Acneiform Research Articles

Comedogenic acne following radiation therapy

ejd.2011.1537 Auteur(s) : Evren Odyakmaz Demirsoy1 evrenodyakmaz@yahoo.com, Rebiay Kiran1, Burcu Ozturk1, Sevgiye Ozkara Kacar2, Aysun Sikar Akturk1 1 Department of Dermatology 2 Department of Pathology, Kocaeli University Medical Faculty Kocaeli, Turkey Different types of radiation may induce acneiform eruptions. Favre-Racouchot syndrome, which is characterized by yellow atrophic plaques with large comedones, wrinkles and furrows on sun-exposed areas, is the most commonly seen form of radiation-induced [...]

Phytomenadione pre‐treatment in EGFR inhibitor‐induced folliculitis

Targeted oncology therapy with inhibitors of epidermal growth factor receptor is associated with numerous cutaneous side effects. Acneiform eruptions are the most frequent skin toxicities reported. They may lead to impairment of patients' quality of life and sometimes may even become severe enough to necessitate the interruption or cessation of therapy. To assess the possible effect of topical phytomenadione (vitamin K1 ) pre-treatment in diminishing the extent and severity of acne-like follicular rash associated with epidermal growth factor receptor inhibitor therapy. A series of 20 patients with colorectal cancer or head and neck cancer were pre-treated with phytomenadione cream (0.05% in seven patients and 0.1% in 13 patients), starting morning before the first infusion of cetuximab or panitumumab, and followed up for the development of therapy-associated folliculitis. The cream was prepared from phytomenadione solution added to a hydrophilic cream base, oil in water, to obtain the concentration of 0.05% or 0.1%. Majority of patients (15 out of 20, 75%) pre-treated with phytomenadione cream experienced only mild, grade I acneiform eruptions. Five patients (25%) had grade II rash, which included two of seven patients pre-treated with 0.05% phytomenadione cream and three of 13 patients who used 0.1% phytomenadione cream. Topical phytomenadione cream was well tolerated and no abnormalities in blood coagulation were observed. Topical pre-treatment with phytomenadione cream might become useful in epidermal growth factor inhibitor-associated acneiform eruptions.

Tracheal granuloma pyogenicum with erlotinib treatment for lung cancer

To the Editors: We present the case of a 64 yr-old ex-smoker (20 pack-yrs) with a squamous cell carcinoma of the lung who developed a tracheitis and granuloma pyogenicum during treatment with erlotinib. Among the specific side-effects of epidermal growth factor receptor (EGFR) inhibitors, paronychia with granuloma pyogenicum has been reported frequently; however, granuloma pyogenicum has never been described in the trachea with erlotinib treatment. Monoclonal antibodies against the EGFR ( e.g. cetuximab) and EGFR tyrosine receptor inhibitors (TKIs) ( e.g. gefinitib and erlotinib) have been shown to improve treatment outcomes in nonsmall cell lung cancer. Generally, these agents are better tolerated than classical cytotoxic agents showing a different toxicity profile. Specific side-effects of EGFR-targeting agents include diarrhoea and particularly skin toxicity, such as acneiform eruptions, xerosis, eczema, fissures, teleangiectasia, hyperpigmentation, hair changes and paronychia with granuloma pyogenicum [1]. Skin toxicity has been associated with EGFR inhibitor antitumor activity [1]. A 64 yr-old male was diagnosed with squamous cell carcinoma of the right upper lobe and was treated with a right upper lobectomy in December 2002 (pathological (p)T1 pN1 (three positive lymph nodes out of 33 removed)). No adjuvant …

Concomitant occurrence of acneiform eruption, alopecia areata, and urticaria during adalimumab treatment in a patient with pustulosis palmoplantaris: Case report and literature review

Abstract Adalimumab is a fully human immunoglobulin G1 monoclonal antibody against tumor necrosis factor (TNF)-α that is increasingly used for the treatment of many autoimmune diseases. However, it has also been reported that adalimumab can induce many adverse cutaneous reactions, including paradoxical psoriasiform eruptions. We describe a patient with pustulosis palmoplantaris who developed four cutaneous adverse reactions, including eczematous lesions, acneiform eruption, alopecia areata, and urticaria during adalimumab treatment. A common histopathological finding in these acneiform and urticarial lesions was the presence of eosinophilic infiltrates. Some authors assume that cross-regulation between TNF-α and interferon-α may contribute to development of a clinical spectrum of cutaneous reactions in predisposed individuals undergoing anti-TNF therapy. The use of different biologics, including adalimumab, etanercept, and ustekinumab, did not seem to improve pustulosis palmoplantaris disease activity in our patient.

