Severity Of Rash Research Articles

Dose Per Body Weight Predicts Incidence and Severity of Apalutamide-Related Skin Rash in Metastatic Castration-Sensitive Prostate Cancer

BackgroundA survival advantage with apalutamide (APA) combined with androgen deprivation therapy for metastatic castration-sensitive prostate cancer (mCSPC) has been demonstrated in clinical trials, irrespective of race. However, the incidence of APA-induced skin rash in the Japanese subpopulation is higher than that in the global population. In the present study, we investigated the predictive value of APA dose per body weight for the incidence of skin rash. MethodsA total of 128 patients with mCSPC treated with APA between January 2018 and December 2022 were retrospectively reviewed. A receiver operating characteristic analysis was performed to identify the optimal APA cutoff dose. In addition to comparing the status of APA-induced skin rash, the progression-free survival (PFS) was compared after propensity score matching. ResultsThe optimal cutoff dose predicting the occurrence of skin rash was 3.33 mg/kg. Our cutoff value significantly stratified the 2 groups in time to occurrence of APA-induced skin rash and discontinuation of APA due to skin rash (P = .005 and P = .009, respectively). The incidence of a ≥G3 skin rash in patients receiving ≥3.33 mg/kg was significantly higher than in others (6.5% vs. 19.7%, P = .037). There was no significant difference in the PFS between patients administered <3.33 mg/kg and those administered ≥3.33 mg/kg. ConclusionsOur data suggest that the drug dosage per body weight may predict the incidence and severity of APA-induced skin rash. Further large-scale prospective studies are needed to validate the predictive value of drug dosage per body weight and identify the optimal cutoff value.

Exploring Preventive Measures and Disease Dynamics of Hereditary Polymorphic Light Eruption in American Indian Children

Hereditary polymorphic light eruption (HPLE) is a condition related to polymorphic light eruption (PLE). Unlike PLE, HPLE is unique to American Indian populations demonstrating autosomal dominant inheritance pattern with incomplete penetrance. Affected individuals possess hypersensitivity to long UV radiation, which heightens the risk for skin damage. Onset is typically childhood and disease severity results in complications including psychosocial trauma, streptococcal pyoderma, and glomerulonephritis. HPLE can be difficult to diagnose due to its overlapping qualities with other conditions, underscoring the importance of accurate diagnosis and management. Preventive measures play critical roles in mitigating disease occurrence and complications. Literature analysis of five articles using PubMed and Google was conducted to understand HPLE among the Native American community, particularly children. Search terms included hereditary polymorphic light eruption, Native Americans, American Indians, polymorphic light eruption, actinic prurigo, UV toxicity, and photosensitivity. Literature delineated the disease process of HPLE and preventive measures. Studies revealed a higher incidence among children/adolescents who presented with rashes within two hours of sun exposure. Rash severity increased as seasons progressed to summertime. It is imperative that affected individuals utilize broad spectrum coverage sunscreen, covering UVA and UVB rays. Other measures proven to be effective include protective clothing, limiting time outdoors during peak sun hours, and using specially formulated lip balm. HPLE creates a unique challenge among American Indian populations necessitating increased awareness and educational strategies to minimize and avoid complications. Providing education on prevention and actively implementing measures can help decrease the complications of HPLE and increase quality of life.

Successful Dupilumab Administration in Adolescent with Alopecia Areata and Atopic Dermatitis: Clinical Case

Background. Alopecia areata is an autoimmune disease characterized by hair loss that develops with the involvement of CD8+ T-cells of the immune system and cytokines produced by T-helper 2 cells (Th2). Efficacy of alopecia areata management is limited. The one potentially effective variant for treatment of severe forms of alopecia areata complicated with atopic dermatitis (AD) is genetically engineered biologic drug dupilumab (interleukin 4 receptor antagonist that suppresses Th2 response). Clinical case description. 11 years old boy was admitted to the dermatology department with complaints on aggravation of AD and numerous hair loss foci. Dupilumab, 300 mg, was prescribed once every 4 weeks. Severity of erythematous papular rashes significantly decreased within 9 months, as well as irritation intensity. Complete restoration of hair growth was noted in areas of former alopecia areata foci. Conclusion. Dupilumab can be effective in the management of severe forms of alopecia areata in children with comorbid AD. Clinical studies on the efficacy and safety of such therapy are needed to confirm this hypothesis.

