Acneiform Research Articles

Knowledge, attitude and behaviour towards the role of diet in acne vulgaris among students

Background: Acne is one of the most common chronic inflammatory conditions reported on daily basis in a skin clinic. It’s pathology lies at the level of pilosebaceous apparatus and is influenced by various factors like hormones, certain foods, drug intake and so on. There are several discrepancies surrounding the role of diet in acne. The aim of the study was to explore the knowledge, attitude and behaviour towards the role of diet in acne vulgaris among students.Methods: This was a cross sectional study conducted in Sree Balaji Medical College and Hospital, Chennai during January 2021 to May 2021. 107 random medical students with acne were enrolled in the study. Students with acne vulgaris not willing to participate in the study and students with acneiform eruptions were excluded. Data was collected using a standard, semi-structured questionnaire. Questionnaire was presented in English through a google form. The questionnaire comprised of socio-demographic data like age and gender. Data was entered in Microsoft word and represented in frequency and percentage.Results: Among the 107 students enrolled in the study, 37 were males and 70 were females. 56 students were in 17-20 age group and remaining 51 were in 21-24 years age group. Our study showed that 64.5% (69) agreed that there was an association between diet and acne vulgaris, while 9.3% (10) denied it and 26.2% (28) were unsure about the association between the two. Majority of them encountered acne localized to face mainly involving cheeks, only 2 people reported acne over trunk. Out of 97 students who opined of the association of diet with acne, only 13 students consulted a dermatologist and opted for medication. Out of 13, only 7 reported to have a positive outcome with combination of advised medication and stoppage of triggered foods. Out of 97 students who opined of the association of diet with acne, only 13 students consulted a dermatologist and opted for medication.Conclusions: The understanding of the disease and the ways adopted by these students look decent enough but mandate few changes in their attitude and behaviour.

28456 Efficacy and tolerability of oral antibiotics for cetuximab-induced acneiform eruption

28456 Efficacy and tolerability of oral antibiotics for cetuximab-induced acneiform eruption

The impact of COVID-19 pandemic in dermatology outpatient clinics in Turkey: A survey study.

BackgroundThe COVID‐19 pandemic has substantially affected the healthcare systems around the world. It has also induced some changes in working habits at dermatology clinics. The majority of dermatology clinics limited the number of patients at outpatient clinics and postponed the elective procedures.Aims and ObjectivesTo evaluate the working conditions and habits of dermatologists in Turkey during the COVID‐19 pandemic.MethodsThis is a survey study with seventeen questions in which two hundred fifteen dermatologists working in Turkey participated.ResultsOur results revealed that 53.5% of the participants worked in the areas related to COVID‐19 during the pandemic. The average number of dermatology outpatient days in a week was five among the 48.8% of dermatologists, 21.4% of those had three working days, and 18.1% of those had four days. During the pandemic, the most common reasons for referral to outpatient clinics were acne and acneiform eruptions (88.8%), dermatitis (73.5%), and hair loss (71.2%). Participants hesitated to use the following treatments: long‐term systemic steroid (77.7%), cyclosporine (69.8%), and methotrexate (60%).ConclusionIt is observed that the COVID‐19 pandemic had affected the working habits and conditions of the dermatologists, which might be considered for the designing of new working approaches.

The Efficacy and Safety of Chitosan on Facial Skin Sebum

Introduction: Seborrhea or oily skin has been one of the most common complaints affecting both men and women physically and psychologically. Chitosan is a biopolymer obtained from the alkaline deacetylation of chitin. Due to its positively charged nature, chitosan can effectively bind to lipids. Therefore, chitosan nanoparticle (CN) formulation may benefit in the reduction of skin sebum. Objective: The aim of this study was to evaluate the efficacy and safety of CN formulation in the reduction of skin sebum. Method: The study was a randomized, double-blinded, placebo-controlled trial in 24 participants aged 18–40 years with clinical seborrhea. Participants were randomly assigned to apply the CN and gum (CN-G) or placebo (gum alone) twice daily for 4 weeks. Sebum level, corneometry, transepidermal water loss (TEWL), and clinical seborrhea grading were evaluated at baseline and week 2 and 4. Results: In the T-zone, sebum levels in the CN-G group were significantly lower than the placebo group at week 4 (p = 0.043), while for the U-zone, sebum levels were not different between groups. There were no statistical differences in corneometry and TEWL at any visit. Although the clinical seborrhea grading in CN-G was lower, it was not significantly different from the placebo. A few cases reported mild and self-limiting scaling and acneiform eruption. Conclusion: The CN-G gel could significantly reduce sebum levels on seborrhea patients with acceptable safety profiles.

