Acneiform eruption induced by lithium carbonate.

A 26-year-old female developed a severe acneiform eruption on her face, chest and back soon after she started taking lithium carbonate for psychosis. Histopathological examination revealed it to be folliculitis, rather than true acne. The eruption continued for six months but was resolved three months after discontinuing the drug. It has not reappeared in the following 3 years.     

阿法替尼引起痤疮样药疹二例

阿法替尼属于表皮生长因子受体抑制剂,现广泛应用于非小细胞肺癌的治疗,该药物的主要毒性反应之一为皮肤不良反应,最常见为痤疮样药疹,本文报道2例服用阿法替尼后出现痤疮样药疹的患者。     

Acneiform eruptions caused by vitamin B12: A report of five cases and review of the literature

We describe five cases of acneiform eruption caused by vitamin B12 in five females aged 37, 32, 62, 29, and 21 years, respectively. The eruption appeared from 1 week to 5 months after the beginning of the therapy with i.m. or oral vitamin B12. Clinical picture was characterized by papules and pustules located on the face. In three patients, similar lesions were also present on the neck, shoulders, chest, and upper portion of the back. Comedones and cysts were absent. In two patients, serum vitamin B12 levels were very high. Histopathologic examination in one patient revealed an eosinophilic folliculitis. Spontaneous and complete remission was observed in all patients 3‐6 weeks after vitamin B12 discontinuation.     

A review of photodynamic therapy in cutaneous leishmaniasis

We present a review of six clinical studies investigating the use of photodynamic therapy (PDT) using porphyrin precursors for the treatment of Old World cutaneous leishmaniasis (CL). Thirty-nine patients with a total of 77 lesions received PDT using a range of treatment schedules following topical application of aminolevulinic acid (ALA) or methyl-aminolevulinate (MAL). The tissue response to PDT is accompanied by a mild burning sensation, erythema and reversible hypo- and hyperpigmentation. Few mechanistic studies have addressed the principles underlying the use of PDT for CL. All six reviewed papers suggest that PDT with porphyrin precursors is relatively effective in treating CL. Data are still limited, and PDT cannot at this point be recommended in routine clinical practice. The mechanism of action of this promising therapeutic modality needs to investigated further and additional controlled trials need to be performed.     

Drug eruption caused by enzalutamide: A case and literature review of androgen receptor inhibitor‐related drug eruptions

Enzalutamide is an androgen receptor inhibitor. We report a new cutaneous eruption to this drug and review cases of drug eruptions caused by androgen receptor inhibitors.     

Confusion in determination of two types of cutaneous adverse reactions to drugs,maculopapular eruption and erythema multiforme,among the experts: A proposal of standardized terminology

The clinical classification of cutaneous adverse reactions by drugs should be clearly distinguished to avoid conceptual confusion and inconsistency. Although dermatologists appear to have established a roughly common consensus for cutaneous adverse reactions, some types are more rigorously defined than other, possibly misleading classifications. To assess the consensus on the clinical classifications, we investigated the concordance rate of diagnosis by Japanese experts through a snap visual inspection of various clinical pictures exhibiting erythema multiforme and maculopapular eruption types of cutaneous adverse reactions. The experts were shown images on a screen and were then asked to decide whether to classify cases as maculopapular eruption or erythema multiforme type, and the concordance rates were calculated. Overall, the mean concordance rate was 71.6% (standard deviation, 17.3%), and only 33.8% of cases had a 90% or more concordance rate. Our study shows that the determinations of erythema multiforme and maculopapular eruption types by the existing classification criteria were confusing even among experts, which prompted us to standardize the terminology. We propose clinically defining erythema multiforme type as generalized macules mainly of 1 cm or more with a tendency of elevation and coalescence, and maculopapular eruption type as generalized erythema other than erythema multiforme type. Currently, the clinical definitions of cutaneous adverse reactions are poorly described, which may be problematic upon analyzing large volumes of data. Our proposal for a new terminology will enhance the accuracy and consistency of information for the correct analysis of cutaneous adverse reactions.     

