effects. We report a case of hand-foot syndrome associated with a papulo-pustular and seborrheic dermatitis-like eruption of the face in a 61-year-old patient treated with erlotinib for lung cancer.

Seborrheic dermatitis-like eruption in patients taking isotretinoin therapy for acne: retrospective study of five patients.

BACKGROUND: Isotretinoin therapy for acne is often associated with mucocutaneous reactions that are usually dose dependent. OBJECTIVE: To describe the characteristics of five patients who presented with a peculiar facial rash that developed during or after a successful course of isotretinoin therapy for acne. METHODS: In this retrospective study, five patients who were treated with isotretinoin and who developed, during or following treatment, a peculiar facial eruption that has not previously been reported, are described. The clinical characteristics, laboratory findings, therapy, and course of the eruption are presented. RESULTS: The rash was characterized by small, yellow, adherent, greasy scales, either flat-topped or spiky, mostly on the cheeks, that resembled seborrheic dermatitis. Cultures obtained in one case grew Staphylococcus coagulase-negative, Acinetobacter, and Pityrosporum ovale organisms. In another patient, microscopic study showed hyperkeratotic scales with many spores and Gram-negative coccobacilli. Topical administration of ointments containing chloramphenicol 3% for 2-3 weeks was curative. CONCLUSION: Seborrheic dermatitis-like eruption may be another adverse cutaneous effect of isotretinoin treatment. Its pathogenesis probably involves a minimal toxic retinoid effect on epidermal differentiation with overgrowth of commensal microorganisms in susceptible individuals.

Efectos cutáneos adversos causados por erlotinib / Adverse cutaneous reactions to erlotinib

Introducción. El erlotinib es un inhibidor del factor de crecimiento epidérmico humano aprobado en el tratamiento del cáncer de pulmón no microcítico. El objetivo de este estudio prospectivo y observacional es determinar la prevalencia de los efectos cutáneos adversos por erlotinib y su manejo. Métodos. Once pacientes con cáncer de pulmón y una con cáncer de ovario fueron tratados con erlotinib en dosis de 150 mg diarios. Se evaluó la prevalencia, la intensidad y la cronología de los efectos cutáneos adversos. Resultados. La reacción cutánea más frecuente fue la erupción acneiforme (10 casos). Los pacientes fueron tratados con eritromicina o clindamicina tópicas, o con doxicilina. Los pacientes también desarrollaron dermatitis seborreica (5), paroniquia (4), xerosis (3), aftas orales (3), blefaritis (2), queilitis (1) y fisuras en manos y pies (1). Los efectos adversos más precoces fueron la dermatitis seborreica (9,8 días hasta la aparición) y la erupción acneiforme (11,8 días), mientras que la paroniquia fue el efecto más tardío (65,3 días). Un paciente con erupción acneiforme y otro con paroniquia suspendieron el tratamiento con erlotinib hasta la mejoría de las lesiones. Conclusiones. El erlotinib produce efectos cutáneos adversos en la gran mayoría de los pacientes tratados. La erupción acneiforme, la dermatitis seborreica y la paroniquia son los efectos más frecuentes, que pueden llevar a interrumpir temporalmente la administración de erlotinib

Introduction. Erlotinib is an inhibitor of human epidermal growth factor approved for treating non-small cell lung cancer. The aim of this prospective observational study was to determine the prevalence of adverse cutaneous reactions caused by erlotinib and assess the management of such effects. Methods. Eleven patients with lung cancer and 1 with ovarian cancer received erlotinib at a dose of 150 mg/d. The prevalence, severity, and time course of the adverse cutaneous reactions were assessed. Results. The most frequent cutaneous reaction was acneiform eruption (10 cases). The patients were treated with topical erythromycin and clindamycin, or with doxycycline. Also reported were seborrheic dermatitis (5), paronychia (4), xerosis (3), mouth blisters (3), blepharitis (2), cheilitis (1), and fissures on the hands and feet (1). The first reactions to appear were seborrheic dermatitis (9.8 days until onset) and acneiform eruption (11.8 days), whereas the paronychia presented latest (65.3 days). One patient with acneiform eruption and another with paronychia suspended treatment until the lesions improved. Conclusions. Erlotinib induces adverse effects in most patients treated. Acneiform eruption, seborrheic dermatitis, and paronychia are the most frequently reported reactions and can lead to temporary suspension of erlotinib administrat

Hepatotoxicidad por ebastina / Ebastine-induced hepatotoxicity

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Atypical antipsychotics and seborrheic dermatitis: three case reports.

Seborrheic dermatitis (SD) has no diagnostic criteria and its etiology remains unknown. SD is distributed in the areas rich in sebaceous glands. Initially, MALASSEZIA FURFUR was thought to be the causing agent. Currently, SD is thought as not being proportional to the mean yeast count, but rather as an abnormal host immune response to the yeasts on the skin. There are a variety of topical and systemic antifungal agents available as a remedy. Corticosteroids and ultraviolet B are also used as treatment.

[The use of lamotrigine in female patients]. / Lamotrigin bei Frauen: Eine Anwendungsbeobachtung.

