Localized Dermatitis Research Articles

Sub-ulcer Foam Sclerotherapy in Patients with Venous Leg Ulcer, Analysis and Technical Aspects of 134 Consecutive Patients.

For this retrospective study, we analyzed the sub-ulcer foam sclerotherapy technique in patients with venous leg ulcer (VLU). This study included 134 patients treated with sub-ulcer foam sclerotherapy at the Oulu University Hospital vascular outpatient clinic from January 2012 to December 2021. All included patients received sub-ulcer foam sclerotherapy as part of the treatment strategy for superficial venous insufficiency. Compression therapy and local wound care were organized for VLU treatment. A follow-up visit was scheduled for one month after the sub-ulcer foam sclerotherapy. Change in ulcer size, local (skin necrosis, infection) or systemic (deep vein thrombosis, pulmonary embolism) complications, and time to ulcer healing were monitored. The occurrence of major limb-related complications (amputation, surgical revision) was monitored for one year postoperatively. One month after sub-ulcer treatment, ulcers were smaller or completely healed in 108 (81%) patients. Ulcer healing was completed in 123 (92%) patients at one year and 131 (98%) patients at two years. Complications were recorded in four (3%) patients, three (2%) who were diagnosed with erysipelas requiring antibiotic treatment and one (1%) patient diagnosed with local dermatitis. During the one-year follow-up, no major limb-related complications (surgical revisions or amputations) arose. Sub-ulcer foam sclerotherapy may be a feasible addition to superficial vein reflux elimination in patients with VLU and a low risk for complications.

Patch Testing in Patients With Severe Atopic Dermatitis Treated With Dupilumab: A Multicentric Approach in Spain.

Background: Persistent localized dermatitis (PLD) or eczema flare-ups (EF) may occur in atopic dermatitis (AD) patients treated with dupilumab. They may reflect concomitant allergic contact dermatitis (ACD) exposed by the inhibition of the Th2 pathway by dupilumab in some cases. Objective: To evaluate the prevalence and etiology of these events and the impact of dupilumab on patch test outcome. Methods: We performed patch tests on 54 AD patients treated with dupilumab and evaluated the prevalence and final diagnosis of EF and PLD as well as the patch test results. Results: The patch test results were positive in 20/54 (37.0%). 21/54 patients (38.9%) had PLD and 12/54 (22.2%) had EF. Ten of 54 (18.5%) had both conditions and 11/54 (20.4%) had neither PLD nor EF. 64.5% of PLD involved the face. 83.9% patients with PLD and 90.9% patients with EF were diagnosed with inadequately controlled AD. 9.7% patients with PLD and 4.5% patients with EF were finally diagnosed with ACD. Nine of 21 (42.9%) patients patch tested twice were positive either before and/or during dupilumab. Patch tests results changed over time in all of them. Conclusions: Patch testing assisted us to exclude ACD as the cause of PLD/EF in AD patients treated with dupilumab. Most PLD and EF were, however, diagnosed as poorly controlled AD. Dupilumab appeared to impact the patch test outcomes.

Local and systemic contact dermatitis elicited by dental plastic fillings in a patient allergic to 2-hydroxyethyl methacrylate.

Local and systemic contact dermatitis elicited by dental plastic fillings in a patient allergic to 2-hydroxyethyl methacrylate.

Research on design of micron bubble dressing

Dogs that suffer from local dermatitis are not easily treated by medicine bath. To achieve the effect of bath treatment, a prototype of a dressing embedded with micron bubbles containing an antibacterial agent was designed in this study to treat the disease. In the experiment, a generator of micron bubbles, an aqueous antibacterial agent, and a nozzle comprising high-density stainless steel screens were used to generate micron bubbles containing the antibacterial agent, which were embedded in the dressing so that the bubbles could come into contact with S. pseudintermedius. Meanwhile, the flow of the micron bubbles and bactericidal action time were adjusted to identify the effective combinations of conditions. Specifically, a high-density stainless steel screen of one, two, or three layers; two different dressings; two flows of micron bubbles; and three bactericidal action times were tested in the design process. The three different layers of the screen could generate micron bubbles of the three different sizes used in the disinfection experiment. Then, statistical analysis of percentages of survived colonies was performed against the various combinations. The results showed that (1) the micron bubbles containing antibacterial agent generated by a high-density stainless steel screen nozzle and embedded in a dressing can effectively disinfect S. pseudintermedius; (2) the smaller the size of the micron bubbles, the better the disinfection effectiveness; (3) the variables of the flow of micron bubbles, bactericidal action time, and layers of the high-density stainless steel screen are the main factors affecting the disinfection of S. pseudintermedius. The overall disinfection effectiveness was 84.68%, with some combinations being 100% effective. The disinfecting solution for S. pseudintermedius with the micron bubble dressing proposed in this study aims to minimize canine local dermatitis and reduce medical consultation frequency.