Efficacy and safety of dupilumab in the treatment of moderate to severe atopic dermatitis

Objective: To analyse the efficacy and safety of dupilumab in the treatment of moderate to severe atopic dermatitis (AD). Methods: The clinical data of moderate to severe AD patients who received dupilumab therapy in the Department of Dermatology, Xiangya Hospital, Central South University from August 2020 to November 2022 were retrospectively analyzed. The efficacy was evaluated by Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), Numerical Rating Scale (NRS), Patient Oriented Eczema Measure (POEM), and Dermatology Quality of Life Index (DLQI) before treatment and 2, 4, 16 and 24 weeks after treatment. Adverse events that occurred during treatment were recorded. Repeated Measures ANOVA and Generalized Estimating Equations were used to compare changes in scores and changes in laboratory indices at different time points before and after treatment. Results: The age of 259 patients was (35.4±25.9) years, the duration of AD was 4.00 (2.00, 9.00) years, and 64.1% (166 patients) were men patients. The scores of EASI, SCORAD, POEM, DLQI and NRS at 2, 4, 16 and 24 weeks after treatment with dupilumab were significantly lower than those before treatment (all P<0.001). The proportions of EASI50, EASI75, and EASI90 were 91.0% (101/111), 71.2% (79/111), and 40.5% (45/111) at 16 weeks, and 95.0% (76/80), 80.0% (64/80) and 45.0% (36/80) at 24 weeks, respectively. Basal total IgE levels (P=0.005) and EOS counts (P<0.001) at Week 24 were significantly lower than those before treatment. Adverse events occurred in 54 patients (20.9%), mainly manifested as intractable erythema of the face and neck (5.0%, 13 patients) and conjunctivitis (1.9%, 5 patients). Conclusions: Dupilumab can effectively improve the rash area, rash severity and itchiness of moderate to severe atopic dermatitis, improve the quality of life of patients, and reduce the incidence of adverse effects.

Changes in Blood Vessel Morphology in Erythematous Skin of Atopic Dermatitis Patients

Background: Atopic dermatitis is an inflammatory skin disease characterized by erythematous changes and abnormalities in microvasculature. Regarding the research questions, this cross-sectional study conducted from January 5 to July 5, 2019 at Watim Medical and Dental College, Rawat and the findings on observed vascular alterations supposed to present the mean age, standard deviation and p-value as follows: Objectives: , the morphology of the blood vessels in the erythematous skin of the patients with AD and controls matched based on their age will be examined. Study Design: A Cross-sectional study. Place and Duration of Study: from 05-Jan-2019 to 05-Jan-2020 in the Department Pathology, Watim Medical and Dental College Rawat, Pakistan. Methods: This descriptive cross sectional study recruited the patients from the Department of Pathology, Watim Medical and Dental College, Rawat over a period of six months from January 5, 2019 to July 5, 2019. Adult patients, comprising 100 in number, diagnosed to have atopic dermatitis were used in the study. The patient ages were noted down and dermoscopy of the morphological changes occurring in the blood vessels at erythematous lesions were observed. Descriptive statistics were used in a bid to calculate mean age, standard deviation as well as the p-value. This research study was reviewed and cleared by the Institution’s ethical committee before its conduct. Results: Patients 100 Patients were selected for the study, Moreover the patients diagnosed with atopic dermatitis were between the age group of 18-65 years with mean age of 35. 4 years (SD 12. 7), refer to the table 1. Morphological assessment of blood vessels in erythematous skin showed that 60% of the patients were having abnormal morphological pattern whereas 40% of patients demonstrated normal morphology (table 2). Co-relating and comparing the normal and altered Vascular architecture mathematical statistics revealed the fact with P-values equal to 0. 045 (Table 4). The findings of increased vascular alterations in lesions of atopic dermatitis evident from the results in Table 5 indicate that blood vessel alterations are associated with the severity of skin condition rashes. Conclusion: our study identify that extensive vascular changes at the skin of those with atopic dermatitis while stressing on the importance of these changes in disease progression. Targeted therapies for the aforementioned vascular changes could be promising in the future as compared to the ones that address mere clinical manifestations. Keywords: AMD, Vasculature, Redness of the Skin, Swelling.

