Cutaneous Side Effects Research Articles

The Applicability of Tyrosine Kinase Inhibitors in Pediatric Chronic Myeloid Leukemia

INTRODUCTION The advent of tyrosine kinase inhibitors (TKIs) has shifted the treatment paradigm of adult CML, limiting SCT to a last-resort option for TKI-ineligible or resistant cases. However, determination of the optimal dosing and duration, potential long-term side effects, and the viability of therapy discontinuation remain under-explored aspects of TKIs in pediatric CML. Emerging data supports administering novel TKIs as initial or second-line treatments in pediatric CML amid variable results. This review discusses the RCTs conducted on pediatric patients with CML who received TKIs, aiding in better understanding of the effectiveness and safety of TKIs in the pediatric CML population. METHODS We searched Medline, OVID, and Web of Science for all RCTs reporting the efficacy and safety of TKI in pediatric CML (< 18 years). We compiled the individual efficacy and safety data into distinct tables, emphasizing demographics, treatment modalities, and outcomes pertaining to both the safety and efficacy of TKI. RESULTS This review analyzed 17 Randomized Controlled Trials (RCTs) with 887 pediatric CML patients. Median age was 11.3 years (range 6.5-14 years). Efficacy studies had 718 patients, safety studies had 851.. The median white blood cell count was 234 x10 9/uL [range 19 to 378; reported in 9 RCTs], median hemoglobin level was 9 g/dL [range 5.6 to 10.8; from 7 RCTs], and the median platelet count was 431.5 x10 9/µL, [range 31 to 594; from 6 RCTs]. TKIs were first-line treatment in 65% of the studies, Imatinib being the commonest (61% of studies). Dasatinib and Nilotinib were used in 17% and 11% of studies, respectively, while 6% received a combination of imatinib and chemotherapy. Efficacy reporting in the RCTs was a major concern that challenged the accumulation of results (Table 1). BCR-ABL response of <10% ranged from 60 % to 78%, and the complete cytogenetic response (CCYR) at 24 months ranged from 62% to 94%. Progression free survival (PFS) ranged from 56.8% to 100%; however, the timepoint for PFS analysis was not standardized among studies (36 to 48 months). Safety data from 16 studies (851 patients) included anemia (n=228), thrombocytopenia (n=161), neutropenia (n=257), hepatotoxicity (n=98), and cutaneous side-effects (n=156). Cardiovascular complications with second generation TKIs included QTc prolongation with Nilotinib (n= 11) and heart failure with Dasatinib (n=4). Nausea/vomiting were reported in 119 patients on imatinib, vs. 64 and 37 patients on Dasatinib and Nilotinib, respectively. Diarrhea occurred in 40 patients on Imatinib ,and 20 and 2 patients in Dasatinib and Nilotinib cohorts, respectively. Other AEs included impaired bone growth (70 on Imatinib and 10 on Dasatinib), headache (44 on Imatinib, 38 on Nilotinib and 13 in Dasatinib), musculoskeletal pain (161 on Imatinib, 31 on Dasatinib and 8 on Nilotinib). Treatment AEs leading to drug discontinuation were reported in 22 patients (6 studies), however the exact AE leading to drug discontinuation were not reported. CONCLUSION There remains a limited experience in treating pediatric CML with TKIs. Hence, evidence from prospective clinical trials and real-life clinical practice are required to establish appropriate guidelines for the standard therapeutic management in this population. Imatinib has the most extensice efficacy and toxicity data in pediatric patients. The Safety profile of TKIs was consistent with the known safety profile in adults. With the availability of three TKIs as first line options, multiple factors should be considered when selecting first line TKI, including drug formulation, administration, comorbidities, and financial issues. Careful monitoring of adverse events, especially in growing children should be considered in long term follow-up clinical trials.

Defining the short-term and long-term skin manifestations of COVID-19: insights after more than three years of the pandemic.