139 Local dermatitis upon tapestripping and vaseline treatment of healthy human skin is attenuated by coal tar: insights into AHR-targeting therapies for inflammatory skin diseases

Coal tar therapy, an old dermatological therapy, exerts its therapeutic effect through activation of the aryl hydrocarbon receptor (AHR) and AHR-targeting molecules show therapeutic efficacy in phase 2/3 trials for chronic inflammatory skin diseases. The anti-inflammatory mechanisms of AHR activation in the skin are partially understood, but mostly studied in animal models. Here we aimed to investigate the therapeutic effects of AHR activation by coal tar application on epidermal responses after skin barrier disruption and inflammatory cues in human skin. Healthy volunteers (n=9) were treated with pix lithanthracis (5% in vaseline lanette) or vehicle (vaseline lanette) after complete removal of the stratum corneum by tape stripping. Non-invasive biophysical measurements (TEWL, hydration, erythema), stratum corneum tapes (NMF and protein profiling) and biopies were taken during 4 days of treatment. Application of vaseline on tapestripped skin led to an acute inflammatory response characterized by increased keratinocyte proliferation and subsequent acanthosis, a dense dermal CD45+ and MPO+ immune cell infiltrate indicative of (neutrophilic) granulocytes and increased levels of human beta defensin-2 (hBD2). Most strikingly, coal tar treated sites clearly showed less immune cell infiltrate, less pronounced acanthosis and hBD2 levels in the stratum corneum were significantly lower than upon vaseline treatment. No differential effects were found between vaseline and coal tar treatment for the other parameters we investigated. This in vivo human acute dermatitis model indicates that activation of AHR signaling reduces the influx of inflammatory cells potentially resulting in less epidermal activation. The lack in positive effects on skin barrier parameters by coal tar may be due to the relative short study period. Further investigations on the inflammatory signaling molecules driving the acute inflammation can provide new insights in the coal tar and AHR-mediated therapeutic effects.

Dermatitis in Sun-Exposed Areas in a 4-year-old Boy

Dermatitis in Sun-Exposed Areas in a 4-year-old Boy

Use of chlormethine 0.04% gel for mycosis fungoides after treatment with topical chlormethine 0.02% gel: A phase 2 extension study

Use of chlormethine 0.04% gel for mycosis fungoides after treatment with topical chlormethine 0.02% gel: A phase 2 extension study

Chlorhexidine-impregnated sponge dressing for prevention of catheter exit-site infection in peritoneal dialysis patients: a pilot study.

The study aimed to examine effect of chlorhexidine dressing in the prevention of peritoneal dialysis (PD)-related infection in PD patients. This single-center pilot study recruited 50 incident PD patients to use weekly chlorhexidine dressing. The primary outcome was exit-site/tunnel infection rate. Secondary outcomes were peritonitis rate, time to first PD-related infection, infection-related hospitalization, technique and patient survival, adverse events, and chlorhexidine dressing acceptability. These clinical outcomes were compared with those of a historical cohort (2016-2017) using daily gentamicin cream. A total of 50 patients were recruited to use chlorhexidine and followed up for one year. The exit-site/tunnel infection rate was 0.09 (95% confidence interval [CI] 0.02-0.22) and peritonitis rate was 0.07 (95% CI 0.01-0.19) episodes per patient-year with chlorhexidine dressing. The 1-year infection-free survival rates for exit-site/tunnel infection and peritonitis were 92% and 94%, respectively. The 1-year technique and patient survival rates were 86% and 96%, respectively. Overall, 12% of participants developed localized contact dermatitis with chlorhexidine. Most participants (73%) reported that chlorhexidine dressings were very acceptable. Compared to a historical cohort using gentamicin cream (n = 238), the chlorhexidine group had similar exit-site/tunnel infection rates (incidence rate ratio [IRR] 0.65, 95% CI 0.22-1.92) but had lower peritonitis rates (IRR 0.24, 95% CI 0.07-0.77), and lower PD infection-related hospitalization rates (IRR 0.21, 95% CI 0.06-0.69) after adjusting for age, sex, race, primary kidney disease, and diabetes mellitus. Weekly chlorhexidine dressing was associated with acceptable PD-related infection outcomes and was well-accepted by patients, although had a 12% rate of delayed localized contact dermatitis. The study was registered under www.clinicaltrials.gov with the reference number of NCT03406520 on 23 January 2018.