Impact of a rash management guide in patients receiving apalutamide for high-risk localized prostate cancer in the Apa-RP study.

Based on the SPARTAN and TITAN studies, apalutamide is approved for patients with nonmetastatic castration-resistant and metastatic castration-sensitive prostate cancer. Skin rash was a common adverse reaction across indications. We hypothesized that earlier identification and intervention could improve rash outcomes. A prespecified rash management guide outlining recommended skin care practices was provided to all patients enrolled in Apa-RP (NCT04523207). Rash-related safety data from Apa-RP were compared descriptively with data from SPARTAN and TITAN. Patients in Apa-RP experienced improved rash-related outcomes vs those in SPARTAN and TITAN. Increased vigilance and proactive management may reduce the incidence, severity, and duration of rash during apalutamide treatment.

An Observational Study: Association Between Atopic Dermatitis and Bacterial Colony of the Skin Based on 16S rRNA Gene Sequencing.

Atopic dermatitis (AD) often accompanies skin infections, and bacterial skin infections often cause persistent and worsening symptoms. In this study, we explored the key changes in the microbiota of AD patients, as well as the effects of different ages and the severity of rash on changes in the microbiota. A total of 95 AD patients and 77 healthy volunteers were recruited. The AD patients were divided into three groups based age and three groups according to the EASI score. Microorganisms collected from the skin were analyzed through 16S rRNA gene sequencing, revealing species diversity via α and β diversity analyses. Species compositions were compared at the phylum and genus levels. The significance of skin microbiota at the genus level was assessed using the random forest algorithm. Finally, the impact of relationships between different microbial communities on the microbial community composition and the pathogenesis of AD was explored using Pearson correlation coefficients. The species diversity of the skin microbiota in the AD group significantly decreased. Compared with that in the healthy volunteers (HV) group, the bacterial diversity in the two groups of samples significantly differed. Staphylococcus dominated the bacterial communities, and as AD symptoms gradually worsened, the abundance of Staphylococcus gradually increased. Among all bacterial genera with a relative abundance greater than 1%, Staphylococcus showed a negative correlation with other genera, and showed significant consistency in specimens from different age groups. Changes in the abundance of Staphylococcus in the skin bacterial colonies are the main cause of AD. Brevundimonas, Paracoccus, Corynebacterium, and Veillonella may serve as characteristic biomarkers for AD. These results indicate that altering the microbiota composition of the skin may aid in the treatment of AD.

Prevention of pemetrexed-induced rash with low-dose dexamethasone in patients with NSCLC receiving immunotherapy: A prospective, single-arm clinical trial.

e20596 Background: Pemetrexed is highly active in non-small cell lung cancer (NSCLC). Rashes associated with pemetrexed are more commonly than other chemotherapies. It is recommended that patients receive pemetrexed are required dexamethasone as a pretreatment. However, the immunosuppressive effects of dexamethasone especially high doses of glucocorticoids may reduce the efficacy of immune checkpoint inhibitors (ICIs). This study aims to prospectively evaluate the efficacy of low-dose dexamethasone in pretreatment of pemetrexed-induced rash, particularly in NSCLC patients receiving immunotherapy. Methods: This is a prospective, single-arm clinical trial that enrolled NSCLC patients scheduled to receive chemotherapy including pemetrexed, with/without immunotherapy. Patients received low-dose dexamethasone: 8mg, 4mg, 2 mg of dexamethasone for 3 days recpectively from the day preceding pemetrexed (the recommended administration is 8 mg/day of dexamethasone for 3 days) . Rash severity is described according to CTCAE v5.0 (Common toxicity criteria for adverse events version 5.0). The primary endpoint was the 3-week incidence of rash after pemetrexed. Results: A total of forty-seven stage IIB-IVB patients were enrolled between February 2022 and December 2023, including eighteen patients were combined with immunotherapy. They all received the low-dose dexamethasone regimen prior to a total of 149 cycles of chemotherapy. The incidence of skin rash after 3 weeks was of 7 episodes in 149 cycles (4.70%), 7 patients (12.77%) presented rash. In the eighteen patients receiving immunotherapy, rash within 3 weeks after pemetrexed administration occurred in 4 episodes in 72 cycles (5.56%), 4 patients ( 22.22%) presented rash. And one patient presented two episodes of cutaneous toxicity. Most skin rash episodes were of grade 1 (approximately 85%), while the rest were grade 2 (approximately 15%). No grade 3 or 4 skin rash was reported in the entire study population. Most cutaneous toxicities occurred during the first or second cycle. The incidence of rash in this study was significantly lower than the rate of 67.5-93% reported in patients treated without corticosteroids and did not increase compared with the rate of 14-56% reported in patients treated with corticosteroids. Conclusions: Administration of low-dose dexamethasone (8mg, 4mg, 2 mg of dexamethasone for 3 days from the day preceding pemetrexed) significantly reduces the incidence of rash after pemetrexed. The regimen may provide a standard preventive strategy for pemetrexed-induced rash, especially in NSCLC patients combined with immunotherapy(This study is registered with the Chinese Clinical Trial Registry (ChiCTR2400079622). Clinical trial information: ChiCTR2400079622.

