Acneiform Research Articles

Clinical spectrum of cutaneous adverse drug reactions

Background: Cutaneous adverse drug reactions (CADRs) are common, comprising 10%–30% of all reported adverse drug reactions (ADRs) and its incidence in hospitalized patients is 2%–3%. Aims: The aim is to study the different clinical spectrum of CADRs in outpatient and inpatient and to find out the offending drug. Settings and Design: A prospective observational, nonrandomized hospital-based study was conducted at a tertiary care hospital over a period of 12 months. Materials and Methods: Patients presenting with suspected drug-related cutaneous lesions were included if drug identity could be ascertained. Clinical profiling was done. The severity of the reaction was assessed using modified Hartwig and Siegel ADR severity assessment scale. Statistical Analysis Used: Data were analyzed using Stata Version 13. Results: Out of the total study population, most commonly observed cutaneous ADRs were fixed drug reaction in 28.75%, followed by maculopapular drug rash in 26.3%, and urticarial rash in 20.6%. Few less frequently observed CADRs were a lichenoid eruption, acneiform eruption, and baboon syndrome, generalized pruritus, pityriasis rosea, and vasculitis. Antimicrobials accounted for 37.5% of the total followed by nonsteroidal anti-inflammatory drugs 25%, anti-epileptics 12.5%, and antifungal 6.25%. Anti-retroviral therapy contributed 3.125%, whereas 1.875% were due to Anti-Koch's therapy. About 28.1% of patients were taking monotherapy, whereas 71.9% of patients were received polytherapy. Conclusions: Wide spectrums of drug reaction were observed in this study. Sound knowledge of these drug eruptions may help the clinician to diagnose and effectively manage their cases. Polypharmacy is a well-known predictor of ADRs in children and adults.

Haloperidol decanoate-induced acneiform eruption: A case report

Haloperidol decanoate is a depot preparation of haloperidol, which may rarely cause dermatological side effects among other commonly seen side effects. A PubMed search did not reveal any report of acneiform drug eruption associated with haloperidol decanoate in English literature, although it is listed as a side effect by the manufacturer. We report a case of bipolar disorder patient with manic episode who developed acneiform lesions after treatment with haloperidol decanoate 300 mg for psychotic symptoms, and it subsided two weeks of injection of the drug.

Long-Term Health Effects of PCBs and Related Compounds: A Comparative Analysis of Patients Suffering from Yusho and the General Population.

Yusho, which refers to a mass poisoning caused by the ingestion of rice bran oil contaminated with polychlorinated biphenyls, polychlorinated dibenzo-p-dioxins, and polychlorinated dibenzofurans, was first reported in October 1968 in Japan. Yusho patients suffer from various symptoms; however, after 40years, some emerging symptoms have been attributed to aging. The prevalence of symptoms and diseases among Yusho patients and the general population was compared in this study. The data obtained from the survey among Yusho patients (1131 patients) by the Ministry of Health, Labour, and Welfare of Japan in 2008 were compared with the data from a survey conducted among the general population. When selecting the comparison group, the age and residential area (prefecture) were taken into account to match the baseline characteristics of Yusho patients. A logistic regression analysis was performed to identify the association between Yusho and the prevalence of symptoms and was adjusted for various potential confounding factors (age, sex, body mass index, cigarette smoking, frequency of drinking, and walking time). Skin pigmentation and acneiform eruption were found to be characteristic symptoms of Yusho and were more prevalent in these patients. Other symptoms and diseases associated with Yusho included orthostatic hypotension, hypohidrosis, dysgeusia, Basedow's disease, hoarseness, cardiac insufficiency, tachycardia, eczema, and hair loss. Symptoms related to aging, such as general fatigue, arthralgia, and numbness in the extremities, were significantly higher in Yusho patients after adjusting for age and lifestyle. This study demonstrated that, 40years after the outbreak of Yusho, the prevalence of various symptoms and diseases in Yusho patients, including age-related diseases, was higher than that in the general population.