A Cross-sectional Study of Acneiform Eruptions at a Tertiary Center

Background: Acneiform eruptions represent 1% of all drug-induced skin reactions following exposure to drugs such as hormones, vitamins, halogens, anti-tubercular drugs, neuropsychotherapeutic drugs, immunomodulating agents, and other miscellaneous drugs. Aim: The aim of the study was to identify the topical, inhalational, intralesional, and systemic drugs causing acneiform eruptions. Materials and Methods A total of 46 patients presenting with acneiform eruptions were studied with detailed drug history. Conclusions: Acneiform eruption is a relatively common and often misdiagnosed entity. Systemic steroids are the most common cause of acneiform eruption.

The Efficacy and Safety of Fractional 1064 nm Nd:YAG Picosecond Laser Combined With Intense Pulsed Light in the Treatment of Atrophic Acne Scar: A Split-Face Study.

To evaluate the efficacy and safety of fractional 1064 nm Nd:YAG picosecond laser combined with intense pulsed light (IPL) in the treatment of atrophic acne scar with post-inflammatory erythema (PIE). © 2021 Wiley Periodicals LLC. Seventeen patients received five sessions of treatment at weeks 0, 4, 8, 12, 16 and were followed up at week 28. One half of the face was randomly treated by fractional 1064 nm Nd:YAG picosecond laser combined with IPL (FxPico + IPL), and the other by IPL alone as a control. For the 15 patients who completed the study, the FxPico + IPL side demonstrated significant median Échelle D'évaluation clinique des cicatrices D'acné (ECCA) score improvement (P < 0.01), while IPL alone side did not (P = 0.1250). The pore counts for both sides decreased but more pore count reduction was seen on the FxPico + IPL side (P < 0.05). Better scar improvement was observed on the FxPico + IPL-treated side (P < 0.05) while no difference in erythema improvement was seen between the two sides. There was no difference between the two treatments in terms of overall satisfaction. Pain, erythema, edema, petechiae, crusting, reactive acneiform eruptions, and pruritus were common adverse effects and were mild to moderate. FxPico + IPL is an effective, efficient, and safe treatment regimen for atrophic acne scars complicated by PIE.

Chloracne: a case series on cutaneous expression of CYP1A1 as diagnostic biomarker.

Chloracne, also known as metabolizing acquired dioxin-induced skin hamartomas (MADISH), is a rare disfiguring disease related to dioxin exposure. There is a paucity of literature on the clinical manifestations and pathogenesis of chloracne/MADISH. The aim of this study was to assess the clinical features of this very unusual acneiform eruption and to explore the pathogenesis of the disease. This was a retrospective, observational report study was conducted on five patients belonging to the same nuclear family (father, mother and three children) and a relative (father's brother) living in the same house. Histopathological, immunohistochemical, laboratory and toxicological analyses were performed for all patients. The results suggest that CYP1A1 in human skin is a diagnostic biomarker in chloracne, and was positive for all the patients in our sample. Tetrachlorodibenzo-p-dioxin is the most investigated dioxin responsible for chloracne; however, several other agonists, whether dioxin-like or not, can activate the aryl hydrocarbon receptor. To our knowledge, this Italian case series is the first study to suggest polychlorinated biphenyls as a possible cause of an overstimulation of aryl hydrocarbons causing the consequent acneiform eruption.

Clinical profile of cutaneous adverse events of immune checkpoint inhibitors in a single tertiary center

Programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have demonstrated their efficacy in the treatment of various malignancies. Despite their benefits, their immunomodulatory activities can cause unpredictable cutaneous adverse events (CAE). This study aimed to identify characteristics of CAE in patients treated with PD-1/PD-L1 inhibitors through the medical records, photographs, and pathology reports. Fifty CAE occurred in 47 (2.75%) of 1711 patients treated with PD-1/PD-L1 inhibitors. Pruritic, psoriasiform, urticarial, and acneiform eruptions were the four most common types. Melanoma patients showed CAE more frequently than other malignancies. Acneiform eruption occurred more often at ages under 60years. Urticarial eruption appeared earlier, while keratoacanthoma appeared later after immunotherapy. The overall survival times were not significantly different between the two groups with and without CAE by Kaplan-Meier analysis (p=0.055). Studies on CAE may provide more information to understand these drugs and to help manage the patients.