Prostaglandin E1-induced urticaria with harlequin change in a neonate with transposition of great vessels: A case report

Prostaglandin E1 (PGE1) is an emergency drug used in neonates with critical congenital heart diseases (CHDs) to maintain the ductal patency. There are many adverse effects of this drug explained – cutaneous side effects being one of them, of which limited literature is available. In this case report, we describe a term neonate with critical CHD, started on PGE1 infusion to maintain ductal patency. Baby developed erythematous migratory annular rashes to harlequin colour change in a dose-dependent manner. The severity of rashes decreased, and there was a complete resolution with tapering down of drug doses to a minimum level to maintain a ductal patency. No antihistamines or steroids were administered for the treatment. The PGE1 should be tapered to a minimum dose to maintain the required saturation in case of severe cutaneous reaction and should not be stopped abruptly as it is a lifesaving drug in critical CHD.

N-benzyl-N-methyldecan-1-amine, derived from garlic, and its derivative alleviate 2,4-dinitrochlorobenzene-induced atopic dermatitis-like skin lesions in mice

Given the intricate etiology and pathogenesis of atopic dermatitis (AD), the complete cure of AD remains challenging. This study aimed to investigate if topically applying N-benzyl-N-methyldecan-1-amine (BMDA), derived from garlic, and its derivative [decyl-(4-methoxy-benzyl)-methyl-1-amine] (DMMA) could effectively alleviate AD-like skin lesions in 2,4-dinitrochlorobenzene (DNCB)-treated mice. Administering these compounds to the irritated skin of DNCB-treated mice significantly reduced swelling, rash, and excoriation severity, alongside a corresponding decrease in inflamed epidermis and dermis. Moreover, they inhibited spleen and lymph node enlargement and showed fewer infiltrated mast cells in the epidermis and dermis through toluidine-blue staining. Additionally, they led to a lower IgE titer in mouse sera as determined by ELISA, compared to vehicle treatment. Analyzing skin tissue from the mice revealed decreased transcript levels of inflammatory cytokines (TNF-α, IL-1β, and IL-6), IL-4, iNOS, and COX-2, compared to control mice. Simultaneously, the compounds impeded the activation of inflammation-related signaling molecules such as JNK, p38 MAPK, and NF-κB in the mouse skin. In summary, these findings suggest that BMDA and DMMA hold the potential to be developed as a novel treatment for healing inflammatory AD.

Complex Approach to the Management of Acneiform Rash Induced by Epidermal Growth Factor Receptor Inhibitors