Prevalence and Sociodemographic Profile of Lithium-induced Cutaneous Side Effects in Bipolar Affective Disorder Patients: A 1-year Prospective Observational Study in South India.

Objectives:Objective in our study is i) To assess the prevalence and sociodemographic profile of cutaneous side effects in bipolar affective disorder patients (BPAD) on lithium. ii) To assess the course of pre-existing skin reactions, when patient is initiated on lithium therapy.Methods:Lithium induced cutaneous side effects were assessed at baseline and monthly for 6 months followed by every 2 months over a year. Dermatologist opinion obtained to diagnose and treat for each patient who developed cutaneous side effects. Data were analyzed in percentage.Results:The prevalence of lithium induced cutaneous side effects in our study is 38.46%. On analyzing the individual subtype of cutaneous lesions, acneiform eruption and hairfall were most common. The cutaneous adverse reactions on lithium are more common in early adulthood than in the late adulthood and geriatric age group and among the subtypes of skin lesion acneiform eruptions are more common among males than in females. On analyzing the course of pre-existing lesions, severe alopecia developed with pre-existing systemic lupus erythematosis.Conclusion:These novel finding indicate that prevalence of lithium induced cutaneous side effects continues to be high. Hence, clinician should educate the patients before initiating lithium to improve attrition rate.

Clinico-aetiological study of cutaneous adverse drug reactions in a tertiary care hospital

Background: Healthcare professionals, and indeed patients, face numerous challenges when considering ADRs. Methods: The objectives of this study is to observe the prevalence, clinico-aetiological patterns and clinical type of drug eruptions. A Prospective observational, Non-invasive study was carried out at Department of Dermatology, Osmania General Hospital, a Tertiary Care Teaching Hospital for a period of 12 months. A total of 100 cases of drug eruptions were randomly selected into the study. Results: Females seem to be more susceptible to drug reactions than Males. Adults and middle aged people were seems to be more prone for drug reactions. Fixed drug eruption was the commonest reaction followed by Urticaria, Pruritus, Lichenoid eruption and Acneiform eruption in this order. Common offending drugs, in order of frequency are Sulphonamides, NSAIDs, Isoniazid and other antibiotics. Conclusion: By implementing the ADR reporting, one can promote drug safety and better patient care, among healthcare professionals and be aware of these concerns so that they might be anticipated and addressed in future patients with CADRs.

Severe Acneiform Facial Eruption: An Updated Prevention, Pathogenesis and Management

Acne scarrings and papulopustular rosacea (PPR) are well documented cutaneous condition associated with major psychosocial morbidity. The burden of disease to the family and society is significant. A positive family history is a predictor. Inflammation involved an interplay of body inmate immunity and pro-inflammatory mediators, cytokines, neuropeptides and defence immune response to microbiomes results acneiform eruption. Modern research in molecular biology, neuroimmunology and clinical science enable the practicing physician to understand more about the pathogenesis of this complex skin disease and hence better therapeutic measures and management of the disease.

Severe acneiform eruption to EGFR inhibitor treated with isotretinoin

Severe acneiform eruption to EGFR inhibitor treated with isotretinoin

Retrospective review of steroid-induced acne in patients with breast cancer.