Folliculotropic mycosis fungoides complicated by eosinophilia: a case report

A 69-year-old man presented with a 3-year history of scattered erythematous patches, perifollicular papules, acneiform lesions (such as milia, cysts) on the head, trunk and limbs as well as alopecia and peripheral eosinophilia. Histopathological examination revealed chronic focal dermal and perifollicular inflammatory infiltration with vascular proliferation and presence of a small number of eosinophils. He was initially diagnosed with folliculitis, and treated with antihistamines and antibiotics. Thereafter, lesional inflammation and pruritus were attenuated. However, plaques and alopecia developed in the occipital area 3 months later. The second histopathology of biopsy specimens revealed a dense dermal infiltrate of lymphoid cells and eosinophils, perifollicular infiltrate with numerous lymphoid cells, eosinophils and atypical lymphocytes migrating into hair follicles. Alcian blue stain showed epidermal mucinosis in follicles. Immunohistochemical examination showed positive staining of atypical cells for CD3, CD4, CD5, CD2, CD43 and ubiquitin carboxyl-terminal esterase L1 (UCHL1), but negative staining for CD20, CD79a, Epstein-barr virus, CD56, phosphoglucomutase-1, myeloperoxidase, CD7, or AE1 and AE3 monoclonal anti-keratin antibodies. T-cell receptor gene rearrangement was undetected. He was diagnosed with folliculotropic mycosis fungoides. Novel skin lesions still emerged after treatment with photochemotherapy (PUVA) plus acitretin. Follow up of the patient still continued.

The Acne Continuum: An Age-Based Approach to Therapy

Acne vulgaris is classically considered a disease of adolescence. Although it most commonly occurs and has been best studied in that age group, it can develop at any time during childhood. It is important that health care practitioners recognize the manifestations of neonatal, infantile and childhood acne, as well as the differential diagnosis and best therapeutic approach in the younger child. Acneiform eruptions in infants and toddlers can occasionally be associated with scarring or with other significant disorders that may be life-threatening. In this article, the authors draw on their own clinical experience as well as the available literature to suggest an age-based approach to managing acne in children from the neonatal period through age 11 years.

Acute generalized exanthematous pustulosis-like, folliculitic drug reaction pattern caused by celecoxib

An extensive range of diseases or reactions can cause pustular eruptions of the skin. Drug-provoked cutaneous eruptions includes acute generalized exanthematous pustulosis (AGEP) and acneiform eruption. We report a 50-year-old man who developed fever and a sudden eruption of widespread pustules 12 days after ingestion of celecoxib prescribed for a prolapsed intervertebral disc. AGEP was diagnosed based on the typical history, characteristic features, and laboratory findings. However, histopathological findings were consistent with folliculitic drug reaction pattern without features of AGEP. We present, the first known reported case of folliculitic drug reaction pattern caused by celecoxib.

Vellus hair cysts presenting as an atypical acneiform eruption

A 32-year-old male patient presented for 8 months an asymptomatic therapy-resistant acneiform eruption on his back and buttocks. Skin examination showed several inflammatory papules, which evolved to hyperpigmentation. At the same distribution non inflammatory papules, which resembled rice grains, were also observed. Light microscopy showed small keratin-filled cysts, with an epithelial multilayered wall, without granular layer. Keratin and some vellus hairs were identified inside the cyst, confirming the diagnosis of vellus hair cysts. Diagnosis of vellus hair cysts should be suspected in cases of multiple papules or therapy-resistant cases of acneiform eruptions.