This review aimed to assess the impact of coronavirus disease 2019 (COVID-19) on skin health to establish a classification of the skin lesions that occur most frequently during the disease and whether a particular category of skin damage is more likely to occur both in the short term and in the long term. We conducted a literature search of the PubMed database. Ultimately, 109 articles were included in this review. The exact phrases∕syntax and connectors used for the database search∕query were as follows: "Coronavirus and skin", "COVID-19 and skin", "SARS-CoV-2 and skin", "Coronavirus cutaneous manifestations", "COVID-19 cutaneous manifestations", "SARS-CoV-2 cutaneous manifestations", "Coronavirus dermatology", "SARS-CoV-2 and dermatology", "COVID-19 and dermatology", "COVID-19 and skin eruption", "Coronavirus and skin rash", "COVID-19 and hair", "Coronavirus and hair", "Coronavirus and nails", "SARS-CoV-2 and hair", and "SARS-CoV-2 and nails". Only articles with abstracts referring strictly to cutaneous manifestations of COVID-19 were chosen. Articles without abstracts were not considered. We established six of the most frequently reported clinical patterns associated with COVID-19 and their probability of occurring during COVID-19 disease evolution based on the current literature reports. We did not identify the particular types of skin lesions that are most prone to long-term persistence; most such cases are rare, and no conclusion can be drawn based on them. Apart from classified COVID-19-related skin disorders, this pandemic has been a challenge for dermatologists and a wide range of cutaneous side effects related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) treatments have been reported. We are aware of other polymorphic clinical presentations, with novel data being reported periodically, but the pathophysiological mechanisms and evolution are largely unknown.

Annular elastolytic giant cell granuloma after COVID-19 vaccination

The pandemic of SARS-CoV-2 during the first years of the 2020s led to a great commitment to develop effective vaccines. Despite of the good safety and tolerability profile, vaccines may trigger a broad spectrum of cutaneous side effects. Granulomatous dermatitis has been rarely reported after SARS-CoV-2 mRNA vaccines, but no cases of annular elastolytic giant cell granuloma have been already described. Moreover, in our case, it was also associated with a central area of mid-dermal elastolysis, confirming the strong association between these two diseases already reported in literature. The observation of occasional eosinophils within the infiltrate and the presentation of the cutaneous eruption few days after the administration of the second dose of Pfizer/BioNTech (BNT162b2) vaccine are highly suggestive of a drug-related eruption. To our knowledge, this is the first report in literature of an annular elastolytic giant cell granuloma as an adverse effect of SARS-CoV-2 vaccination.

Retrospective Analysis of Liver Enzyme Abnormalities in Patients Prescribed Terbinafine and Itraconazole for Onychomycosis.

Introduction Onychomycosis (OM) is defined as a nail fungal infection. Its prevalence increases with advancing age. Human-to-human transmission makes it a serious public health risk. Although OM is not a life-threatening disease, it has a detrimental effect on patients' quality of life. Due to the long therapy duration and potential side effects of systemic antifungal medicines, physicians may be reluctant to treat OM orally. In this study, we aimed to evaluate the effect of terbinafine and itraconazole on liver transaminases, the side effects of these treatments, and patients' adherence to systemic treatment of OM. Methods This is a retrospective study conducted in our dermatology department (Ordu University, Ordu) between June 2020 and October 2021. Hospital records were analyzed, and patients with the diagnosis of tinea unguium (ICD code B35.1) were investigated. Patients who were prescribed terbinafine or itraconazole were included in the study. Following a clinical diagnosis of OM, the researchers first tried to confirm it through direct microscopic examination with potassium hydroxide (KOH). If the direct microscopic examination was negative but the suspicion about OM continued, confirmation was done through a fungal culture. Results This study included 735 patients, of whom 409 (55.6%) were female and 326 (44.4%) were male. The research covered all of the patients who were given one of these two medications. To find patients who could apply to other hospitals, the Turkish National Healthcare System was checked in addition to hospital information. To identify patients who could apply to other healthcare institutions, all hospitals share their data with this national healthcare system. Terbinafine was used by 433 patients (76.4%), 75 patients (13.2%), and 37 patients (6.5%), respectively, for one, two, and three months. A total of 119 patients (70.8%) took itraconazole for a month, 32 patients (19%) took it for two months, and four patients (2.33%) took it for three months. At the end of the first month, the proportion of the patients with elevated aspartate transaminase (AST) levels was 5.2% for terbinafine and 0% for itraconazole. Eighteen (8.4%) patients with terbinafine had elevated alanine aminotransferase (ALT) levels, and four patients (7.5%) who were on itraconazole treatment had high ALT levels. None of the patients reported cutaneous adverse drug reactions, gastrointestinal disturbances, or headaches due to OM treatment. Also, no patients discontinued treatment because of hepatotoxicity. Conclusion In this study, none of the patients discontinued the treatment because of hepatotoxicity. According to the results of this study, oral terbinafine and itraconazole can be used with close follow-up. Baseline and regular laboratory monitoring for AST and ALT should be done to monitor liver toxicity with terbinafine and itraconazole. Besides, we did not observe other side effects like cutaneous or cardiac side effects or drug-drug interactions.

