Acneiform Research Articles

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.

18107 Using oral retinoids to treat epidermal growth factor receptor–induced acneiform eruptions: A case series

Up to 80% of patients treated with epidermal growth factor receptor (EGFR) inhibitors have cutaneous side effects, which may necessitate dose adjustments or discontinuation. However, as cutaneous toxicity has been associated with greater drug efficacy, many patients would benefit from continued EGFR inhibitor therapy. We present a case series of 6 patients who were treated for papulopustular reactions related to EGFR inhibitors with oral retinoids after failing first line therapies. Six patients were identified by chart review (ages 37-73, 5 male, 1 female).

English

BACKGROUND Cutaneous adverse drug reactions are an important group of disorders which pose considerable amount of diagnostic and therapeutic challenges. The incidence of CADRs is estimated to be 1 - 2 % in the general population. We wanted to compare the clinico-epidemiological features of cutaneous adverse drug reactions in children and adults. METHODS The study sample comprised of two hundred and twenty patients of CADRs over a period of one and a half years. Patients were assessed using the WHO based algorithm of causality assessment of adverse drug reactions. RESULTS 222 rashes were seen in 220 patients and 315 drugs were implicated. The incidence of CADRs among dermatology patients was 10.18 per thousand patients. The incidence of CADRs among adults and children was 10.15 and 10.34 per thousand patients respectively. Out of the two hundred and twenty cases, thirty five (15.9 %) were in the paediatric age group (< 18 years of age). The most common cutaneous adverse drug reaction seen in our patients was maculopapular rash which was seen in 22 % patients. Antimicrobials were found to be the most common cause of CADRs in both adults and children, while drugs acting on the central nervous system were a close second. When rashes were taken individually, antimicrobials were the most common cause of maculopapular reactions, urticaria and toxic epidermal necrolysis in both children and adults. Acneiform eruptions were caused by steroids in 82 % of cases. Although fixed drug eruptions were most commonly caused by antimicrobials in adults (especially quinolones and nitroimidazoles), NSAIDs particularly nimesulide was also implicated in a substantial number of cases. CONCLUSIONS Newer antibiotics like cephalosporins are being used more often and thus a higher number of adverse drug reactions are seen with them. Therefore it would be useful for every individual institution to maintain a drug reaction registry. KEYWORDS Cutaneous Adverse Drug Reaction, Maculopapular Reactions, Urticaria, Toxic Epidermal Necrolysis

Choosing between isotretinoin and acitretin for epidermal growth factor receptor inhibitor and small molecule tyrosine kinase inhibitor acneiform eruptions

Choosing between isotretinoin and acitretin for epidermal growth factor receptor inhibitor and small molecule tyrosine kinase inhibitor acneiform eruptions

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.

Cetuximab Induced Hidrocystomas: A Case Report

Cetuximab is an epidermal growth factor receptor (EGFR) inhibitor that commonly results in follicular-based acneiform eruptions. EGFR is expressed in the epidermis, hair follicle epithelium, sweat gland apparatus, and plays an important role in the differentiation and development of the hair follicle. In this report we describe a 70-year-old man who developed an acneiform eruption on his nose, cheeks, neck, and back when cetuximab was started for metastatic colorectal carcinoma. This initial eruption improved with cessation of cetuximab but left residual cystic papules on his nose and multiple superficial white cysts on his bilateral cheeks, neck and back. Skin biopsy of a representative lesion on the nose revealed a cyst-like cavity lined with epithelium similar to sweat glands within the dermis consistent with a hidrocystoma. In this case, it is plausible that the use of an EGFR inhibitor resulted in a cutaneous inflammatory reaction, that subsequently healed with blockage of the sweat duct apparatus causing the formation of cutaneous cysts, including both hidrocystomas and milia. Alternatively, the blockage of the duct may have resulted from inhibition of basal cell migration and increased cell adhesion within the eccrine gland causing accumulation of eccrine gland secretion, and eventually hidrocystomas. To our knowledge, this is the first case describing the resolution of a typical cetuximab-induced acneiform eruption with residual hidrocystomas and milia.