Prevalence of Clinical Spectrum of Cutaneous Adverse Drug Reactions in Patients Presenting at a Tertiary Care Hospital in Pakistan.

Introduction: Cutaneous adverse drug reactions (CADRs) are the most common adverse drug reactions reported in the literature. CADRs have resulted in disabling infirmities during hospitalization and complications following outdoor drug therapy. The pattern of CADRs and the responsible drugs usually changes with the introduction of newer drugs and evolving clinical practices. Moreover, several international studies showed variable prevalence, emphasizing the need for local data in light of different socioeconomic and demographic practices. Therefore, the purpose of this study is to evaluate the prevalence of adverse cutaneous drug reactions and identify the clinical spectrum and any potential risk factors.Methodology: The current study is a descriptive cross-sectional study conducted at Aga Khan University Hospital, Pakistan. One hundred ninety-three patients who met the study inclusion criteria were included. Data were collected from patients on a proforma after taking informed consent. Quantitative data were presented as simple descriptive statistics giving mean and standard deviation, while qualitative variables were presented as frequency and percentages. Effect modifiers were controlled through stratification to highlight the effect of these on the outcome variable. The post-stratification chi-square test was applied and the p-value of ≤0.05 was statistically significant.Results: A total of 193 patients who had cutaneous adverse drug reactions were included in the study. The mean age in this study was 47.78±8.33 years. One hundred eight (56%) were male and 85 (44%) were female. Out of 193 patients, 135 (69.9%), 50 (25.9%), 24 (12.4%), 12 (6.2%), 20 (10.4%), 11 (5.7%) and six (3.1%) had maculopapular rash, acneiform eruptions, Stevens-Johnson syndrome, erythema multiform, urticaria, fixed drug eruptions and toxic epidermal necrolysis, respectively.Conclusion: CADRs are a common clinical presentation and awareness and knowledge about their diagnosis and prevention is important. It can be assumed that in our local setup, the clinical trends and medications causing ADRs are strikingly similar to those found in other countries. Physicians commonly come across these cases and they should be well aware of the clinical spectrum of skin reactions to enable early diagnosis and management.

Severe Acneiform Eruption Secondary to Cetuximab Successfully Treated with Isotretinoin

Severe Acneiform Eruption Secondary to Cetuximab Successfully Treated with Isotretinoin

PPE-associated dermatoses: effect on work and wellbeing

The COVID-19 pandemic has led to more stringent infection control practice within hospitals, with the added requirement of personal protective equipment (PPE). Consequentially, the incidence of PPE-related dermatoses in healthcare workers is increasing. Analysis of staff members seen in a dermatology self-referral service during the first COVID-19 peak revealed a wide range of healthcare professionals being affected, with irritant hand dermatitis and acneiform eruptions being the commonest diagnoses. These PPE-related dermatoses had significant effects on staff members' work and wellbeing, which improved following assessment and treatment by dermatology. Given the change to our behaviour wearing PPE daily, which is likely to continue for the foreseeable future, the consequences will inevitably affect both healthcare workers and the general public, with these common dermatoses presenting in both primary and secondary care. It is therefore imperative to recognise both the physical and emotional impact that COVID-19 PPE has, and initiate prompt treatment to improve wellbeing.

Incidence of Adverse Cutaneous Reactions to Epidermal Growth Factor Receptor Inhibitors in Patients with Non-Small-Cell Lung Cancer

Background: Epidermal growth factor receptor (EGFR) inhibitors are routinely used in advanced non-small-cell lung cancer (NSCLC) harboring EGFR mutations. However, their use is associated with gastrointestinal and cutaneous toxicities, including acneiform eruptions, pruritus, xerosis, nail and hair changes. Aside from reducing patients’ quality of life, such cutaneous reactions have a considerable impact on the oncologic treatment given that dose reduction or even drug discontinuation may be necessary, especially for the severe forms. Objectives: To assess the incidence, impact on treatment and management of EGFR inhibitor-related cutaneous reactions in patients with NSCLC. Methods: We conducted a prospective observational study on 87 consecutive patients with advanced NSCLC treated with EGFR-tyrosine kinase inhibitors from January to December 2019. Patients who developed mucocutaneous reactions were evaluated and treated by both oncologists and dermatologists, and underwent dermatologic follow-up until resolution of the cutaneous reaction. Demographic and clinical data were collected for each patient, and the severity of the cutaneous reaction was graded using the Common Terminology Criteria for Adverse Events. Results: Seventy-one patients (81.6%) developed cutaneous reactions. The number of cutaneous reactions per patient was 1 in 37%, 2 in 41% and 3 or more in 22%. The most common cutaneous reactions included acneiform eruptions (56.3%), xerosis ± asteatotic eczema (48.3%), nail changes (39.1%), mucositis (29.9%), pruritus (24.1%) and hair changes (12.6%). Afatinib was associated with a higher rate of nail changes and mucositis (p < 0.01 and p < 0.005, respectively) compared to other agents, while no patient-related predictive factors were identified. Dose reduction was performed in 18% of patients. Multidisciplinary management involving dermatologists allowed to resume the drug in all patients who had discontinued it due to the cutaneous reactions. Conclusions: A multidisciplinary approach to EGFR inhibitor-related cutaneous reactions is advantageous and can reduce the need to discontinue oncologic treatment.