e12570 Background: With the rapid development of targeted inhibitors, the incidence of cutaneous chemotoxicities is rising and represents a significant cause of morbidity in cancer patients. Therefore, rapid recognition of rashes that warrant dose reduction or discontinuing treatment is critical. Unfortunately, the concomitant use of systemic steroids with chemotherapeutics that can produce acneiform eruptions, make it difficult to distinguish a cutaneous chemotoxicity from systemic steroid induced acne (SSIA). Although SSIA is a well known complication of systemic steroid administration, there are few published studies regarding this condition, none of which have been done in cancer patients. In this study, we sought to examine the incidence of SSIA, the patient and tumor characteristics as well as the chemotherapy regimen most commonly associated with SSIA in breast cancer patients treated with chemotherapy at the City of Hope National Comprehensive Cancer Center. Methods: We performed a retrospective study. Using the institutional registry of patients, we identified 3,848 patients that received a diagnosis of breast cancer between 1/2009-6/2015, 1,991 (51%) of which received at least one cycle of chemotherapy. 61 of these patients received a ICD-9 billing code for “acne” or “ steroid acne”, 10 of whom had explicit documentation of acne or acneiform eruption in their chart. Results: All 10 patients were female with a median age of 49 (range 36-56). 50% of patients had ER+/PR+ disease and 30% had ER-/PR-/HER2- breast cancer. 90% of patients had stage I or II disease. 70% of patients developed steroid induced acne after the 1st cycle of chemotherapy. All regimens contained either docetaxel or paclitaxel. Dexamethasone was implicated in all but one case. We report an overall incidence of SSIA of 0.05% among breast cancer patients treated with at least once cycle of chemotherapy at our institution. Conclusions: These results suggest that breast cancer patients at highest risk for SSIA are on taxane-based regimens with early stage disease and are most likely to develop the reaction after their first cycle of chemotherapy. This study however is limited by the retrospective design, the reliance on ICD 9 billing codes, and the limited sample size.

Cutaneous adverse effects during ipilimumab treatment for metastatic melanoma: a prospective study.

Ipilimumab is an immunomodulatory antibody directed against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), which is administered to patients with advanced melanoma, with a proven positive effect on overall survival. The cutaneous adverse effects (AEs) of ipilimumab are relatively frequent, although described as usually mild and rarely life threatening. To describe a three-year experience of a single institute in detecting and managing cutaneous AEs. A cohort of patients (n=41) treated with ipilimumab (3mg/kg/three weeks) for metastatic melanoma, from 2013 to 2016, was investigated for adverse cutaneous events. On dermatological evaluation, 34.1% of the patients in our series developed cutaneous AEs: rash (7.3%; n=3), folliculitis (7.3%; n=3), mucositis (2.4%; n=1), rosacea (2.4%; n=1), eczema (2.4%; n=1), acneiform eruption (2.4%; n=1), syringometaplasia mucinosa (2.4%; n=1), Stevens-Johnson syndrome (2.4%; n=1), and vitiligo (4.9%; n=2). These were all Grade 1 and 2 AEs, except for the case of Stevens-Johnson syndrome (Grade 4). On a patient-reported scale, 4.9% (n=2) and 9.8% (n=4) of the patients complained of severe xerosis and pruritus, respectively. Ipilimumab was relatively well tolerated in our series, mainly causing mild cutaneous AEs, which, in our experience, responded satisfactorily to conventional therapies. Only in one case was the treatment discontinued, due to Grade 4 side effects.

A Case Report on Steroid Induced Acneiform Eruptions

A Case Report on Steroid Induced Acneiform Eruptions

A study of cutaneous adverse drug reactions in the outpatient department of Dermatology at a tertiary care center in Gujarat, India

Background: The data for adverse cutaneous drug reactions (ACDRs) is limited in Gujarat. The ACDRs are one of the frequent ADRs and cause of significant morbidity and mortality in patients of all areas of healthcare today. They are responsible for significant number of hospital admissions. Thus, the present study emphasises on the need and importance of an effective pharmacovigilance programme.Methods: A prospective study was undertaken in a 183 cases tertiary care teaching hospital of India. Male to female ratio, most common class of drug, individual drug causing ACDR, common types of ACDRs Parameters were studied. Other Parameters like Causality, preventability and severe or non-severe reactions were analyzed.Results: Majority of the patients (48%) with CADR belonged to the age group 25-44 followed by 45-64 (28%). Most frequent adverse cutaneous drug reactions reported were Urticaria (40%), Maculopapular rash (25%) & Fixed drug eruptions (21%) in decreasing order of frequency. Majority of reactions (96%) were Bizarre/Unpredictable in nature. As a group, antimicrobials (46%) were most frequently associated with CADR followed by NSAIDs (31%) and antiepileptics (11%). Most of the reactions (93%) were mild-moderate and probable (77%) in nature. Approximately 60% of ACDRs reported in this study were preventable.Conclusions: There was slight male preponderance except acneiform eruptions. Cotrimoxazole being the most common offending drug then after Ibuprofen, Phenytoin among the anti-inflammatory, analgesics, antiepileptics class. Causality assessment resulted in high score 77% of probable category.