A Survey of Ticks Infesting Dogs and Cats in Ireland.

Simple SummaryTicks are important ectoparasites of companion animals not only causing localised skin damage, but are also vectors for a variety of pathogens. Veterinarians submitted ticks found on dogs and cats during routine examination for identification and completed a short questionnaire. A total of 120 ticks were submitted and we found that Ixodes ricinus, the sheep/castor bean tick, was the most abundant species on dogs while Ixodes hexagonus, the hedgehog tick, was the most abundant species on cats. Although most veterinary practitioners indicated that ticks were a concern to their clients, at the same time neither vets nor their clients were particularly concerned about tick-borne diseases in their animals. Interviews of dog walkers in the greater Dublin area indicate that pet owners are well aware of the presence of ticks in their surroundings. The loss of efficacy of some ectoparasiticides flagged by many pet owners requires further investigation.Ticks are important ectoparasites of dogs and cats. Infestations can result in itching and localised dermatitis. In addition, ticks can act as vector of a range of viral, bacterial and protozoal pathogens. This paper reports the results of a nationwide survey of ticks infesting dogs and cats in Ireland. Seventy veterinary practices submitted a total of 120 ticks collected from 56 dogs and 16 cats. Ixodes ricinus was the most abundant species on dogs while Ixodes hexagonus was the most abundant species on cats. The remainder were identified as Ixodes canisuga and a single Rhipicephalus sanguineus specimen. The garden was most frequently associated with tick exposure in both dogs and cats. Sporting dog breeds (n = 17; 31%) were more likely to be infested with ticks than any other breed. Nearly all (n = 56; 95%) veterinarians indicated that ticks are a concern to their clients when they are found on their pets. Pet owners used a variety of products to control ectoparasites on their animals but a significant number (n = 18, 31%) indicated that they felt that the products are less effective highlighting the need for further investigations. Field sampling indicated that ticks are present at a low level in much of the greater Dublin area.

Caterpillar Venom: A Health Hazard of the 21st Century.

Caterpillar envenomation is a global health threat in the 21st century. Every direct or indirect contact with the urticating hairs of a caterpillar results in clinical manifestations ranging from local dermatitis symptoms to potentially life-threatening systemic effects. This is mainly due to the action of bioactive components in the venom that interfere with targets in the human body. The problem is that doctors are limited to relieve symptoms, since an effective treatment is still lacking. Only for Lonomia species an effective antivenom does exist. The health and economical damage are an underestimated problem and will be even more of a concern in the future. For some caterpillar species, the venom composition has been the subject of investigation, while for many others it remains unknown. Moreover, the targets involved in the pathophysiology are poorly understood. This review aims to give an overview of the knowledge we have today on the venom composition of different caterpillar species along with their pharmacological targets. Epidemiology, mode of action, clinical time course and treatments are also addressed. Finally, we briefly discuss the future perspectives that may open the doors for future research in the world of caterpillar toxins to find an adequate treatment.