Efficacy of treatment for acneiform eruptions related to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) for non-small cell lung cancer (NSCLC): A protocol of systematic review and network meta-analysis.

Background:Acneiform eruptions from epidermal growth factor receptor tyrosine kinase inhibitors is a frequent adverse event in non-small cell lung cancer patients but the efficacy of its treatment including antibiotics, corticosteroid, sunscreen is still poorly understood.Methods:Eight electronic databases (PubMed, EMBASE, ClinicalTrials.gov, etc) will be searched from inception to April 2020. Risk of bias of randomized controlled trials will be assessed in terms of the Risk of Bias 2 (RoB 2) tool. Eligible randomized controlled trials will be enrolled for a Bayesian network meta-analysis using R software.Results:This study is still ongoing and the results will be submitted and published in a peer-reviewed scientific journal.Conclusion:We hope the results of this study will provide reliable evidence for the management of acneiform due to epidermal growth factor receptor tyrosine kinase inhibitors for non-small cell lung cancer.Ethics and dissemination:Ethical approval is not applicable for this study is based on published trials.Protocol registration number:CRD42020206724

Olanzapine Induced Acneiform Eruption: A Case Report

Olanzapine Induced Acneiform Eruption: A Case Report

Pattern of Drug Utilisation in the Management of Hyperpigmentary Disorders in a Tertiary Care Hospital- An Observational Study

Introduction: Hyperpigmentary disorders, a common skin disorder affecting individuals with darker skin especially Asians, Blacks, Hispanics and American Indians, has a great impact on patient’s Quality of Life (QOL) with physical distress and psychological impact, and studies have shown that there is an improvement in QOL after treatment. The topical medications include sunscreens, demelanising agents, immunomodulators like tacrolimus, retinoids and Glucocorticoids (GCs). Systemic therapy includes GCs and antioxidants. Physical therapy includes chemical peels, microderma abrasion, Laser and light therapies and mesotherapy. Aim: To determine the pattern of drug use in hyperpigmentary disorders, to assess the tolerability of therapy and to analyse the effect of hyperpigmentary disorders of skin to the prescribed medications on the QOL before and after treatment. Materials and Methods: This was a prospective, observational study conducted on 102 newly diagnosed and untreated participants with hyperpigmentary disorders, who attended Dermatology Outpatient Department of a tertiary care hospital, Bangalore, India. The pattern of drug therapy, route of administration and Adverse Events (AEs) to the therapy was documented and analysed using descriptive statistics. The QOL using Dermatology Life Quality Index (DLQI) was assessed before and after treatment using Analysis of Variance (ANOVA). The patients were monitored every 30 days for three months to study the appropriateness, changing trends in prescription pattern, tolerability and QOL. Results: A total of 102 participants were enrolled for the study. The mean age was 33.71±10.68 years in males and 34.07±10.27 years in females. The different classes of drugs used were demelanising agents, sunscreens, antifibrinolytics, calcineurin inhibitors, keratolytics, glucocorticoids. The number ranged from 2-4 drugs per participant with a mean of 3.01±1.01. A significant improvement in the QOL was observed after treatment (p-value &lt;0.01). Most of the AEs were self limiting except a few (acneiform eruption, rosacea) which were topical GCs induced. Conclusion: The individualised prescription pattern by treating physician was in concurrence with the standard line of therapy as they fulfilled the desired objectives. Hydroquinone (HQ), tranexamic acid and triple formula were the mainstay of treatment. The QOL improved after treatment.