免疫检查点抑制剂和靶向药物辅助治疗可切除黑素瘤疗效的网状Meta分析

目的通过贝叶斯网状Meta分析评估免疫检查点抑制剂和靶向药物对可切除黑素瘤的治疗效果。方法通过PubMed、Embase和Cochrane数据库检索可切除黑素瘤辅助治疗的随机对照试验。基于风险比,应用贝叶斯固定效应模型对无复发生存期进行网状Meta分析来评估相对治疗效果。通过StataSE 15和OpenBUGS 3.2.3软件对数据进行综合分析。结果共纳入6篇文章,包括5587例患者和7种治疗方法。其中Ⅲ期亚组5019例,存在溃疡亚组2085例,不存在溃疡亚组2629例,BRAF突变亚组2054例;7种治疗分别为手术+观察或安慰剂、手术+dabrafenib联合trametinib辅助治疗、手术+nivolumab辅助治疗、手术+ipilimumab辅助治疗、手术+pembrolizumab辅助治疗、手术+bevacizumab辅助治疗以及手术+vemurafenib辅助治疗。在网状Meta分析中,dabrafenib联合trametinib(HR 0.47,95%CI 0.39~0.57)、nivolumab(HR 0.49,95%CI 0.36~0.65)和pembrolizumab(HR 0.57,95%CI 0.43~0.75)辅助治疗在改善无复发生存期上明显比单纯手术治疗更有效;Ⅲ期和存在溃疡的可切除黑素瘤患者亚组分析结果与上述网状Meta分析相同。不存在溃疡的可切除黑素瘤亚组分析中,vemurafenib(HR 0.48,95%CI 0.29~0.79)、dabrafenib联合trametinib(HR 0.48,95%CI 0.33~0.70)和nivolumab(HR 0.50,95%CI 0.31~0.79)辅助治疗较单纯手术治疗可显著延长患者的无复发生存期,但pembrolizumab(HR 0.69,95%CI 0.45~1.06)并没有比单纯手术治疗效果更好。在BRAF突变的黑素瘤亚组分析中,与单纯手术相比,bevacizumab(HR 0.60,95%CI 0.43~0.85)、dabrafenib联合trametinib(HR 0.47,95%CI 0.38~0.57)、pembrolizumab(HR 0.59,95%CI 0.38~0.92)和vemurafenib(HR 0.65,95%CI 0.50~0.85)辅助治疗均能明显延长患者的无复发生存期。采用网状Meta分析对各种辅助治疗进行排序,dabrafenib联合trametinib在网状Meta分析中以及Ⅲ期亚组、存在溃疡亚组和BRAF突变亚组中排第一的可能性最大,而不存在溃疡的亚组分析中,vemurafenib排第一的可能性最大。结论对于存在溃疡或BRAF突变的可切除黑素瘤患者,dabrafenib联合trametinib是最佳辅助治疗;对于BRAF突变状态未知或野生型的可切除黑素瘤患者,nivolumab是最佳辅助治疗。     

Subacute cutaneous lupus erythematosus with positive anti-Ro antibodies following palbociclib and letrozole treatment: A case report and literature review

Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) is an uncommon but well-described phenomenon, most often seen in association with antihypertensives and antifungal medications. In recent years, rare reports of DI-SCLE have been described in patients being treated with targeted therapies. Herein, we describe a case of DI-SCLE in association with palbociclib and letrozole treatment for metastatic breast cancer. This report is the first known case of DI-SCLE with positive anti-Ro antibodies in this setting. We also summarize the literature describing DI-SCLE in association with targeted therapies to date and its possible association with dysregulation of the vascular endothelial growth factor pathway.     

Neonatal vesiculopustular eruption in Down syndrome and transient myeloproliferative disorder: A case report and review of the literature

Transient myeloproliferative disorder (TMD) is a spontaneously resolving clonal myeloid proliferation characterized by circulating megakaryoblasts in the peripheral blood that is restricted to neonates with Down syndrome (DS) or those with trisomy 21 mosaicism. Cutaneous manifestations of TMD are observed in only 5% of affected neonates and present as a diffuse eruption of erythematous, crusted papules, papulovesicles, and pustules, often with prominent and initial facial involvement. We describe the case of a male infant with DS and TMD, associated with a vesiculopustular eruption, which appeared on day 36 of life, and review previous cases.     

Photodynamic therapy: A targeted literature review focussing on outcomes and optimisation in solid organ transplant recipients

Squamous cell carcinoma incidence is 65- to 250-fold in solid organ transplant recipients, BCC is 10-fold and in Australia, rates of skin cancer in solid organ transplant recipients reach 70–82% prevalence within the first 20 years; hence, effective, evidence-based treatment of early and precancerous lesions is an essential tool in dermatological patient care. Photodynamic therapy is used to treat a range of conditions including actinic keratoses, squamous cell carcinoma in situ, superficial basal cell carcinoma and nodular basal cell carcinoma. A literature review was undertaken to examine the outcomes of photodynamic therapy in solid organ transplant recipients and methods of optimising outcomes in solid organ transplant recipients. Study sizes were small and protocols varied widely, so meta-analysis was not possible; however, photodynamic therapy appears to be an acceptable treatment for approved indications in solid organ transplant recipients in whom ongoing surveillance is maintained to ensure clearance and detect recurrence. Methods for improving efficacy were also reviewed for this population. Improved outcomes may be achieved by combining photodynamic therapy with other local methods such as 5-fluorouracil or ablative fractional laser.     