Dyshidrotic Eczema Associated with Contraceptive Tubal Occlusion Device

Nickel-related hypersensitivity reactions associated with the Essure micro-insert (Contraceptive Tubal Occlusion Device and Delivery System) are extremely rare, with only four reports in the current literature. We present a case of a 37-year-old woman who presented to our clinic for initial dermatologic evaluation of dermatitis localized to both hands three years after device placement. A diagnosis of dyshidrotic eczema, classically associated with systemic nickel exposure, was made after careful clinical and histopathologic evaluation. The micro-insert contraceptive device was suspected as the cause given our patient’s self-reported history of nickel allergy, which was further supported by positive patch test results. Currently, our patient has seen significant improvement in her condition with topical steroids and occasional intralesional steroid injections. This case represents a diagnostic challenge given the presentation of a seemingly localized dermatitis secondary to systemic nickel exposure from a distant source. In addition, the delayed development of our patient’s rash posed a clinical challenge in drawing a causal relationship between device placement and her allergic reaction. Practitioners should be cognizant of eliciting a history of implanted devices (plates, screws, implants, endovascular prostheses etc.) for all patients, even if the allergic reaction is seemingly localized such as dyshidrotic eczema.

The molluscum contagiosum BOTE sign-Infected or inflamed?

Molluscum contagiosum (MC) is a common skin infection in the pediatric age group. The infection is self-limited and manifests as discrete, umbilicated skin-colored papules on any skin surface of the body. At times, complications such as local dermatitis and swelling, erythema, and pus formation may appear. These signs of inflammation are commonly presumed to represent bacterial infection. This multicenter study was a retrospective analysis of data collected on all patients diagnosed with inflamed lesions secondary to MC and treated at the Hadassah Medical Centers and Shaare Zedek Medical Center in Jerusalem, Israel, from 1/1/2008 to 1/07/2018. Characteristics of children with positive cultures were compared to those with negative cultures and those with contaminants. A total of 56 cases were reviewed; the mean age at presentation was 4.6years. Fever was reported in 12.5%, and 62.5% received systemic antibiotics because of their inflamed MC prior to admission. Fifty-five percent had sterile cultures or cultures growing only contaminants. Only seven had positive cultures with the common cutaneous pathogens. No statistical difference was observed between the patients with pathogenic isolates and patients with sterile or non-pathogenic cultures in terms of demographics, lesion characteristics, inflammatory markers, or length of hospitalization. The findings suggest that most cases of suspected MC-related secondary infection can be attributed to inflammation rather than to bacterial infection. However, in some cases, true bacterial infection should be suspected and treated accordingly.

497P - Safety of tumour treating fields delivery to the torso: Meta analysis from TTFields clinical trials

BackgroundTumor Treating Fields (TTFields) are a non-invasive, antimitotic therapy delivered to the tumor via transducer arrays applied to the skin at tumor site. The only TTFields-related adverse event (AE) reported in clinical trials was localized dermatitis beneath the arrays. The safety of TTFields has also been investigated in glioblastoma, non-small-cell lung cancer (NSCLC), mesothelioma, pancreatic and ovarian cancer. This meta-analysis reported AEs in clinical studies with TTFields torso delivery. Methods192 patients from 4 pilot studies were included in the analysis: EF-15 (n=41, advanced NSCLC), PANOVA-2 (n=40, advanced pancreatic adenocarcinoma), STELLAR (n=80, malignant pleural mesothelioma) and INNOVATE (n=31, recurrent ovarian carcinoma). The frequency of TTFields applied was 150kHz in all except 200kHz in the INNOVATE study. All patients received standard of care systemic chemotherapy for their disease in addition to TTFields. Severity and frequency, of AEs were reported using CTCAE Version 4 and CTCAE 3 in EF-15. AEs were reported as incidence by body system and MedDRA terms. ResultsThe median age was 63 (range: 44-78), 73 (49-81), 67 (27-78) and 60 (45-77) for EF-15, PANOVA-2, STELLAR and INNOVATE, respectively. Patients had an ECOG score of 0-1, except for 7 patients in the EF-15 study with ECOG score of 2. Low grade gastrointestinal (GI) toxicities reported with an incidence ≥5%: constipation (16%), diarrhea (14%), nausea (27%), vomiting (13%). None of the GI toxicities was associated with TTFields, and the incidence of high-grade GI toxicities did not reach 10%. Low grade disorders such as asthenia (12%), fatigue (18%) and anorexia (2%) were common (<20%) but not associated with TTFields. Both low and high grade dyspnea (11% and 5%, respectively) were reported. The incidence of arrhythmia was <2%. 58% of the patients had dermatological AE. Low grade dermatitis was reported in 53% and high grade in only 6%. 9% of patients reported low grade pruritus. ConclusionsThis meta-analysis detected no new safety signals in clinical studies where TTFields were applied to the torso. The incidence of TTFields-related skin toxicity was similar to that reported in glioblastoma patients. The application of TTFields to the torso is safe. Clinical trial identificationNCT: 01971281, 02244502; 02397928; 00749346. Legal entity responsible for the studyNovocure. FundingNovocure. DisclosureF. Grosso: Travel / Accommodation / Expenses: Novocure. G.L. Ceresoli: Travel / Accommodation / Expenses: Novocure. All other authors have declared no conflicts of interest.