SORAFENIB INDUCED ACNEIFORM ERUPTIONS: A CASE REPORT

ABSTRACTSorafenib an oral tyrosine kinase inhibitor is used in the treatment of hepatocellular carcinoma, renal cell carcinoma and thyroid cancer. Sorafenib acts by inhibiting various kinases like tyrosine kinase, RET tyrosine kinase, endothelial growth factor receptor, vascular endothelial growth factor 2 and 3 inhibits angiogenesis and cell proliferation. Acneiform eruptions are known side effect of EGFR inhibitors with incidence ranging between 20 to 90 percent [3], but acneiform eruptions with Sorafenib is seldom seen. Hence, we report a case of Sorafenib induced acneiform eruptions.Keywords: Sorafenib, EGFR, acneiform eruptions, adverse drug reactions

Review and Management of Acneiform Eruptions in Patients with Immune Disorders

Immune disorders are associated with acne or acneiform lesions secondary to the occurrence of acne vulgaris or acneiform eruptions arising as a result of immunosuppressive medication or infection. In this review, we aim to provide an overview of acne and acneiform eruptions that can arise in the immunosuppressed host. Tips for differentiating between various acneiform entities are discussed, as well as a brief overview of treatment considerations.

Nursing interventions to minimize cetuximab-induced dermatologic toxicity

Objective: This study investigated early nursing interventions with the purpose to minimize cetuximab-induced acneiform eruption. The most important side-effect of cetuximab is dermatologic toxicity, up to 90%. Dose-reduction or interruption of cetuximab reduces severity of dermatologic toxicity, probably at the cost of reduced efficacy of the cancer therapy. Thus, prevention or effective supportive care during treatment is important. The study evaluated if patient education could ensure compliance of cancer treatment and effect of oral tetracycline on acneiform eruption, with the purpose to minimize severity of dermatologic toxicity and reduce the use of tetracycline.Methods: The design was a single group prospective interventional study. Gastro-intestinal (GI) cancer patients treated with cetuximab between April 2009 and June 2011 were educated to start treatment with tetracycline 500 mg twice daily when acneiform eruption occurred. Patient’s dermatologic toxicity were graded (by CTCAE) and registered by nurses.Results: Sixty-three patients were evaluable. Patients started tetracycline when acneiform eruption occurred. It reduced severity but not incidence of acneiform eruption, 10% of the patients never developed acneiform eruption and therefore never received tetracycline.Conclusions: Patient-education by a trained oncology nurse in the handling of cetuximab induced acneiform eruption is manageable and effective and ensures a high number of patients carrying through treatment with a full dose of cetuximab.

Misuse of Topical Corticosteroids over Face: A Clinical Study.