Акнеподобная сыпь – дерматологическое нежелательное явление терапии моноклональными антителами к EGFR

Акнеподобная сыпь – дерматологическое нежелательное явление терапии моноклональными антителами к EGFR

Cutaneous reactions in children treated with MEK inhibitors, BRAF inhibitors, or combination therapy: A multicenter study

Treatment with BRAF inhibitors (BRAFI) and MEK inhibitors (MEKI) causes cutaneous reactions in children, limiting dosing or resulting in treatment cessation. The spectrum and severity of these reactions is not defined. To determine the frequency and spectrum of cutaneous reactions in children receiving BRAFI and MEKI and their effects on continued therapy. A multicenter, retrospective study was conducted at 11 clinical sites in the United States and Canada enrolling 99 children treated with BRAFI and/or MEKI for any indication from January 1, 2012, to January 1, 2018. All children in this study had a cutaneous reaction; most had multiple, with a mean per patient of 3.5 reactions on BRAFI, 3.7 on MEKI, and 3.4 on combination BRAFI/MEKI. Three patients discontinued treatment because of a cutaneous reaction. Treatment was altered in 27% of patients on BRAFI, 39.5% on MEKI, and 33% on combination therapy. The cutaneous reactions most likely to alter treatment were dermatitis, panniculitis, and keratosis pilaris-like reactions for BRAFI and dermatitis, acneiform eruptions, and paronychia for MEKI. Cutaneous reactions are common in children receiving BRAFI and MEKI, and many result in alterations or interruptions in oncologic therapy. Implementing preventative strategies at the start of therapy may minimize cutaneous reactions.

Clinico-epidemiological study of topical steroid dependent face in a tertiary care hospital at Mysore

Background: Topical steroids are the most commonly prescribed drugs in dermatology. The adverse effects of steroid misuse are noticeable 3 to 4 weeks after application. Steroid rosacea, hypertrichosis and acneiform eruptions are few of them. A new entity known as topical steroid dependent face, topical steroid dependent face (TSDF) has been recently coined to encompass symptoms such as erythema, burning sensation on attempted cessation of topical steroid application.Methods: A questionnaire-based analysis was done among patients attending dermatology outpatient department of government medical college hospital, Mysore between November 2018 to May 2019. Prior approval of the institutional ethics committee, and consent of patients were obtained. A total of 200 outpatients with facial dermatosis using topical steroids on face for a period greater than one month were taken up for study.Results: The results included population across different age groups, between 16 to 60 years. 56% belonged to the age group of 16 to 30 years. Most common steroid abused was mometasone cream 0.1% (50%), betamethasone valerate cream 0.1% (24.5%) followed by clobetasol ointment 0.05% (21.5%). The major adverse effect with steroid abuse, were acne 72% facial redness 67%. Hyperpigmentation 51%, hypertrichosis 32.5% and skin atrophy 21%.Conclusions: The present study highlights and creates awareness on the burden of facial topical steroid abuse and the poor attitude towards them.

COVID-19 and personal protective equipment: Treatment and prevention of skin conditions related to the occupational use of personal protective equipment

To the Editor: There have been an increasing number of reports of occupationally induced skin conditions in health care workers related to the use of personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic.1,2 The breadth and variety of different types of PPE, such as facemasks, gloves, and respiratory equipment, as well as the extended use beyond previous standards, have led to a spectrum of common dermatologic conditions, including contact/irritant dermatitis, pressure-related skin injury, acneiform eruptions, and moisture-associated skin irritation (Table I).

Persistent Chloracne in a Tank Mechanic

Chloracne is characterized by acquired dioxin-induced skin hamartomas (MADISH), often involving the post-auricular skin. Chloracne classically occurs in individuals exposed to Agent Orange and dioxin-containing oils used in machinery. Since new-onset acne vulgaris is unusual in adults, a thorough occupational history must be elicited in this patient population. The herein patient is a retired tank mechanic with no known exposure to Agent Orange and presents with persistent acneiform eruptions.

Propranolol-induced acneiform eruptions: revisiting a rare cutaneous side effect

Propranolol is a frequently prescribed non-selective beta-blocker for the management of hypertension, cardiac arrhythmias, post myocardial infarction, thyrotoxicosis, tremors and migraine prophylaxis.1 Although rare, it may produce dermatological side effects...

Twelve cases of acneiform eruptions while on anti-CTLA4 therapy.