Symmetrical drug-related intertriginous and flexural exanthema and acneiform eruption in a patient with metastatic colorectal cancer treated with cetuximab

Symmetrical drug-related intertriginous and flexural exanthema and acneiform eruption in a patient with metastatic colorectal cancer treated with cetuximab

Cutaneous side effects during therapy with Erlotinib: Case report

Erlotinib is an antineoplastic drug used in the treatment of non-small cell lung cancer and pancreatic cancer. It is a potent, selective inhibitor of tyrosine kinase, a receptor for epidermal growth factor receptor (EGFR). Cutaneous side effects such as acneiform eruption, xerosis, telangiectasia, hair and nail changes are common. A case of a 70-year-old patient who developed unusual cutaneous side effects after 6 years of treatment with erlotinib was presented.

Effective treatment option for lichen planus: Steroids or low molecular weight heparins?

Background: Data on safety and efficacy of low molecular weight heparin (LMWH) in lichen planus (LP) and comparison with oral corticosteroids (OCs) in Indian patients is limited. Aims: The aim of this article is to compare the clinical efficacy of LMWH and systemic corticosteroids in LP. Materials and Methods: This study was a single-center prospective comparative study. The patients received either LMWH subcutaneously (3 mg weekly for 6 weeks) or OC (20 mg/day for 6 weeks, tapered gradually). Results: Fifty patients were enrolled in the study, and 35 (70.0%) were females. Mean age of the study population was 35.46 years with age ranging between 21 and 40 years. Itching (92.0%) was a common symptom; generalized cutaneous lesions (90.0%) and involvement of mucous membrane were seen in 40%. Classical LP was common (56.0%). Early results were seen with OC (week 4) compared to LMWH (week 5); higher cure rate was seen with OC (89.47% vs. 76.0%) at week 6. There was no significant statistical difference (P > 0.05) in the therapeutic response between the study groups. No new lesions were noted in 23 and 13 patients treated with OC and LMWH, respectively. Relapse rate (33.33%) was higher in patients treated with LMWH (P < 0.05). Treatment with low-dose LMWH was associated with no side effects, whereas gastric irritation (42.1%) was the most common side effect followed by facial puffiness (31.57%) and acneiform eruptions (26.31%) with OC. The cost of treatment was more for LMWH compared with OC. Conclusion: Both treatment modalities were comparable in efficacy and tolerated well. LMWH had no adverse effect but had a high relapse rate. Therapy with OC is cost-effective.

Erosive pustular dermatosis of the scalp induced by gefitinib: case and review of the literature

Gefitinib is a selective tyrosine kinase inhibitor of epidermal growth factor receptor (EGFR) used for the treatment of malignant neoplasms. The most frequent skin complication during gefitinib therapy is an acneiform papulopustular eruption, usually distributed in the seborrheic areas but occasionally widespread. We report a patient with erosive pustular dermatosis of the scalp, a neutrophil-mediated skin disease presenting with sterile pustules evolving into erosions and crusts on the scalp, during treatment with the EGFR inhibitor gefitinib for lung cancer. A literature review of the drug-induced cases of this rare entity is provided.

Duration of Oral Antibiotics Administration for Cetuximab-Induced Acneiform Eruption

Background: Acneiform eruption is the most common cutaneous adverse event associated with cetuximab. As it can affect quality of life and adversely affect chemotherapy schedule, additional medical care is required. Objectives: To investigate the adherence to and the duration of antibiotic administration to treat cetuximab-induced acneiform eruption. Methods: Medical data of patients who were referred to the Department of Dermatology were reviewed from January 2013 to June 2018. Dermatologists assessed the severity of acneiform eruption and prescribed tetracycline-class antibiotics according to the severity every 2 or 4 weeks. We investigated the duration and amount of oral antibiotic administration and analyzed the factors that may affect the control of acneiform eruption statistically. Results: A total of 207 of 267 patients referred to the Department of Dermatology showed acneiform eruption; 124 patients were treated with minocycline, 34 patients with doxycycline, 27 patients with both, and 22 patients with topical agents. The mean duration of oral antibiotic medication was 82.7 days. A statistical analysis of the factors that prolonged the use of antibiotics for more than 90 days showed that male and younger age were risk factors. Shorter time interval from starting cetuximab to starting antibiotics was associated with longer duration of antibiotic use, statistically. Conclusions: Cetuximab-induced acneiform eruption can be well controlled with tetracycline-class antibiotics in about 3 months. It can last longer in male and younger patients. The sooner and the more severe it appears, the longer it can last.