Rationale. Acneiform (papulopustular) rash is the leading dermatological adverse event of EGFR inhibitors. The development of optimal regimens for the supportive treatment of acneiform rash remains an important interdisciplinary problem in supportive oncology. Aims — to comparatively evaluate the clinical efficacy of the supportive treatment for acneiform rash induced by epidermal growth factor receptor inhibitors, including topical treatment with ivermectin cream and balneotherapy. Methods. In an open, prospective, randomized study, data from 114 patients with acneiform rash induced by monoclonal antibodies to EGFR were analyzed. All groups received intermittent supportive treatment according to a single regimen, continuous external therapy included: in group 1 — hypotonic thermal water, in group 2 — ivermectin 1% cream, in group 3 — hypotonic thermal water and ivermectin 1% cream. The observation period was 3 months. Acneiform rash severity was assessed using the CTCAE-NCI v5.0 criteria and a developed acneiform rash clinical severity scale. The intensity of subjective symptoms was assessed using a 10-point visual analog scale (VAS). The modified dermatological life quality index (mDLQI) was used to assess the impact of acneiform rash on patient’s quality of life. Results. A significant decrease in all of the studied parameters was observed in the groups by the end of the 1st week of supportive treatment and remained up to the end of the observation period (p 0.05). There were no statistically significant differences between groups 2 and 3 with respect to the acneiform rash clinical severity scale, but their values were significantly lower than those of group 1 (group 1 vs. group 2, p 0.001; group 1 vs. group 3, p 0.001). The most rapid resolution of all subjective symptoms was observed in group 3. Significantly lower mDLQI values were also observed in group 3 starting from the 1st week of supportive treatment until the end of the follow-up period (р 0.05). No severe adverse reactions were registered in any of the groups during the study. Conclusions. The developed regimens for the supportive treatment of acneiform rash have demonstrated a high efficacy in resolving papulopustular rash and associated subjective symptoms. The use of a complex approach including continuous topical therapy with ivermectin cream and hypotonic thermal water leads to the resolution of rash and relief of subjective symptoms in the shortest time, allows to safely maintain the achieved clinical effect for a long period of observation, has the most significant positive impact on the quality of life of cancer patients.

Impact of a rash management guide on incidence and severity of rash with apalutamide: Experience from the Apa-RP study in high-risk localized prostate cancer.

Impact of a rash management guide on incidence and severity of rash with apalutamide: Experience from the Apa-RP study in high-risk localized prostate cancer.

PERBEDAAN EFEKTIFITAS PEMBERIAN MINYAK ZAITUN (OLIVE OIL) DAN MINYAK KELAPA MURNI (VIRGIN COCONUT OIL) TERHADAP PENYEMBUHN RUAM PADA POPOK BAYI DI KLINIK TAHUN 2023

Babies will be sensitive to everything around them. Babies have relatively thin skin, making them susceptible to infection, inflammation and allergies. One of the most common skin problems is diaper rash. Diaper rash appears on the baby's thighs and buttocks. Causes of diaper rash include poor skin hygiene, severe hot flashes, and diarrhea. OBJECTIVE: To find out whether there is a difference in the effect between olive oil and coconut oil in healing diaper rash in babies. METHODS: This study used a two-group design with a quasi-experimental style, before and after a test-control design. The study population consisted of babies aged 0-12 months who suffered from diaper rash in Kasih Ibu, Deli Tua District, Deli Serdang Regency, who had an average of 17 visits. Non-random sampling and targeted sampling using the Federer formula were used in this sample, with a total sample size of 16 people. An observation sheet with the Mann-Whitney test was used as an instrument. RESULTS: The results of the bivariate analysis test using Mann-Whitney showed that the average value for giving olive oil was (1.75) from 8 samples and for giving pure coconut oil, it was (1.25) with an average difference of (50). ) with Z count for giving olive oil (2.936) and giving muri coconut oil (0.3032). Based on the results of the Mann-Whitney test, the p-value was 0.023. Because the p-value &lt;0.05, it can be concluded that there is a significant difference between the use of olive oil and pure coconut oil for healing diaper rash in babies at the Kasih Ibu Clinic, Deli Tua District, Deli Serdang Regency in 2023 Suggestion: In the future, it is hoped that research will be more advanced and the results will be enriched by looking for other treatments that can be used to reduce the severity of diaper rash, such as giving aloe vera or honey.

A pilot study to evaluate the potential therapeutic effect of hydrogen-water bathing on atopic dermatitis in humans

BackgroundHydrogen molecules, which have excellent antioxidant and anti-inflammatory effects, are absorbed through the skin and spread hematogenously throughout the body. Hydrogen-water bathing (HWB) is expected to be effective against atopic dermatitis (AD); however, its usefulness remains controversial in humans. ObjectiveThis study aimed to determine whether HWB has the potential to have a therapeutic effect in a pilot study conducted on six patients with AD. MethodsAD severity was assessed based on the itching intensity per the visual analog scales (VAS) and the transepidermal water loss (TEWL) values of the lesions, in addition to macroscopic observations. ResultsHWB for eight weeks ameliorated the severity of rashes and increased TEWL levels in the trunk/limb areas that could be completely immersed in the bathwater, resulting in ameliorations in severe itching. The specificity of its therapeutic effect was further investigated in one patient who first underwent HWB for four weeks, discontinued it for two weeks, and resumed it for another four weeks. The rashes on the trunk/limb areas visibly improved after four weeks of HWB but worsened again after it was stopped for two weeks, only to improve again after the resumption of HWB for four weeks. The VAS and TEWL values also showed changes that reflected the skin condition. ConclusionThese results suggest that HWB may be useful in the treatment of AD. To conclude the effectiveness of HWB for AD, it needs to be supported by randomized controlled trials with larger sample sizes and longer study durations in the future.