Drug-Induced Acneiform Eruption

Drug-induced acne is a specific subset of acne that usually has some specific features, namely a monomorphic pattern, an unusual location of the lesions beyond the seborrheic areas, an unusual age of onset, a resistance to conventional acne therapy and, of course, the notion of a recent drug introduction. Many drugs can be responsible for such a clinical pattern. Corticosteroids, neuropsychotherapeutic drugs, antituberculosis drugs, and immunomodulating molecules are the more classical drugs associated with induced acne. Recently, new drugs, mainly targeted therapy in the field of oncology, such as epidermal growth factor receptor inhibitors, have been associated with an increased frequency of this adverse effect. Disruption of the culprit drug is rarely mandatory in cases of drug-induced acne. Close cooperation between the dermatologist and medical staff in charge of the patient is an important challenge to achieve optimal management of the initial disease.

The adverse events of deep fractional CO2: A retrospective study of 490 treatments in 374 patients

Fractionated carbon dioxide CO(2) laser resurfacing unites the idea of fractional photothermolysis with an ablative 10,600-nm wavelength. This technology permits effective treatment of deeper rhytides, photodamaged skin, and scars, with shorter recovery and a decreased side effect profile as compared to traditional CO(2) laser resurfacing. To study the rate of the adverse events associated with the use of deep fractional CO(2) laser. A retrospective study of 490 fractionated CO(2) laser treatments in 374 patients by ten physicians within one practice was performed between March 3, 2008 and July 28, 2010. Treatment areas included the face, neck, chest, hands, back, and abdomen. Of the 490 treatments, 365 were of both superficial and deep fractional treatments while 125 treatments were deep. Patients treated were of Fitzpatrick skin types I-IV. Four hundred ninety treatments resulted in 67 adverse events (13.6%) in 63 patients (16.8%), the most frequent adverse events were acneiform eruption (5.3%), herpes simplex outbreak (2.2%), bacterial infections (1.8%), yeast infections (1.2%), hyperpigmentation (1.2%), prolonged erythema beyond 1 month (0.8%), and (0.8%) contact dermatitis. There were no reports of scarring or hypopigmentation. Fractional deep CO(2) laser is a safe method for treating rhytides, photodamaged skin, and scars with a low incidence of adverse events.