We present the first detailed report of acneiform eruptions in patients on CTLA-4 inhibitor therapy. Acneiform eruptions commonly occur (up to 75-100%) as a cutaneous adverse event associated with EGFR inhibition; however, acneiform eruptions have not been highly reported as a cutaneous adverse event associated with CTLA-4 inhibitor therapy. We conducted a retrospective chart review of our institution's database to assess cutaneous adverse events associated with ipilimumab and tremelimumab, identifying 12 patients with acneiform eruptions (2 on tremelimumab and 10 on ipilimumab). The median time to onset of rash was 3weeks after starting CTLA-4 inhibitor therapy, ranging from 0.7-45weeks. Median time to cutaneous resolution was 6weeks, ranging from 2 to 282weeks. Treatment included oral and topical antibiotics, antihistamines, and oral or topical corticosteroids with four patients receiving no treatment. Acneiform eruptions are seen less commonly with CTLA-4 inhibitors than other cancer therapies, but awareness that it does occur is important for clinical practice. Better description is a necessary help to aid in early diagnosis and intervention. While EGFR inhibitor-associated acneiform eruptions are associated with clinical benefit, our sample size is too small to determine whether CTLA-4 inhibitor associated acneiform eruptions display the same correlation.

EGFRI-associated health-related quality of life by severity of skin toxicity in metastatic colorectal cancer patients receiving epidermal growth factor receptor inhibitor target therapy

The purposes of this study were to assess the levels of symptom distress, body image, and epidermal growth factor receptor inhibitors (EGFRI)-associated health-related quality of life (QoL); identify the factors related to EGFRI-associated health-related QoL; and examine the differences in EGFRI-associated health-related QoL by grade of skin toxicity in mCRC patients receiving target therapy. This cross-sectional study examined mCRC patients who received cetuximab-based target therapy from the oncology and CRC inpatient and outpatient departments of a medical center in northern Taiwan. Structured questionnaires were used to measure patients' symptom distress, body image, and EGFRI-associated health-related QoL. Of the 111 mCRC patients studied, 79.2% reported acneiform eruption and 52.2% reported paronychia. The most common symptoms were dry skin and itching. Poor EGFRI-associated health-related QoL was associated with more symptom distress, more negative body image, a higher cumulative dose of target therapy, and being married; these factors explained 66.6% of the variance in EGFRI-associated health-related QoL. Patient-specific skin care and emotional support are needed to relieve distressful dermatological symptoms and emotional distress during and post-treatment for mCRC.

Study of Clinical Profile of Patients Presenting with Topical Steroid-Induced Facial Dermatosis to a Tertiary Care Hospital.

Background:Topical corticosteroids (TCs) are widely used for various indications in dermatology. However, these can cause a plethora of symptoms if overused or abused. Topical steroid damaged face is a relatively new entity which was described in 2008. TC abuse cause a myriad of side effects viz, erythema, telangiectasia, acne, acneiform eruption, hyper/hypopigmentation, rosacea, and photosensitivity when used inappropriately.Aim:The aim of the study was to ascertain the prevalence, demographics, and clinical presentations of TC abuse on faceamong our population.Materials and Methods:This was a cross-sectional study performed at dermatology department of a tertiary care teaching hospitallocated in eastern India for 1 year. All patients with facial dermatoses attending the outpatient department were asked about use of TC in recent past and those with positive history were included. A detailed clinical evaluation was undertaken and various demographic and clinical data were recorded.Results:A total of 316 patients (53 males, 263 females) presented with topical steroid-induced facial dermatoses during the entire study period. Majority of them used these agents on suggestion of close friends and relatives, pharmacists, television commercials, and doctors. Mometasone in the form “No-Scar” preparation was the most commonly abused topical steroid in our study. The most common side effects encountered were steroid-induced acne (45.2%) or flare of pre-existing acne followed by erythema and telangiectasia (21.2%), hypertrichosis (6.6%), rosacea (2.2%), and atrophy (1.5%). The most common reason for abusing TC was to get a fairer skin tone.Conclusion:Our study reports the clinical patterns of TC abused facial dermatoses. The fantasy to get a fairer skin among the people of our country has led to the abuse of topical corticosteroids. We conducted this study to create awareness among these patients about the dreadful effects of steroid misuse.