Introduction:Topical corticosteroids (TCS) have been widely used in various dermatological diseases. However, because of inadvertent use, TCS misuse has become a common problem faced by dermatologists in various parts of the world. Prolonged use over the face can cause various side effects such as steroid rosacea, acneiform eruptions, and hypertrichosis.Aim:To study the effects of TCS misuse and analyze various factors promoting its use on face.Materials and Methods:A total of 100 patients presenting with various facial dermatoses following the misuse of TCS on the face were studied. Detailed history was noted and the various side effects were recorded.Results:Majority of the patients (70%) were females with maximum number of patients belonging to the age group of 11–20 years. Eighty-five percent of the patients were applying TCS for medical conditions, with acne being the most common indication, and the rest were applying as a general face cream. Pruritus and acneiform eruptions were the most common side effects observed and the other reported were erythema, photosensitivity, steroid dependent face, and telangiectasia.Conclusion:TCS misuse especially over the face can lead to a multitude of side effects. It is high time to create awareness among the patients as well as doctors regarding the proper usage of this wonder drug.

Efficacy of Topical Compound Danxiong Granules for Treatment of Dermatologic Toxicities Induced by Targeted Anticancer Therapy: A Randomized, Double-Blind, Placebo-Controlled Trial.

Dermatologic toxicities resulting in dose reduction or discontinuation of treatment pose challenges for targeted anticancer therapies. We conducted this randomized, double-blind, placebo-controlled trial to investigate the efficacy of topical application of Compound Danxiong Granules (CDG) for treatment of dermatologic toxicities associated with targeted anticancer therapies. One hundred and ten patients with dermatologic toxicities induced by targeted anticancer therapies were randomly assigned to CDG or placebo group. Each crude herb (Rhizoma Chuanxiong, Paeonia suffruticosa Andr., Cortex Phellodendri, Geranium sibiricum L., and Flos Carthami) was prepared as an instant herbal powder. Application of the CDG via topical washes lasted 20 minutes, twice daily, for 10 days. The primary outcome was the total effective rate, defined as reduction in at least one grade of skin toxicity. The total effective rate was 77.61% (52/67) in the CDG group and 27.27% (9/33) in the placebo group (P < 0.0001). Compared to the placebo treatment, CDG treatment achieved a higher total effective rate for hand-foot skin reaction (95.45% versus 27.27%), acneiform eruption (69.23% versus 30.78%), and paronychia (68.42% versus 22.22%). Topical application of CDG can effectively attenuate dermatologic toxicities induced by targeted anticancer therapies. The effect of CDG was more pronounced in hand-foot skin reaction.

Effects of air pollution on the skin: A review.

The increase in air pollution over the years has had major effects on the human skin. Various air pollutants such as ultraviolet radiation, polycyclic aromatic hydrocarbons, volatile organic compounds, oxides, particulate matter, ozone and cigarette smoke affect the skin as it is the outermost barrier. Air pollutants damage the skin by inducing oxidative stress. Although human skin acts as a biological shield against pro-oxidative chemicals and physical air pollutants, prolonged or repetitive exposure to high levels of these pollutants may have profound negative effects on the skin. Exposure to ultraviolet radiation has been associated with extrinsic skin aging and skin cancers. Cigarette smoke contributes to premature aging and an increase in the incidence of psoriasis, acne and skin cancers. It is also implicated in allergic skin conditions such as atopic dermatitis and eczema. Polyaromatic hydrocarbons are associated with extrinsic skin aging, pigmentation, cancers and acneiform eruptions. Volatile organic compounds have been associated with atopic dermatitis. Given the increasing levels of air pollution and its detrimental effects on the skin, it is advisable to use strategies to decrease air pollution.

Cutaneous Side Effects and Transepidermal Water Loss To Gefitinib: A Study of 11 Patients.