Laser therapy in cutaneous and genital warts: A review article

Traditional treatment modalities for wart require long‐term treatment course and usually have high recurrence rates and unwanted side effects. In this review article, we evaluated different types of laser therapy in the treatment of warts. Published articles since 2000 up to July 2020 about laser therapy in genital and non‐genital warts were searched and assessed. Fifty articles were selected for the final review, including 22 pulsed dye laser (PDL), 10 neodymium‐yttrium‐aluminum‐garnet (Nd: YAG), 3 erbium‐doped yttrium‐aluminum‐garnet (Er: YAG), 14 carbon dioxide (CO₂) laser and one systematic review. Complete response rates were different in terms of laser type used (0%‐100%, 9.1%‐100%, 83.3%‐100%, and 59.15%‐100% for PDL, Nd: YAG, Er: YAG, and CO₂ laser, respectively). There was no significant difference between conventional treatment modalities and laser therapy regarding efficacy and recurrence rate. Combination of lasers with keratolytic agents, immunomodulators and photodynamic therapy can be helpful especially in immunosuppressed patients, refractory, and recurrent lesions. PDL has the lowest occurrence of adverse effects relative to other types of lasers.     

Cutaneous adverse events induced by azacitidine in myelodysplastic syndrome patients: Case reports and a lesson from published work review

Subcutaneous injection of azacitidine (AZA) is an important treatment option for myelodysplastic syndrome (MDS), which improves overall survival. In hematology, the incidence of AZA-induced cutaneous adverse events (AE) has been known to be relatively high, which has not been well recognized by dermatologists. Discontinuation of AZA can result in the deterioration of MDS disease activity. Therefore, on dermatological consultation, precise evaluation of AE severity and careful consideration is required for post-AE medication management. To enhance our understanding of AZA-induced cutaneous AE, we report four cases with two representative cutaneous AE subtypes and summarize the clinicopathological phenotypes and courses of the cases in the published work. Case 1, a 71-year-old man, developed neutrophilic dermatosis involving the dermis and subcutaneous tissue. The other three cases, a 75-year-old man, a 78-year-old woman and a 68-year-old man, presented injection-site erythema associated with flare-up reaction. Discontinuation of AZA was necessary for case 1 alone. The published work review delineated three major subtypes of AZA-induced cutaneous AE: systemic cutaneous reaction, neutrophilic dermatosis type and erythematous type injection-site reaction. Histologically, the first two subtypes are mostly characterized by neutrophil infiltration, while the third subtype presents lymphocytic cell infiltration. Neither AZA discontinuation nor intensive interventions were required for the erythematous type injection-site reaction, while AZA termination or systemic treatments, represented by corticosteroid administration, were preferentially conducted for the systemic cutaneous reaction or the neutrophilic dermatosis type injection-site reaction subgroup. These observations support the necessity of subtype-dependent treatment strategies for the management of AZA-induced cutaneous AE.     

Trends in the prognosis of metastatic melanoma in the era of targeted therapy and immunotherapy: A single‐institution survey in Japan

Advances in anticancer therapy, including the development of targeted therapy and immunotherapy, have drastically changed treatment options for metastatic melanoma. However, to date, only a few studies have been published that directly compare overall survival (OS) before and after introduction of these new therapeutic options in Japan. We retrospectively surveyed patients with metastatic melanoma treated in our hospital between 1989 and 2019 to investigate the OS benefit of the new therapies. A total of 115 patients with metastatic melanoma (cutaneous origin, 92; mucosal, 14; uveal, two) were included in the study. Kaplan–Meier analysis showed that the patient group receiving targeted therapy/immunotherapy (TT/IT) (n = 47) had a median OS of 19.0 months, which was longer than that in patients receiving conventional chemotherapy (n = 42, 8.0 months) or no treatment (n = 26, 6.0 months) (P < 0.001). In the subgroup analysis performed for the TT/IT group, patients of younger age and with the BRAF mutation had significantly improved OS. As the number of treatment lines increased, the median OS tended to become longer. Our real‐world data confirmed an improvement of median OS upon the introduction of the new therapies for metastatic melanoma. However, the long‐term OS benefit was limited, possibly because of racial differences in some of the clinical characteristics. To improve the overall melanoma prognosis, the entire treatment strategy, including perioperative therapy needs strengthening.