Microbiological analysis of epidermal growth factor receptor inhibitor therapy-associated paronychia.

BACKGROUND: Paronychia is a well-known, but difficult to treat cutaneous toxicity associated with epidermal growth factor receptor (EGFR) inhibitor therapy. Although bacterial and fungal infections as well as mechanical trauma may play a role as co-pathogens, there is no good basis for an empirical antimicrobial chemotherapy in these patients. MATERIALS AND METHODS: We retrospectively analysed the microbiological results and resistance analysis of 42 cases of EGFR inhibitor-associated paronychia induced by cetuximab. RESULTS: We identified 20 different species, among these 72% Gram-positive bacteria, 23% Gram-negative bacteria and 5%Candida species. About half of the microbes identified may be considered as residential bacterial flora of the skin, but isolation of microbes from paronychia may indicate a pathogenic relevance for this type of reaction. Eight of our patients were treated with oral antibiotics, whereas two patients received oral antimycotic therapy. All other cases of paronychia were controlled using topical antiseptic, antibiotic and antimycotic agents. CONCLUSION: Empirical oral antibiotic treatment may be performed with oral cephalosporines, ciprofloxacin, levofloxacin or moxifloxacin, as these antimicrobials have high in vitro activity against the majority of the isolated microorganisms and reach high concentrations in the relevant tissue.

Risk factors in Hymenoptera venom allergy.

. Risk factors should be part of the decision, of which patient should be offered venom immunotherapy (VIT) and how VIT should be performed. Risk factors for a severe systemic anaphylactic reaction (SAR) after a Hymenoptera field sting include a preceding less severe sting reaction, a wasp sting, an increased baseline serum tryptase concentration (BSTC), mastocytosis, older age, ACE inhibitor medication, and male gender. During VIT, treatment with honey bee venom is the most important risk factor for a SAR. Further risk factors include a high BSTC (for vespid VIT only), presence of venom specific IgE in serum, any antihypertensive medication during therapy, and an ultra-rush protocol for build-up. Treatment failure is more common in patients suffering from honey bee venom allergy, high BSTC (for vespid VIT only) or mastocytosis, and in those who had experienced side effects during VIT. Besides discontinuing antihypertensive medication or switching to a moderate type of dose increase during build-up, little can be done to minimize the risks associated with VIT. Increasing the maintenance dose may improve the efficacy of VIT. In patients with a particularly high risk for treatment failure, or in case of treatment failure, VIT should include an increased maintenance dose right from the beginning. Usually, 200 µg will be sufficient.

Correlations of splitting and phobic anxiety with dreaming.

Dream characteristics of 28 women from a graduate counseling program were correlated with measures of phobic anxiety, splitting, and sleepiness. Significant correlations between splitting and recurrent nightmares (.68), agoraphobia and dreams about death (.44), and global phobia and recurrent nightmares (.56) were obtained. Results are discussed in terms of how phobic anxieties and splitting may relate to traumatic content and the dream process.

Analysis of factor structure in a dream inventory.

Intercorrelations of responses to the KJP dream inventory, initially a checklist of dream elements, were factor analyzed from a database from 65 graduate majors in psychology. Six factors were identified within the checklist: repetitive traumatic dreaming, reoccurring pleasantness, openness or depth, discontentedness, dissociative avoidance, and uninhibitedness. Scoring criteria were developed for each subscale.

Fear of fat and the dream process: a correlational investigation.

Dream characteristics of 27 women from a graduate counseling program were correlated with the Goldfarb Fear of Fat Scale. Significant positive correlations were obtained for scores with recurrent nightmares (.38) and dreaming one is dreaming (.40). An inverse relationship was noted between sexual content of dreams and scores for fear of fat (-.41). Results were discussed in terms of associations among dissociation, body image, and the dream process.

Risk-taking, death anxiety, and dreaming.

Dream characteristics of 29 women from a graduate program were correlated with scores on the Sensation-Seeking and Death Anxiety scales. Significant positive correlations were obtained between Sensation Seeking and dream frequency (.38), meaningful dreams (.38), and Openness and depth of dreaming (.39) as well as between Thrill-seeking and dream frequency (.41) and meaningful dreams (.41). Death Anxiety scores positively related to the occurrence of nightmares (.37), representations of death in dreams (.55), and recurring nightmares (.38), but no support was found for a relationship between death anxiety and Sensation Seeking.

[Cutaneous side effects of EGFR inhibitors--appearance and management]. / Hautreaktionen unter EGFR-Inhibitoren--Klinik und Management.

Epidermal growth factor receptor (EGFR) inhibitors such as cetuximab, erlotinib, panitumumab und gefitinib, are increasingly used for the treatment of advanced, metastatic, or recurrent tumours like colorectal carcinoma, non-small cell lung cancer (NSCLC), squamous cell carcinoma of the head and neck (SCCHN) and pancreatic cancer. For this reason the treatment of common cutaneous side effects of EGFR inhibitors has become important: they stigmatize the patient in daily life and may lead to efficacious therapie being discontinued. Depending on the particular EGFR inhibitor, an acneiform rash occurs in 30 to 90 % of patients. Severity, site, stage of eruptions and individual response influence the decision of treatment in the given case. It follows the forms of treatment for acne and rosacea, including topical and systemic antibiotics for their antimicrobial effect and anti-inflammatory effect, sometimes in combination with topical steroids. After several weeks additional sebostatic skin reactions, paronychia and changes in the hair structure may occur, calling for individualized treatment. Only multidisciplinary collaboration between oncologists, radiotherapist and dermatologists may provide an optimal patient care. This article gives an overview of the occurrence and latest treatment options of the cutaneous side effects caused by treatment with EGFR inhibitors.

[Therapy of severe cetuximab-induced acneiform eruptions with oral retinoid, topical antibiotic and topical corticosteroid]. / Therapie schwerer akneiformer Cetuximab-Exantheme mit oralem Retinoid, topischem Antibiotikum und Steroidexternum.

The biological agent cetuximab specifically inhibits the epidermal growth factor receptor (EGFR) function. Cetuximab is licensed for treatment of metastatic colorectal carcinoma, as it enhances the efficacy of cytostatic therapy. Acneiform drug eruptions are common side effects. We report two patients with metastatic colorectal carcinoma, who developed a severe acneiform drug eruption on the face and upper part of the body during the treatment with cetuximab. Triple therapy consisting of systemic isotretinoin, topical nadifloxacin and topical corticosteroid produced rapid improvement with moderate cheilitis the only side effect. We conclude that triple therapy is an effective treatment for patients with severe acneiform drug eruptions caused by cetuximab.