Abstract CT202: Safety of Tumor Treating Fields delivery to the torso: Pooled analysis from TTFields clinical trials

Abstract Tumor Treating Fields (TTFields) are a non-invasive, loco-regional, antimitotic treatment modality, which have been approved for the treatment of glioblastoma (GBM) by the FDA. TTFields are delivered to the tumor via transducer arrays applied to the skin surrounding the tumor. The only TTFields-related adverse event (AE) reported in Phase III GBM trials was localized dermatitis beneath the arrays. The safety of TTFields has also been investigated in non-small-cell lung cancer (NSCLC), mesothelioma, pancreatic and ovarian cancer. No TTFields-related serious AEs were reported in these studies. Here we present a meta-analysis of AEs reported across clinical studies conducted to date, where TTFields were applied to the torso. Methods: 192 patients from 4 pilot studies were included in the analysis: EF-15 (n=41, advanced NSCLC), PANOVA-2 (n=40, advanced pancreatic adenocarcinoma), STELLAR (n=80, malignant pleural mesothelioma) and INNOVATE (n=31, recurrent ovarian carcinoma). The frequency of TTFields applied was 150 kHz in all except 200kHz in the INNOVATE study. The compliance required per protocol with TTFields was 12 hours/day on average in EF-15, and 18 hours/day in the other trials. All patients received standard of care systemic chemotherapy for their disease in addition to TTFields. AEs, their severity and frequency, and their association with the experimental treatment were reported using CTCAE Version 4, except for EF-15, where CTCAE version 3 was used. Toxicities were reported as incidence by body system and MedDRA term in the number of patients who received any amount of TTFields treatment. Results: The median age was 63 (range: 44-78), 73 (49-81), 67 (27-78) and 60 (45-77) for EF-15, PANOVA-2, STELLAR and INNOVATE, respectively. Patients enrolled in the trials had an ECOG score of 0-1, except for 7 patients enrolled in the EF-15 study with ECOG score of 2. Low grade gastrointestinal (GI) toxicities reported with an incidence ≥5%: constipation (16%), diarrhea (14%), nausea (27%), vomiting (13%). None of the GI toxicities was associated with TTFields, and the incidence of high-grade GI toxicities did not reach 10%. Low grade disorders such as asthenia (12%), fatigue (18%) and anorexia (2%) were common (&amp;lt;20%) but not associated with TTFields. Both low and high grade dyspnea (11% and 5%, respectively) were reported. The incidence of different types of arrhythmia was &amp;lt;2%. 58% of the patients had dermatological AE. Low grade dermatitis was reported in 53% of the patients, while high grade in only 6%. 9% of patients reported low grade pruritus. Conclusions: No new safety signals were identified following the meta-analysis of adverse events from pilot clinical studies, in which TTFields were applied to the torso. The incidence of TTFields-related skin toxicity was similar to that reported in glioblastoma patients. The application of TTFields to the torso is safe. Citation Format: Giovanni Luca Ceresoli, Ignace Vergote, Fernando Rivera, Miklos Pless. Safety of Tumor Treating Fields delivery to the torso: Pooled analysis from TTFields clinical trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT202.

Meta-analysis of toxicity data in thoracic and abdominal malignancies from: Clinical trials in tumor treating fields.