IntroductionCutaneous side effects caused by epidermal growth factor receptor (EGFR) inhibitors occurred in 45–100% of patients which may lead to therapy modification or interruption. This study aimed to evaluate cutaneous side effects and transepidermal water loss (TEWL) values in non-small cell lung carcinoma (NSCLC) patients who received gefitinib EGFR inhibitor.MethodsA descriptive observational study with cross-sectional design and a consecutive sampling method was conducted from 1 February to 4 March 2016. Eleven NSCLC patients with EGFR mutation who visited the Hemato-Oncology Clinic/Internal Medicine Department, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, were assessed through history taking, physical examination, and TEWL examination using Tewameter.ResultsTen of the eleven patients experienced cutaneous side effects. The most frequently observed was xerosis cutis (8/10 patients), followed by acneiform eruptions (7/10 patients), and paronychia (3/10 patients). None of these patients experienced hair changes, mucositis, or drug hypersensitivity. Mean TEWL value of these patients was higher than normal (11.205 ± 1.881 g/m2/h).ConclusionsPatients who received gefitinib EGFR inhibitor experienced cutaneous side effects including xerosis cutis, acneiform eruptions, and paronychia, and have mean TEWL values higher than normal. Therefore, it might affect the skin barrier function.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-016-0163-0) contains supplementary material, which is available to authorized users.

Cutaneous Reactions in Children Treated with the Mitogen-Activated Protein Kinase Extracellular Signal-Regulated Kinase Inhibitor Trametinib for Neural Tumors.

The mitogen-activated protein kinase (MAPK) pathway is a target for the treatment of a growing number of malignancies. The cutaneous reactions to medications that inhibit this pathway have not been described in children. A retrospective chart review was completed for eight children with neural tumors treated with the MAPK extracellular signal-regulated kinase inhibitor trametinib. All children were evaluated by a pediatric dermatologist with documentation of cutaneous findings. All patients had at least two separate skin reactions while on treatment with trametinib. Common skin findings included xerotic dermatitis, bacterial folliculitis, acneiform eruptions, paronychia, and hair thinning. No child needed to discontinue use of trametinib due to cutaneous toxicities. Cutaneous reactions are common in children receiving trametinib. Identification of these reactions is the initial step in establishing treatment guidelines that will minimize skin eruptions and subsequent interruption of trametinib treatment.

526P A retrospective study on the protective effect of nonsteroidal anti-inflammatory drugs on panitumumab-related skin symptoms

Background An acneiform eruption, the most frequently observed adverse event due to anti-epidermal growth factor receptor (EGFR) antibodies, is reported due to local inhibition of EGFR. The utility of nonsteroidal anti-inflammatory drugs (NSAIDs) for the acneiform eruption due to erlotinib, an EGFR tyrosine kinase inhibitor, has been reported; thus, a protective effect of NSAIDs on an acneiform eruption has been expected. The objective of this study is to examine the protective effect of NSAIDs on the acneiform eruption due to panitumumab (Pmab). Methods This study comprised 104 patients with KRAS wild-type unresectable advanced/recurrent colorectal cancer who treated with either Pmab and concomitant NSAIDs (concomitant group) or Pmab alone (non-concomitant group) from April 2010 to March 2016. The protective effects of NSAIDs on Pmab-related skin symptoms were retrospectively and comparatively examined regarding age, sex, ECOG performance status, treatment line, treatment regimen, and incidence rate of acneiform eruption. The period of this study was limited to the first 6 cycles from initiation of Pmab treatment, because the acneiform eruption due to Pmab were frequently observed during this period. Patients treated with protective topical or oral steroids after the time that Pmab treatment was started were excluded from this study. Results Of the 104 patients, 37 were in the concomitant group and 67 in the non- concomitant group. The incidence of acneiform eruption in the concomitant group and non-concomitant group were 74.3% and 88.7% (P value = 0.0498), respectively; the numbers of patients with grade 0, 1, 2, 3, and 4 acneiform eruption in the concomitant group were 10, 20, 7, 0, and 0, and those who in the non-concomitant group were 7, 41, 18, 1, and 0 (P value = 0.0495), respectively. The significant differences in both incidence and severity of acneiform eruption were observed between the two groups. Conclusions The concomitant use of oral NSAIDs seemed to be useful for the prevention of acneiform eruption due to Pmab. Legal entity responsible for the study Shizuoka Cancer Center Funding Shizuoka Cancer Center Disclosure All authors have declared no conflicts of interest.