The Effect of Topical Vitamin K1 on the Treatment of Cetuximab-Induced Skin Rashes in Metastatic Colorectal Cancer Patients.

Considering the prevalence of cetuximab-induced rashes in colorectal cancer patients and its impact on patient's quality of life and treatment, this study aimed at investigating the effect of topical vitamin K1 on the treatment of skin rashes in metastatic colorectal cancer patients treated with cetuximab. This randomized, controlled, triple-blind, clinical trial was conducted on 49 metastatic colorectal cancer patients who were candidates for cetuximab treatment and referred to Omid Hospital in Isfahan during 2021-2022. Vitamin K1 cream with a concentration of 0.1% in the intervention group (n = 25) and placebo cream in the control group (n = 24) were prescribed twice a day (in the morning and before bedtime) for eight weeks. The rash grade was recorded based on common terminology criteria for adverse events-4 (CTCAE-4) criteria before the intervention and in the fourth and eighth weeks during the intervention. During the intervention, skin rash grades in the fourth and eighth weeks with the means of 1.00 ± 0.64 and 0.84 ± 0.55, respectively, were significantly lower in the intervention group, as compared with the control group with the means of 1.42 ± 0.65 and 1.25 ± 0.68, respectively (P value < 0.05). Moreover, the severity of skin rashes decreased significantly in the intervention group over time during eight weeks (P value < 0.05); however, its decrease was not significant in the control group (P value > 0.05). Topical vitamin K1 cream had a significant effect on reducing the severity of cetuximab-induced skin rashes over eight weeks of treatment.

A case of uremic pruritus and papulo-pustular rash associated with anti-EGFR therapy in a patient with rectal cancer and chronic kidney disease

Uremic pruritus is a common symptom in chronic kidney disease and end-stage renal failure. In addition to physical discomfort uremic pruritus disrupts sleep, negatively affects the psycho-emotional state and quality of life. In this group of patients, the association of uremic pruritus with an increase in mortality due to any causes was demonstrated. At the same time, there are no standardized approaches to the treatment of uremic itching. There is also a special category of patients receiving antitumor therapy and developing dermatological adverse events, also potentially accompanied by itching.&#x0D; This article presents a case of uremic pruritus in a patient with papulo-pustular cutaneous reaction (grade II on a Scale Common Terminology Criteria for Adverse Events, CTCAE v 5.0) to the epidermal growth factor (EGFR) inhibitor cetuximab in combination with leucovorin and 5-fluorouracil for rectal cancer. Treatment of uremic pruritus with small doses of gebapentin (300 mg/day) led to complete regression of pruritus. Papulo-pustular rashes completely regressed after recommended systemic and topical therapy according to the severity of rush (doxycycline 100 mg 2 times a day for 5 days, cream with neomycin, natamycin and hydrocortisone 3 times a day for 7 days). Pruritus was absent during the next 6 months of follow-up. Antitumor therapy was not interrupted due to acneiform rush, and following supportive topical therapy allowed to control severity of exacerbations which did not exceed III grade according to CTCAE v 5.0 and did not require the addition of systemic therapy.&#x0D; Thus, therapy of uremic pruritus with gabapentin has shown was effective also in a patient with severe comorbid pathology. Supportive topical therapy consistent with the severity of papulo-pustular rash reduced the severity of exacerbations during following EGFR inhibitor therapy.

Effects of Novel All Natural Plant Based Ointment Formulation on Diaper Rash Severity in Infants: A Clinical Trial

Effects of Novel All Natural Plant Based Ointment Formulation on Diaper Rash Severity in Infants: A Clinical Trial

Persistent alteration of the skin microbiome in patients with skin rash after receiving EGFR inhibitor treatment.