Cancer immunotherapy: Progress and challenges in the clinical setting

Cancer immunologists have made enormous efforts to prove that innate and adaptive immune cells recognize tumor cells and induce tumor rejection in experimental animal models. These observations provided the rationale to study the role of the immune system in the control of tumor growth in cancer patients and to develop immunotherapeutic strategies to treat patients with cancers. Several lines of evidence suggest that anti-tumor immune responses may correlate with better clinical outcome in patients with cancers. Among them is the correlation between the presence of tumor-infiltrating T cells and the improved clinical outcome for patients with solid tumors [1–3]. In addition, a number of immunotherapies, such as high-dose IL-2 [4] and TA-specific monoclonal antibodies (mAb) [5], have provided long-term clinical benefits to a minority of cancer patients. Most importantly, the recent approval by the US FDA of the mAb ipilimumab directed against the co-inhibitory molecule CTLA-4 for patients with unresectable or metastatic melanoma represents a major breakthrough for mAb-based therapies in oncology practice [6]. The successful outcome of the randomized phase III clinical trial with ipilumumab has provided the much-needed incontrovertible clinical evidence that in humans, as in experimental animal models, the host’s immune system can control tumor growth. Furthermore, it has infused a considerable amount of optimism among tumor immunologists and clinical oncologists about the clinical potential of immunotherapy for the treatment of advanced cancers. However, there are also many examples of spontaneous or vaccine-induced TA-specific T- and B-cell immune responses that do not correlate with improved clinical status [7–9]. This discrepancy between immune and clinical responses underlines the need to better dissect the molecular and cellular events leading to tumor rejection in humans. Such an endeavor has greatly benefited from the molecular identification of TA expressed by human tumor cells, which are recognized by T cells and antibodies [5, 10, 11]. As a result, TA-specific immunotherapies have been implemented in clinical trials with molecularly defined cancer vaccines, TA-specific mAb and adoptive transfer of TA-specific T cells. Novel generations of cancer vaccines with molecularly defined TAs and potent adjuvants like toll-like receptor ligands appear to stimulate strong TA-specific T-cell responses but have shown evidence of clinical benefits in only a minority of patients with advanced cancer [7, 8, 12]. The adoptive transfer of TA-specific T cells remains technically challenging and the promising data obtained in terms of objective clinical responses and durability of responses from small monocentric clinical trials will need to be further confirmed in large multicenter clinical trials [13]. TA-specific mAb are clinically effective in a number of hematological malignancies and solid tumors and are routinely used in the clinic [5]. We now have a better understanding of the multiple mechanisms of tumor-induced immune escape, which are likely to cause the failure of the spontaneous or vaccine-induced immune responses to promote tumor regression in humans. In the tumor microenvironment, a number of negative regulators dampens anti-tumor immune responses and/or their therapeutic efficacy, including the production of cytokines (like TGF-β or IL-10), suppressive cells (regulatory T cells, myelosuppressive dendritic cells), defective antigen presentation by tumor cells (HLA or tumor antigen loss, antigen processing machinery defects), amino-acid catabolizing enzymes (indoleamine-2-3dioxygenase, arginase) and co-inhibitory pathways (like CTLA-4/CD28, PD-1/PD-L1) [14–17]. As a consequence, a number of therapies to specifically target these pathways are being developed to enhance TA-specific immune responses and to increase the likelihood of clinical benefits. In this article, commissioned to recognize National Cancer Survivors Day (the first Sunday in June each year, 5 June in 2011, see www.ncsdf.org), we will comment on the successes of immunotherapy of cancer in the clinical setting. In addition, we will discuss the challenges to optimize the use of cancer immunotherapies in the clinic.

Cutaneous Toxicity Associated With Cetuximab Treatment in Metastatic Colorectal Cancer

ObjectiveTo evaluate the impact and type of side-effects in patients treated with cetuximab and provide a description of the general measures and treatment. MethodsRetrospective safety study. We included all patients that received cetuximab from January to December 2009. All information was obtained from the Pharmacy and Oncology Department's Access databases and reviewed the patient's medical history. All data was registered in an Excel workbook. Skin toxicity was graded by the current National Cancer Institute-Common Toxicity Criteria (NCI-CTC). ResultsDuring the study period 43 patients received treatment with cetuximab. Acneiform eruption was present in 30 of the cases (69.8%): 14 patients with grade 1 (48.3%), 13 with grade 2 (44.8%) and 3 with grade 3 (10.3%). These adverse effects appeared in a median of seven (4–28) days. In a median of 40 (20–56) days, ten patients (23.3%) presented xerosis, and three (7%) suffered painful fissures in hands and feet after a median of 28 (21–35) days. Paronychia was present in two patients after a median of 42 (35–49) days. Finally, an alteration in hair growth was observed in two patients with overgrowth of facial hair and one patient with overgrowth of the eyelashes. Five patients presented important conjunctivitis. Three infusion reactions occurred.A grade-based treatment algorithm was used for all patients that presented cutaneous toxicity. ConclusionsA considerable number of patients treated with cetuximab develop dermatological side-effects which left untreated could represent a threat to the efficacy of the therapy. Therefore effective management is mandatory, patient education and immediate treatment based on a grade-based algorithm to alleviate symptoms is necessary, so that patient compliance is guaranteed.