42456 Characterizing the Cutaneous Side Effect Profile in Pediatric Patients Receiving Mitogen- Activated Kinase Inhibitor Therapy

42456 Characterizing the Cutaneous Side Effect Profile in Pediatric Patients Receiving Mitogen- Activated Kinase Inhibitor Therapy

Efficacy of immune checkpoint inhibitors in patients with anorectal melanoma in association with immune-related adverse events: a case series.

Anorectal melanoma (AM) is a rare subtype of mucosal melanoma with a poor prognosis. Given its rarity compared to its cutaneous counterpart, the benefits and side effects of immune checkpoint inhibitor (ICI) therapy and the relationship between side effects and prognosis remain unclear. Herein, we describe the clinical presentation of five patients with AM treated with ICI as well as their relationship to the treatment course and the development of immune-related adverse events (irAEs). Three patients received sequential or concurrent administrations of nivolumab and ipilimumab, one received nivolumab alone, and one received ipilimumab alone. The response rate (RR) and disease control rate (DCR) were 40% and 80%, respectively. Pituitary and hepatic dysfunctions were the most common irAEs observed (40% each), followed by thyroid, diarrhea, and renal dysfunctions (20% each). The RR was 67% in patients with irAEs while no response was observed in patients without irAEs. DCR was 100% and 50% in patients with and without irAEs, respectively. Overall survival was 34months in irAE and 8.75months in non-irAE cases, with a longer survival trend in irAE cases. ICI therapy was effective and well-tolerated by AM patients, with potentially better outcomes for those who experienced irAEs compared to those who did not.

Adverse side effects of Glatiramer acetate and Interferon beta-1a in patients with multiple sclerosis: A systematic review of case reports.

Background: Glatiramer acetate (GA) and Interferon (IFN) beta-1a are used as first-line disease-modifying treatments for multiple sclerosis (MS). In this systematic review, we summarized case reports and case series of adverse side effects of GA and IFN beta-1a in MS patients. Methods: Without any restrictions, PubMed, Scopus, Web of Sciences, and Embase databases, and gray literature were systemically searched until June 2022. Articles were screened and data were extracted based on a predefined table by two independent reviewers. The risk of bias was assessed using the Joanna Briggs Institute (JBI) tool. Results: We identified 2103 records from the preliminary search. After deduplication and screening, 172 articles were included in the systematic review. In total, 229 individuals (52 men, 173 women, and 4 unknown) were included in the study. The most common adverse events were cutaneous (32.75%), hepatic (13.54%), allergic (8.3%), and neurological (5.68%) side effects. Furthermore, most reported side effects were related to autoimmune diseases or hypersensitivity reactions. Conclusion: GA and IFN beta-1a are associated with several side effects which may be related to the immunomodulatory function of medication or other injection-related reactions.

Rare Cutaneous Side Effects of Imiquimod: A Review on Its Mechanisms, Diagnosis, and Management.