e14658 Background: Tumor Treating Fields (TTFields) are a non-invasive, loco-regional, antimitotic treatment modality, which has been approved for the treatment of glioblastoma (GBM) by the FDA. Mild-moderate localized dermatitis was reported in 52% of newly diagnosed GBM patients treated in the EF-14 [NCT0091640] phase 3 trial (with only 2% having Grade 3 skin toxicity). The toxicity of TTFields has been investigated in a number of pilot studies for malignancies located outside of the brain, and here we present a meta-analysis of toxicities reported in them. Methods: A total of 192 patients from four pilot clinical studies in the following malignancies were included: Advanced lung cancer, advanced pancreatic cancer, pleural mesothelioma and recurrent ovarian cancer. All patients received chemotherapy in addition to TTFields. Adverse events (AEs) and their association with the treatment were evaluated using CTCAE Criteria. Toxicities were reported as incidence by body system and MedDRA term out of the number of patients who received any amount of TTFields treatment. Results: The median age of patients was 63 (range: 44-78), 73 (49-81), 67 (27-78) and 60 (45-77) for EF-15 [NCT00749346], PANOVA [NCT01971281], STELLAR [NCT02397928] and INNOVATE [NCT02244502], respectively. The incidence of several low grade gastrointestinal (GI) toxicities was ≥5%: constipation (16%), diarrhea (14%), nausea (27%), vomiting (13%). None of the GI toxicities was associated with TTFields. Low grade general disorders such as asthenia (12%) and fatigue (18%) were common but not associated with TTFields. The incidence of arrhythmias was ≤2%. 58% of the patients had dermatological AEs, but only 6% had grade 3 dermatitis. 9% of patients had low grade pruritus. Conclusions: No new safety signals associated with TTFields were identified in this meta-analysis. The incidence of TTFields-related skin toxicity was similar to that reported in glioblastoma patients. The application of TTFields to the torso is safe. Clinical trial information: [NCT00749346], [NCT01971281], [NCT02397928], [NCT02244502].

The rash with painful and erythematous nodules

Erythematous painful cutaneous nodular lesions are associated with a host of disorders that may erupt acutely as a generalized or localized dermatitis or be associated with chronic and/or recurrent illnesses. This review discusses such disorders presenting with painful nodular lesions and attempts to provide a systematic approach to their clinical diagnosis.

Abstract CT105: The safety of TTFields applied to the torso: A meta-analysis of 176 patients from four phase I-II trials

Abstract Tumor Treating Fields (TTFields) is a non-invasive, loco-regional, antimitotic treatment modality, approved for treatment of glioblastoma. TTFields are delivered to the tumor through transducer arrays applied non-invasively to the region of the body with the highest tumor burden. In a phase 3 trial in newly diagnosed glioblastoma (GBM), addition of TTFields to temozolomide was not associated with any significant increase in rates of systemic adverse events (AEs) versus temozolomide alone. The only common treatment related AE seen in TTFields-treated patients was localized dermatitis underneath the arrays. Mild-moderate dermatitis was reported in 52% of patients (2% had grade 3 skin toxicity). The safety of TTFields was investigated in four phase I-II studies for malignancies located outside of the brain: non-small-cell lung cancer (NSCLC), mesothelioma, pancreatic cancer and ovarian cancer. Methods Four phase I-II clinical studies of TTFields were included in the analysis: EF-15 (n=41, advanced NSCLC; combined with pemetrexed), PANOVA (n=40, advanced pancreatic adenocarcinoma; combined with gemcitabine with or without nab-paclitaxel), STELLAR (n=64, malignant pleural mesothelioma; combined with platinum and pemetrexed) and INNOVATE (n=31, recurrent ovarian carcinoma; combined with weekly paclitaxel). The frequency of TTFields applied was 150-200 kHz depending on tumor histology. The compliance required per protocol with TTFields was 12 - 18 hours/day. All patients received standard of care systemic chemotherapy for their disease in addition to TTFields. Severity and frequency of AEs, and association with the experimental treatment were evaluated using CTCAE criteria. Results The median age of patients was 69 (range: 41-81), 73 (49-81), 68 (43-78) and 60 (45-77) for EF-15, PANOVA, STELLAR and INNOVATE, respectively. Patients enrolled in the trials had an ECOG score of 0-1, except for 7 patients enrolled in the EF-15 study with ECOG score of 2. The incidence of grade 1-2 gastrointestinal (GI) toxicities was ≥5%: constipation (16%), diarrhea (14%), nausea (27%) and vomiting (13%). GI toxicity was related to standard chemotherapy or underlying disease in all cases. Grade 1-2 general disorders such as asthenia, fatigue and anorexia were common but less than 20% for each, and were related to the underlying disease or standard chemotherapy. Grade 3-4 dyspnea (6%) was reported in patients with lung tumors, related to exacerbation of the underlying disease. The incidence of all types of arrhythmias was ≤2% and none were severe. The only common TTFields related adverse event was dermatitis beneath the device transducer arrays. Half of the patients (50%) had grade 1-2 dermatitis, while grade 3 dermatitis was seen in 6% of patients. 7% of patients complained of grade 1-2 pruritus. Dermatologic AEs were managed using published guidelines leading to full resolution in all cases. Conclusions Treatment of solid tumor patients with TTFields at 150-200 kHz to the lungs, abdomen and upper pelvis did not result in treatment related pulmonary, cardiac, hematological or gastrointestinal toxicity. Expected dermatological toxicity beneath the device transducer arrays was seen in half of the patients, and resolved after treatment termination in all cases. Citation Format: Ignace Vergote, Manuel Benavides, Miklos Pless, Giovanni Ceresoli. The safety of TTFields applied to the torso: A meta-analysis of 176 patients from four phase I-II trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT105.