Nonablative Fractional Laser Resurfacing

The desire to achieve cosmetic rejuvenation and reduce effects of aging and photodamage urged scientists to develop effectual techniques which have minimal side effects and impressive long-term efficacy. Traditional ablative resurfacing laser therapy has been used for several years;however, it has harmful side effects on the patient’s skin such as dyspigmentation, persistent erythema, infections, acneiform eruptions and scarring. It also prolongs downtime, so it puts a significant burden on society. Nonablative resurfacing laser therapy declines side effects of traditional therapies, although it has lower effectiveness in comparison with ablative one.Nonablative fractional resurfacing laser therapy commenced a modern technique which diminished side effects, while maintains the efficacy of traditional methods. The aim of of this current review is to sum up nonablative fractional laser therapies used for skin photorejuvenation at the past and present time and to evaluate the indications,advantages and classification of it and non-fractional resurfacing laser therapy

Toxicidad cutánea asociada a cetuximab en cáncer colorrectal metastásico

Objective To evaluate the impact and type of side-effects in patients treated with cetuximab and provide a description of the general measures and treatment. Methods Retrospective safety study. We included all patients that received cetuximab from January to December 2009. All information was obtained from the Pharmacy and Oncology Department's Access databases and reviewed the patient's medical history. All data was registered in an Excel workbook. Skin toxicity was graded by the current National Cancer Institute-Common Toxicity Criteria (NCI-CTC). Results During the study period 43 patients received treatment with cetuximab. Acneiform eruption was present in 30 of the cases (69.8%): 14 patients with grade 1 (48.3%), 13 with grade 2 (44.8%) and 3 with grade 3 (10.3%). These adverse effects appeared in a median of seven (4-28) days. In a median of 40 (20-56) days, ten patients (23.3%) presented xerosis, and three (7%) suffered painful fissures in hands and feet after a median of 28 (21-35) days. Paronychia was present in two patients after a median of 42 (35-49) days. Finally, an alteration in hair growth was observed in two patients with overgrowth of facial hair and one patient with overgrowth of the eyelashes. Five patients presented important conjunctivitis. Three infusion reactions occurred. A grade-based treatment algorithm was used for all patients that presented cutaneous toxicity. Conclusions A considerable number of patients treated with cetuximab develop dermatological side-effects which left untreated could represent a threat to the efficacy of the therapy. Therefore effective management is mandatory, patient education and immediate treatment based on a grade-based algorithm to alleviate symptoms is necessary, so that patient compliance is guaranteed.

Gold for Facial Skin Care: Fact or Fiction?

To the Editor, It is believed that anti-aging preparations or cosmeceuticals, as less-invasive, nonsurgical alternatives, can retard the aging effect of the skin [1]. Table 1 presents some common ingredients in cosmeceuticals. However, the therapeutic benefits of most products remain unsubstantiated [1]. A recent randomized controlled trial showed that a high-priced luxurious antiwrinkle cream (Chanel Ultra Correction Restructuring Anti-Wrinkle Cream SPF 10; Chanel, Paris, France) was no more effective than a regular, cheap moisturizer (ACO Facial Cream; ACO Hud AB, Apteekkituotteet, Finland) [2]. Other options to promote eternal youth are massage with streaming and the use of facial masks. These are popular in spas and salons. Facial massage with an exfoliant may provide immediate superficial debridement, increased blood flow, warmth, substance P release, and an anxiolytic effect [3]. However, no long-term effect has been found, and erythema, edema, dermatitis, and acneiform eruptions may occur after the treatment [3]. Recently, gold for facial skin care has received an interest worldwide and is applied in many cosmetic centers, spas, and salons. It is used in two forms: as an ingredient of topical skin care (mask or cream) and as gold foil or gold leaf for direct application to skin (combined with massage therapy and use of cosmeceuticals with or without streaming). In 2010, an in vitro study showed that gold nanoparticles in an antiwrinkle face mask maximize contact of the active ingredients (L-ascorbic acid, retinoic acid, and collagen) with the skin, enhancing their skin permeation [4]. In animal models, gold facial masks improve blood circulation and cutaneous elasticity, rejuvenate the skin, and reduce wrinkle formation [4]. It is frequently said that Queen Cleopatra of the Nile slept with a pure gold mask every night, and this may have been the secret of her beauty (http://abcnews.go.com/Nightline/future-detox-gold-mask-saltcaves/story?id=9726168p http://www.ub.uni-leipzig.de/), and the Thai-Journal Citation Index Centre (http://www.kmutt. ac.th/jif/public_html/), as well as the online databases of 48 P. Pitak-Arnnop A. Hemprich K. Dhanuthai N. C. Pausch Department of Oral, Craniomaxillofacial, and Facial Plastic Surgery, Scientific Unit for Clinical and Psychosocial Research, Evidence-Based Surgery, and Ethics in Oral and Maxillofacial Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany

Acneiform eruption following molecular targeted chemotherapy

Acneiform eruption following molecular targeted chemotherapy

Erupção acneiforme aguda induzida por interferon beta-1b durante tratamento para esclerose múltipla

Multiple sclerosis is an inflammatory demyelinating disease of presumed autoimmune origin that affects the central nervous system. The main form of therapy is based on the use of immunomodulators such as interferon beta, which are usually well tolerated. Skin manifestations resulting from treatment with interferon beta-1b consist principally of reactions at the site of subcutaneous application of the drug. The present case report describes a female patient who developed an acneiform eruption resulting from treatment with interferon beta-1b.

Nimotuzumab in combination with chemotherapy for patients with malignant gliomas

Nimotuzumab is a humanized monoclonal antibody targeted against epidermal growth factor receptor (EGFR). Recent clinical studies show that patients with malignant gliomas could benefit from nimotuzumab treatment. The aim of the present study was to evaluate the efficacy and side effects of nimotuzumab in combination with chemotherapy for patients with malignant gliomas. The patients received 200 mg of nimotuzumab infusion intravenously over 60 minutes once weekly for the first eight weeks and then once every two weeks until unacceptable toxicity or tumor progression occurred. Individualized chemotherapy was administered based on O(6)-methylguanine-DNA methyltransferase (MGMT) expression and previous chemotherapy responses in combined with nimotuzumab. Fourteen patients received a total of 122 times of nimotuzumab ranging from 2 to 20 (median 7.5 times). Combined chemotherapy regimens included: continuous 21-day temozolomide (10 cases), standard 5-day temozolomide (2 cases), teniposide plus cisplatin (1 case), and teniposide plus nimustine (1 case). Partial response (PR) and stable disease (SD) were found in 3 patients (21.4%)and 6 patients (42.9%), respectively. Disease control rate (PR + SD) was 64.3%. The median progression-free survival (PFS) was 4 months (95%CI: 0.7 - 7.3) and PFS at 6 months was 30.6%. The most common toxicities include grade I-II neutropenia (2 cases), thrombocytopenia (2 cases), lymphopenia (1 case), nausea and vomitting (3 case) and asymptomatic transaminase increase (1 case). One patient developed grade IV neutropenia and thrombocytopenia. One patient developed nimotuzumab-related acneiform rash. Nimotuzumab in combination with chemotherapy has moderate activity in patients with malignant gliomas and the toxicities are well tolerable, therefore, worth further investigation.

Skin manifestations of gefitinib and the association with survival of advanced non-small-cell lung cancer in Taiwan

Epidermal growth factor receptor antagonists, such as gefitinib, erlotinib, and cetuximab, have been used in treating carcinomas. The efficacies have been proposed to correlate with skin reactions, but the most important predictive indicator is still unknown. Our aim was to investigate the types of skin toxicities and to analyze the major therapeutic predictive indicators in Taiwan. A retrospective analysis was used to study 68 patients with advanced non-small-cell lung cancer receiving gefitinib. Acneiform eruption (41.2%), xerosis (38.2%), pruritus (26.5%), and paronychia (16.2%) composed most of the skin reactions. The univariate analysis revealed paronychia as the most substantial survival predictive indicator ( p = 0.0427). In the multivariate analysis, older patients with paronychia had better prognosis ( p = 0.0050). Women tended to develop paronychia ( p = 0.1098). Xerosis positively correlated with paronychia ( p = 0.0082). Paronychia is the most indicative survival predictive factor among the skin manifestations, and it correlates with age, gender, and xerosis. Elucidation of the relationship between cutaneous reactions can provide information on the epidermal growth factor receptor signaling mechanism of skin.

Acneiform Eruption due to Cetuximab Therapy: A Case Report

Acneiform Eruption due to Cetuximab Therapy: A Case Report