As an immune-response modifier, imiquimod can bind to Toll-like receptors on immune cells and enhance innate and adaptive immune responses, exerting potential antitumor and antiviral effects, which led to its approval by the US Food and Drug Administration for the treatment of actinic keratosis, superficial basal cell carcinomas, and anogenital warts, and to its off-label use in treating many other benign and malignant dermatoses. Although topical administration of imiquimod has been considered well tolerated, an increasing number of cutaneous and noncutaneous side effects are being reported as its clinical applications expand. This review primarily focuses on rare cutaneous side effects. To the best of our knowledge, this is the first article to summarize the mechanism, diagnosis, and management of rare cutaneous side effects of imiquimod, which may help to heighten awareness among physicians, especially dermatologists, about potential imiquimod-induced cutaneous side effects.

Pustular Eruption following COVID-19 Vaccination: A Narrative Case-Based Review.

From the beginning of public vaccinations until the relaxation of COVID-19 measures, many case reports, case series and case-control studies have been published indicating cutaneous side effects of COVID-19 vaccination. Post-vaccination pustular eruption was reported as well, with a challenging differential diagnosis between pustular psoriasis, AGEP (acute generalized exanthematous pustulosis) and neutrophil pustular eruptions. We report a case of 56-year-old woman presented with acute generalized pustular flare up culminated 5 days after the second dose of BNT162b2(Pfizer) vaccination. She was diagnosed with pustular psoriasis flare and due to the regulating role of IL-1 in pustular psoriasis and in the cytokine storm observed in cases of COVID-19 postvaccination inflammation; we decided to treat the patient with an IL-1 antagonist, subcutaneous anakinra (100 mg daily) along with acitretin. One week later, after anakinra withdrawal, she presented a pustular psoriasis flare and a 7-day anakinra re-administration led to a satisfactory improvement in the skin lesions. We also reviewed the medical literature and found 28 case reports with pustular eruption after the COVID-19 vaccination. We compared the patients reported, regarding sex, age, number of doses, post-vaccination period and vaccine brand, and compared those results with our patient. Finally, as indicated by our case and other cases with similarly treated pustular eruptions. targeted therapy to this cytokine imbalance such as anakinra (IL-1) antagonist can improve the clinical course of the patient.

Halo Nevi After Covid-19 Vaccination: Molecular Mimicry Attributed Cutaneous Side-Effect?

Covid-19 vaccination is a crucial component of the public health response to reduce the spread of Covid-19. Although well-tolerated, Covid-19 vaccination is associated with several cutaneous adverse reactions. Here, we document a case of a young man who developed numerous halo nevi at sites of pre-existing nevi following Covid-19 vaccination. Our patient is a 21-year-old male who presented to clinic after noticing a recent change in his moles. Three months after receiving the Johnson & Johnson (J&J) Covid-19 vaccine, the patient reported that he developed a ring of “vitiligo” surrounding each of his existing moles. He also received the Moderna Covid-19 booster 8 months after receiving the J&J vaccine and contracted Covid-19 two months later, with no additional change in his moles. The patient was otherwise well with no past medical or family medical history of skin cancer. On examination, the patient was found to have numerous halo nevi that had developed at sites of pre-existing nevi and were distributed over his face, neck, trunk, and extremities. Examination of his scalp revealed patches of white hair, underneath which were additional halo nevi. The development of vitiligo in the setting of Covid-19 vaccination is thought to be related to the activation of autoimmunity. Autoimmunity secondary to Covid-19 vaccination may be the cause of this patient’s halo nevi, given the patient’s age and absence of any systemic symptoms.

Cutaneous adverse effects of chemotherapy in cancer patients: A clinico epidemiological study