The pathological mechanism responsible for EGFR inhibitor (EGFRI)-induced skin rash remains unclear. Recent studies reveal associations between skin dysbiosis and skin inflammatory diseases. This study aimed to examine whether skin dysbiosis is associated with EGFRI-induced skin rash. Bacterial swabs were taken from the forehead of 17 cancer patients at baseline and at several time points after EGFRIs initiation, as well as from 20 healthy controls. The skin microbiome was analysed using 16S rRNA sequencing. The severity of the skin rash was assessed using the rash grade. Skin surface parameters (pH, water capacitance, and sebum level) were also measured. Compared with baseline, the abundance of Cutibacterium acnes decreased in 13 of 15 cases, and that of Staphylococcus aureus, Corynebacterium spp., Staphylococcus epidermidis or Proteobacteria increased in 13 of 15 cases after EGFRIs initiation. Skin pH increased significantly in parallel with a decrease in water capacitance after EGFRI initiation. Also, the composition of the skin microbiome of patients with severe rash was significantly different from that of healthy controls. In addition, the skin dysbiosis did not return to baseline during EGFRIs treatment for >1year. These longitudinal observations indicate that skin dysbiosis is associated with development of skin rash.

The Riddle of Cetuximab-Related Skin Toxicity: 1H-NMR Sebum Analysis Revealed Dynamic Lipid Alterations Associated with Skin Toxicity Development in Metastatic Colorectal Cancer Patients.

The epidermal growth factor receptor inhibitor (EGFRIs) treatments are commonly associated with the development of adverse skin effects. This study aims to investigate the lipid composition change in sebum during cetuximab-based treatment in an attempt to identify specific metabolic signatures useful in predicting the occurrence of severe skin toxicity. Sebum from 30 metastatic colorectal cancer (mCRC) patients was collected at three time points during the targeted therapy by the application of Sebutape® on the forehead, and the major lipid classes were analyzed and quantified by 1H-NMR. Univariate analysis was performed to reveal significant alterations among patients in sebum production as well as lipid composition and over the course of cetuximab therapy. A transient but significant decrease in sebum production associated with a reduction in the relative content of triglycerides (TG) and squalene (SQ) was found to be induced by cetuximab administration. The reduction of these two lipid classes was also found to be associated with the severity of skin rash experienced by patients. The results of this study indicate that cetuximab-based treatment can reduce sebum gland activity, leading to an overall decrease in sebum production and the induction of specific modifications to its composition. The extent of the loss of skin barrier function may be important for determining the severity of skin toxicity development.

Skin rash associated with combined cytotoxic chemotherapy and immunotherapy for cancer: A retrospective single-center case series.

In recent years, the development of combination therapies with immune checkpoint inhibitors (ICIs) and cytotoxic anticancer drugs has radically changed the management of diverse malignancies and significantly improved patient outcomes. Several clinical trials have shown that skin rash caused by combination therapy with ICIs and cytotoxic drugs may be more frequent and severe than that developing after administration of ICIs alone or cytotoxic drug monotherapy. However, most reports provide little information on severity, treatment, post-diagnosis course, and recurrence of rashes on drug rechallenges. We aimed to describe the experience of skin rashes developing within 2 weeks from the first administration of combination therapy with ICIs and cytotoxic drugs in 11 patients visiting our dermatology department. This study included seven men and four women, and the patients' median age was 52 years. The primary disease was non-small-cell lung cancer in eight patients, cervical cancer in two patients, and esophageal cancer in one patient. Nine patients had a maculopapular rash and two patients developed erythema multiforme-like eruptions. The skin rash was often accompanied by extracutaneous symptoms, such as fever (n=9), mucositis (n=4), and liver dysfunction (n=2). In all cases, the symptoms improved with topical steroid therapy alone, with no patients exhibiting severe symptoms requiring systemic steroids or immunosuppressive agents. In addition, when the causative drugs were re-administered after recovery from the rash, only two patients relapsed with accompanying systemic symptoms, and all patients except one were able to continue treatment using the same drug regimen. Although it was suggested that the rash caused by the combination therapy of ICIs and cytotoxic drugs may be more prominent than that caused by each agent alone, comprehensive judgment, including histopathological examination, may indicate the feasibility of continuing the treatment regimen for cancer.