BACKGROUND: Gender aspects are important when assessing the tolerability of antiepileptic drugs (AED). Due to its broad spectrum of action and to the lack of evidence for teratogenicity in monotherapy, lamotrigine (LTG) is an AED of first choice for women with epilepsy with child-bearing potential. METHOD: In an observational study over 6 months including 832 women with epilepsy, we evaluated the efficacy and tolerability of LTG in monotherapy and add-on therapy, with a special focus on parameters of particular importance for women including changes in weight, skin, hair, and patterns of menstruation. RESULTS: Of the treated patients, 94% had seizure reduction of at least 50%. Adverse events occurred in 7.3%; 1% experienced serious adverse events, all of which were reversible. Ninety-six percent continued treatment throughout the observation period, and 83% reported improvement in quality of life by the end of the study. Cognition, functioning at work, and mood improved in 43-54% of patients. In most of them, weight remained stable. Those who were switched from valporate (VPA) or carbamazepine (CPZ) to LTG lost 3.2 kg and 3.1 kg (means), respectively. Many of the women described problems related to menstruation at the beginning of the study: variability in cycle length (31.2%), hypermenorrhea (17.3%), and pains (10%). Skin and hair problems were reported by 18.4% and 17.3%, respectively. There was improvement in all of these aspects at the end of the study, particularly for those women switched from VPA or CBZ to LTG. CONCLUSION: In summary, this observational study confirms the good tolerability of LTG with respect to issues particularly relevant to women. More complete elucidation of the correct LTG dosage, which varies widely according to the accompanying medication, will further improve treatment safety.

Alopecia in association with severe seborrhoeic dermatitis following combination antiretroviral therapy for acute retroviral syndrome.

We present a case where alopecia occurred with severe seborrhoeic dermatitis associated with the commencement of combination antiretroviral therapy for acute retroviral syndrome. We postulate that the eruption could represent a novel manifestation in association with immunological response to antiretroviral therapy.

Unintended cutaneous reactions to CS spray.

CS spray (2-chlorobenzylidene malononitrile 5% w/v in methyl isobutyl ketone) has been used by the police force in the UK as an incapacitant for nearly a decade. It causes a number of well-recognized cutaneous reactions, which are generally regarded as short-lived. These include skin burning, erythema and blistering. However, a range of unpredictable cutaneous reactions to CS spray may also occur. We have found contact allergy, leukoderma, initiation or exacerbation of seborrhoeic dermatitis, and aggravation of rosacea following CS spray exposure in 6 police officers and 1 doorman. These skin reactions have required long-term changes in working practice for the affected individuals. Police officers may have repeated exposure to CS spray during their training and in their work, and designated police officers carry CS spray canisters daily in the line of duty. They may therefore be at greater risk of exposure to CS spray and its unintended effects than many assailants.

Multicenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus minocycline hydrochloride in the treatment of inflammatory acne vulgaris.

BACKGROUND: In addition to tetracyclines, zinc may constitute an alternative treatment in inflammatory lesions of acne. OBJECTIVE: To evaluate the place of zinc gluconate in relation to antibiotics in the treatment of acne vulgaris. METHODS: Zinc was compared to minocycline in a multicenter randomized double-blind trial. 332 patients received either 30 mg elemental zinc or 100 mg minocycline over 3 months. The primary endpoint was defined as the percentage of the clinical success rate on day 90 (i.e. more than 2/3 decrease in inflammatory lesions, i.e. papules and pustules). RESULTS: This clinical success rate was 31.2% for zinc and 63.4% for minocycline. Minocycline nevertheless showed a 9% superiority in action at 1 month and one of 17% at 3 months, with respect to the mean change in lesion count. Regarding safety, the majority of the adverse effects of zinc gluconate and of minocycline concerned the gastrointestinal system and were moderate (5 dropouts with zinc gluconate and 4 with minocycline). CONCLUSION: Minocycline and zinc gluconate are both effective in the treatment of inflammatory acne, but minocycline has a superior effect evaluated to be 17% in our study.

Imedeen in the treatment of photoaged skin: an efficacy and safety trial over 12 months.

BACKGROUND: UV-exposure induces photoaging of the skin. OBJECTIVE: Testing the efficacy and safety of oral Imedeen in photoaged skin. METHODS: Three month placebo-controlled randomized study of 144 subjects and 9-month-uncontrolled continuation. Efficacy measurements included clinical evaluation, self-evaluation, photograph evaluation, as well as ultrasound, transepidermal water loss and replica measurements. RESULTS: After 3 months, no significant effects were detected. One years treatment gave significant improvement compared with baseline in investigator's evaluation of fine lines and overall photoaging, in photograph evaluation of fine lines, overall photoaging, telangiectasia and hyperpigmentation, in self-evaluation of skin condition, density measurements by ultrasound, trans-epidermal water loss and skin smoothness from analysis of skin replica. No serious side-effects related to treatment were reported. CONCLUSION: Imedeen appears effective and safe for treatment of photoaged skin.