With chemotherapy being the major modality of treatment, cutaneous and systemic side effects have been a concern for not only the patients, but also the treating clinicians. Because chemotherapy target not only the cancer cells, but also the other rapidly proliferating cells, skin and skin appendages like hair and nails are most commonly affected.: To study the cutaneous adverse events associated with the commonly used cancer chemotherapy drugs.: 120 patients of clinically diagnosed cancer who underwent chemotherapy and satisfied the inclusion and exclusion criteria were included in this observational study. Photographic images of skin, hair and nails were taken before and after every cycle of chemotherapy were collected. Data were analysed using SPSS version 16.0.: 120 patients including 72 females and 48 males were included in this study with majority (56%) belonging to age group of 55-70 years. The common indications for chemotherapy were carcinoma breast (34%), carcinoma oropharynx (22%) and carcinoma stomach (12%).Hair changes were the most common presentation, reported in 38 patients, skin changes in 35 cases, nail changes in 15 cases. Xerosis (46%) and hyperpigmentation (22%) were the most commonly observed adverse event affecting skin.: Since all cancer chemotherapy agents are not target based, adverse effects of skin and appendages become inevitable. However, early detection of such adverse effects can help them managed effectively and thereby reducing the morbidity and increasing the quality of life of cancer patients.

Cutaneous Side Effects of Modern Targeted Therapy and Immunotherapy in Patients with Dermatological Malignancies.

The advent of immunotherapy and targeted therapies in treating dermatological malignancies has dramatically changed the landscape of dermato-oncology in recent years. Their superior efficacy compared to previous therapeutic options, such as chemotherapy, has resulted in their use in treating devastating malignancies, such as melanoma or unresectable/metastatic basal cell and squamous cell carcinoma. Skin toxicity is a critical safety consideration, among other adverse reactions, that can occur under treatment with these agents. This article aims to summarize the cutaneous side effects of immune checkpoint inhibitors and targeted dermato-oncological therapies. Although the skin side effects of these agents are primarily mild, they can occasionally affect the decision for treatment continuation and the quality of life of the affected patients. Therefore, physicians must be acquainted with the specific cutaneous toxicity profile of such treatments to mitigate their impact on the patients and optimize the overall outcome of dermato-oncological therapy.

Perspectives of adolescents with neurofibromatosis 1 and cutaneous neurofibromas: Implications for clinical trials.

More than 99% of individuals with neurofibromatosis 1 develop cutaneous neurofibromas, benign nerve sheath tumors that manifest as nodules on the skin. These cutaneous neurofibromas emerge with age, appearing most commonly in adolescence. Nevertheless, few data have been published on how adolescents with neurofibromatosis 1 feel about cutaneous neurofibromas. The purpose of this study was to assess the perspectives of adolescents with neurofibromatosis 1 and their caregivers regarding cutaneous neurofibroma morbidity, treatment options, and acceptable risks-benefits of treatment. An online survey was distributed through the world's largest NF registry. Eligibility criteria included self-reported neurofibromatosis 1 diagnosis, adolescent child ages 12-17 years, ≥1 cutaneous neurofibroma, and ability to read English. The survey was designed to collect details about the adolescent's cutaneous neurofibromas, views on morbidity related to cutaneous neurofibromas, social and emotional impact of cutaneous neurofibromas, communication regarding cutaneous neurofibromas, and views regarding current and potential future cutaneous neurofibroma treatment. Survey respondents included 28 adolescents and 32 caregivers. Adolescents reported having several negative feelings about cutaneous neurofibromas, particularly feeling worried about the potential progression of their cutaneous neurofibromas (50%). Pruritus (34%), location (34%), appearance (31%), and number (31%) were the most bothersome cutaneous neurofibroma features. Topical medication (77%-96%), followed by oral medication (54%-93%), was the most preferred treatment modality. Adolescents and caregivers most often replied that cutaneous neurofibroma treatment should be initiated when cutaneous neurofibromas become bothersome. The majority of respondents were willing to treat cutaneous neurofibromas for at least 1 year (64%-75%). Adolescent and caregivers were least willing to risk pain (72%-78%) and nausea/vomiting (59%-81%) as a cutaneous neurofibroma treatment side effect. These data indicate that adolescents with neurofibromatosis 1 are negatively impacted by their cutaneous neurofibromas, and that both adolescents and their caregivers would be willing to try longer-term experimental treatments.

Cutaneous adverse reactions resulting from targeted cancer therapies: histopathologic and clinical findings

Targeted cancer treatments-designed to interfere with specific molecular signals responsible for tumor survival and progression-have shown benefit over conventional chemotherapies but may lead to diverse cutaneous adverse effects. This review highlights clinically significant dermatologic toxicities and their associated histopathologic findings, resulting from various targeted cancer drugs. Case reports and series, clinical trials, reviews, and meta-analyses are included for analysis and summarized herein. Cutaneous side effects resulting from targeted cancer therapies were reported with incidences as high as 90% for certain medications, and reactions are often predictable based on mechanism(s) of action of a given drug. Common and important reaction patterns included: acneiform eruptions, neutrophilic dermatoses, hand-foot skin reaction, secondary cutaneous malignancies, and alopecia. Clinical and histopathologic recognition of these toxicities remains impactful for patient care.

Ocrelizumab-induced Psoriasis in A Patient with Relapsing-Remitting Multiple Sclerosis

Background: Ocrelizumab is widely used as a Disease Modifying Drug (DMD) in Multiple sclerosis. The complete side effects are yet not known. Materials and Methods: We describe a 34-year-old female with longstanding relapsing-remitting Multiple Sclerosis for whom Ocrelizumab was started as an escalation therapy. She reported severe itchy and patchy lesions two months after the first full dose of Ocrelizumab. Pathohistological findings revealed the diagnosis of guttate psoriasis. Psoriasis continued to flare against treatment with topical steroids, and UV therapy and progressed to developed arthritis psoriasis. Results: Treatment escalated to an IL-17 antagonist (Secukinumab), with a favorable outcome. Ocrelizumab was discontinued. After one year of follow-up, the patient remained stable from an MS standpoint. Conclusion: This is the third report showing the possible cutaneous side effect of Ocrelizumab.

Dupilumab-associated cutaneous adverse events among adult patients with atopic dermatitis: A retrospective study.

Dupilumab, a monoclonal antibody inhibiting interleukin (IL) 4 and IL-13, is approved for the treatment of moderate to severe atopic dermatitis (AD) in children aged ≥6 years, adolescents, and adults. Both clinical trials and real-life data demonstrate its efficacy and safety. However, some cutaneous adverse events (cAEs) have been observed during real-world experiences. The authors' aim was to analyze the spectrum of cAEs in patients receiving dupilumab for the treatment of AD in a real-world setting. A retrospective review of electronic medical records was conducted for 916 patients (475 males and 541 females; mean age, 50.23 ± 19.66 years [range, 18-91 years]) who had received dupilumab for a minimum of 1month for the treatment of AD from December 2018 to November 2022 at the Department of Dermatology of University Federico II of Naples (Italy). The mean duration of dupilumab treatment was 27.31 ± 21.26 months. A total of 148 of 916 (16.15%) (90 males; mean age, 50.91 ± 15.34 years) patients reported other cAEs apart of AD flare; namely, facial redness (82 of 916; 8.95%), psoriasis (39 of 916; 4.25%), alopecia areata (11 of 916; 1.2%), skin peeling (11 of 916; 1.2%), parapsoriasis (three of 916; 0.32%), and vitiligo (two of 916; 0.21%). Thirty-one of 916 (3.38%) patients discontinued dupilumab because of cAEs (18 of 916; 1.96%) for facial redness, 10 of 916 (1.09%) for psoriasis, and three of 916 (0.32%) for parapsoriasis. In our population, most of the cAEs were mild and did not require discontinuation of dupilumab. These findings would enable dermatologists understand the cutaneous side effects of dupilumab better, resulting in improved treatment plan decisions in clinical practice.

A Case of Transient Eruptive Keratoacanthoma Associated With Nivolumab

ABSTRACT Anti-PD-1 immunotherapy agents are known to cause cutaneous side effects in up to 42% of patients with melanoma, infrequently including eruptive keratoacanthomas (de Golian et al., 2016, p. 57). Although traditionally documented with pembrolizumab use, increasing reports of eruptive keratoacanthomas with nivolumab use are emerging in the literature (Bednarek et al., 2018, pp. e28–e29). We present a similar case of a 74-year-old woman with melanoma of the right upper extremity with metastases to the lung. She received her first infusion of nivolumab and, within 2 weeks, developed a pruritic rash on the right arm. Within 1 month, the rash spread to all extremities and would blister, scale, and slough off. Punch biopsy of the right lower extremity revealed squamous proliferation suspicious for eruptive keratoacanthoma secondary to nivolumab therapy. The patient continued nivolumab and was referred to dermatology to monitor.

NOT THE USUAL CULPRIT DRUG! AN EXTREMELY RARE CASE OF TOXIC EPIDERMAL NECROLYSIS SECONDARY TO ITRACONAZOLE.

Toxic epidermal necrolysis (TEN) is a severe mucocutaneous adverse reaction, potentially life threatening, which occurs mainly due to drugs and involves more than 30% of the body surface area. Here, we report an extremely rare case of TEN secondary to itraconazole developing in a young female who was prescribed itraconazole for tinea cruris with corporis. Cutaneous side effects of itraconazole are rare and usually mild. It can manifest as maculopapular rash, xed drug eruption, urticaria and angioedema. But development of TEN secondary to itraconazole is extremely uncommon and rarely implicated as a culprit drug for TEN. In countries with high prevalence of tinea cruris and corporis, dermatologists and clinicians should be aware about the possibilities of adverse reactions that can occur due to itraconazole.

Evaluation of effectiveness and tolerability of a moisturiser as an adjuvant to isotretinoin therapy for acne: a real-world evidence

Background: Moisturizers are recommended as an adjuvant to acne therapies especially topical/systemic retinoids to counteract their cutaneous side-effects. Moisturisers also reduce inflammation and the intensity of acne. The compliment study was designed to evaluate effectiveness and tolerability of moisturiser (Excela, Cipla Ltd., Mumbai, India) in patients prescribed isotretinoin for managing their acne in real-world scenario. Methods: This open-label, observational, prospective, non-comparative multicentre study was conducted between June 2019 and January 2020. Patients who were prescribed Excela moisturiser as an adjuvant to isotretinoin for acne management were enrolled. After four weeks, the investigator graded the patient’s skin on smoothness and softness on a five-point scale and dryness, scaling and redness on a four-point scale. Its organoleptic characteristics and tolerability were evaluated using the subject assessment questionnaire. Results: We enrolled 200 patients (average age: 24.02±5.44 years). Investigators rated smoothness and softness of the skin as very good to excellent in 129 (64.5%) and 113 (56.5%) patients. No patient reported severe skin dryness, scaling or redness. Very good to excellent spreadability and appeal was rated by 132 (66.0%) and 133 (66.5%) patients, respectively. Eighty (40%) patients rated the moisturiser as non-greasy/non-sticky. Itching (1%), redness (0.5%), cold (0.5%), and cough (0.5%) were reported as adverse events but were of mild intensity and unrelated to the study product. No patient experienced serious adverse event or moisturiser-related adverse event. Conclusions: Overall, Excela moisturiser was effective and tolerable in patients with acne who were prescribed isotretinoin at the end of 4-week-long treatment period.

Long-pulsed neodymium-doped yttrium aluminum garnet for hair reduction in pediatric microtia repair.

Microtia is the term for congenital malformation of the ear in which the external and internal ear are absent or malformed. Surgical reconstruction is a common management approach and occasionally requires hair reduction of the newly constructed auricle. Few studies have investigated lasers for this purpose. Weconducteda retrospective chart review of patients seen at a single institution between 2012 and 2021 who underwent laser hair reduction with long-pulsed neodymium-doped yttrium aluminum garnet laser (Nd:YAG). Efficacy ratings were done through review of clinical photographs. Twelve patients were identified with 14 total ears treated. The number of laser treatments varied from 1 to 9 sessions with an average of 5.1 treatments. The majority (8/12) had an "excellent" or "very good" response, one patient had a "good" response, and three were lost to follow-up. Other than pain, there were no side effects documented. Nd:YAG laser was both effective and safe in our pediatric cohort, without any cutaneous side effects in patients with darker skin.