Avaliação das alterações metabólicas e da supressão dos hormônios tireoidianos associadas ao uso tópico de aceponato de hidrocortisona 0,0584% em cães com dermatite alérgica localizada

The present study aimed to evaluate the occurrence of metabolic alterations and suppression of thyroid hormones after topical treatment with 0.0584% hydrocortisone aceponate in dogs with localized allergic dermatitis. The sample consisted of ten dogs (four females and six males, mean age 6.5 ± 4.4 years). A 30-day therapy with hydrocortisone aceponate was initiated. The drug was used once daily for seven days, and subsequently three times a week for three weeks. Several laboratory tests were performed before and after treatment (ALT, AF, triglycerides, cholesterol, glycemia, fructosamine, serum insulin, free T4 by equilibrium dialysis and canine TSH) and the results showed no statistically significant difference. We concluded that the protocol used was safe in our sample. Even when used for longer than the time recommended by the manufacturer, the drug caused no observable adverse metabolic effects.

Minimal adverse effects profile following implantation of periauricular percutaneous electrical nerve field stimulators: a retrospective cohort study.

The periauricular percutaneous implantation of the Neuro-Stim System™ family of devices EAD, MFS, and BRIDGE is a procedure involving the use of a non-opiate, neuromodulation analgesic for relieving acute and chronic pain. It has been approved as a minimal-risk procedure by multiple governmental and institutional facilities. This retrospective report of findings will help quantify the incidence of clinically observed bleeding, localized dermatitis, and infections at the implantation sites of the electrode/needle arrays, dermatitis at the site of the generator, and patient syncope. A total of 1,207 devices, each producing up to 16 percutaneous punctures, for a total of 19,312 punctures were monitored for adverse effects, based on retrospective chart audits conducted at six clinical facilities over a 1-year period.

Prosthetic and Device Surgery Considerations

Biomedical implants have a broad array of therapeutic uses, most commonly in orthopedic procedures, such as dynamic hip and knee replacements. There are also wide-ranging applications in cardiology, gynecology, and other specialties. Use of metal components will likely expand with further medical innovations. Hypersensitivity reactions to these devices are well documented but uncommon. Patch testing is currently the best evaluation for metal hypersensitivity reactions (MHR). Preimplant testing for asymptomatic individuals is not necessary. Patients with a history of skin rashes dermatitis after metal contact would likely benefit from preimplant testing. Those individuals with postoperative complications such as aseptic loosening; chronic pain; or new, unexplained local or regional dermatitis may benefit from evaluation for MHR. Metal allergy testing is never indicated in emergent or life-threatening situations. Whether prior to or after implant placement, collaborative efforts between the allergist and surgeon should determine the clinical plan. A positive test for metal allergy should not define treatment. When a metal allergy is revealed prior to implant, every effort should be taken to avoid the allergen(s). Often, titanium or oxidized zirconium alloys are the most appropriate choice for those allergic to stainless steel components. Clinical decision making after implantation is challenging. If the implant is asymptomatic, no action should be taken. Symptomatic patients following implant are more challenging. The surgeon and patient need to determine whether replacement with a non-allergenic alternative is feasible, necessary, and safe. Prospective trials in this field are still necessary to develop a more evolved and evidence-based approach to treatment of patients with MHR.