Nevoid melanoma and eruptive nevi from erlotinib

Cutaneous side effects such as acneiform eruption, xerosis, and paronychia are frequently observed in patients undergoing treatment with epidermal growth factor receptor (EGFR) inhibitors for non-small cell lung cancer and other solid tumors. Interestingly, these side effects appear to positively correlate with length of remission, indicating that disruption of homeostatic EGFR signaling in the skin may serve as a marker of therapeutic EGFR inhibition in tumors. We report the case of a woman with metastatic lung cancer in remission being treated with the EGFR inhibitor, erlotinib, who experienced numerous commonly occurring adverse cutaneous reactions early in her treatment, and after two years of treatment developed eruptive nevi as well as a nevoid melanoma. Changes in pigmented lesions and the development of melanoma have been described during treatment with the BRAF inhibitor, vemurafenib, and are believed to relate to paradoxical activation of BRAF and the MAPK pathway. We speculate that a similar mechanism may occur during treatment with EGFR inhibitors. Therefore, thorough skin examinations are essential for patients undergoing long term treatment with erlotinib.

A clinical study of cutaneous manifestations in patients with chronic kidney disease on conservative management, hemodialysis, and renal transplant recipient

Background: The skin acts as an external reflection of renal diseases. The dermatologic disorders in chronic kidney disease (CKD) can be attributed to the etiology, the disease, or the treatment and can markedly affect a patient's quality of life. Aim: The aim is to study the pattern and proportion of cutaneous manifestations in CKD patients on dialysis, on conservative management and in posttransplant patients. Materials and Methods: A cross-sectional hospital-based study was conducted. Seventy-five patients with CKD on hemodialysis, 25 patients with CKD on conservative management, and 20 posttransplant patients were included in the study. All the patients were clinically examined after written consent. Results: At least, one dermatological manifestation was present in every patient included in the study. The most common underlying disease that leads to CKD was diabetes mellitus. The most common manifestation was xerosis seen in 60% patients followed by pruritus seen in 43%, pallor seen in 41% and pigmentary changes seen in 28% patients. Cutaneous infections were seen in 43%, nail changes in 82%, hair changes in 40%, and oral mucosa changes were seen in 38% of patients. Drug-induced cutaneous manifestations were seen in posttransplant patients like acneiform eruptions in 32% of patients followed by hirsutism in 8%, striae in 8%, and hypertrichosis in 4% of patients. Conclusion: The proportion of xerosis, pruritus, pigmentation, and pallor are more common in the dialytic group than nondialytic group. Early recognition and some prophylactic measures can prevent or decrease some of the adverse changes.

Extranodal natural killer/T-cell lymphoma, nasal type, presenting with acneiform eruptions: A previously undescribed variant

Extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, is an Epstein–Barr virus (EBV)-associated aggressive form of lymphoma that primarily involves areas outside the nasal cavity. Skin is also commonly involved resulting in a variety of skin manifestations. Here, we report an ENKTL, nasal type, in a 29-year-old male with a previously undescribed acneiform presentation. Skin biopsy revealed an angiodestructive, perivascular lymphocytic infiltration, which stained positive for CD3, CD56, and TIA-1 in various proportions. Scattered EBV-infected cells were demonstrated by in situ hybridization. The patient received chemotherapy with almost complete resolution of the skin lesions initially but later experienced flare-ups.

Dermatoses Occurring after Parlor Procedures.

Background:Cosmetic procedures are on the rise and practiced by all age groups, especially by teenagers. These procedures enhance the individual appearance and confidence levels, but they are not without side effects.Aims and Objectives:The aim of this study was to evaluate the side effects occurring after various parlor procedures such as facials, threading, waxing, and laser hair reduction.Setting and Design:A prospective study for 12 months in a tertiary hospital.Materials and Methods:Patients attending the department of dermatology at a tertiary care hospital for 12 months (July 2018–June 2019) were evaluated for any skin lesions, developed after one of the above parlor procedures. Detailed history, clinical examination, and correlation with the parlor procedure were noted.Results:A total of 102 patients were found to have dermatoses after various parlor procedures during the 1-year study period (81 F and 21 M). Acneiform eruptions 26 (25.4%), followed by post-waxing folliculitis 17(16.7%), and hyperpigmentation of face 15 (14.7%) were the most common dermatoses. Molluscum contagiosum, verrucae plana, and tinea faciei were observed in 11, 6, and 3 patients, respectively.Conclusion:Side effects are not uncommon after parlor procedures. Awareness of these is necessary and educating the patients is extremely important to avoid these unwanted complications.

Topical corticosteroid abuse over face: A clinical study

Topical corticosteroid abuse over face: A clinical study - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.063, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol