Cutaneous adverse events of epidermal growth factor receptor inhibitors: A retrospective review of 99 cases.

Background: Previous reports regarding the cutaneous adverse events of epidermal growth factor receptor inhibitors are mostly limited to small case reports and case series, mainly involving Caucasian patients. Aims: We describe the trends in the clinical presentation of Asian patients who had cutaneous adverse events induced by epidermal growth factor receptor inhibitors and to explore the relationship between skin adverse events and tumor response. Methods: From 2006 to 2010, medical records of Thai patients with non‑small cell lung cancer receiving epidermal growth factor receptor inhibitors were retrieved and analyzed. Results: In all, 99 patients were reviewed and analyzed. Erlotinib and gefitinib were commenced in 75 (75.8%) and 24 (24.2%) patients, respectively. Cutaneous adverse events occurred in 43 (57.3%) patients receiving erlotinib and in 15 (62.5%) patients receiving gefitinib. The most common adverse event was xerosis (52.5%). Less common adverse events included papulo-pustular eruption (27.3%), erythematous maculopapular rash (11.1%), mucositis (6.7%), paronychia (5.1%), and trichomegaly (2%). Elderly patients had a higher occurrence of xerosis. The presence of cutaneous adverse events was significantly higher in subjects who had a tumor response. Limitations: The limitations of study include its retrospective nature, and the initial screening of cutaneous adverse events was done by non‑dermatologists. Conclusions: Cutaneous adverse events due to epidermal growth factor receptor inhibitors are not uncommon in the Asian population. We found a positive correlation between the occurrences of cutaneou adverse events and tumor response supporting the view that they are surrogate markers for therapeutic response.

Evaluation of sensitivity and specificity of enzyme-linked immunosorbent assay (ELISA) for detecting antidesmoglein 1 and 3 in Thai patients with pemphigus vulgaris and foliaceus.

OBJECTIVE: Pemphigus is an acquired autoimmune blistering skin diseases, of which pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are two major subtypes. A novel commercial enzyme-linked immunosorbent assay (ELISA) against Dsg1 and Dsg3 has been well established for diagnosis and prediction of disease activity in PF and PV. At present, the benefit of anti-Dsg 1 and anti-Dsg 3 IgG by ELISA in the diagnosis of pemphigus in Thai patients has never been reported. The objective of the present study is to evaluate the sensitivity and specificity of ELISA for detecting antidesmoglein 1 and 3 in Thai patients with pemphigus. MATERIAL AND METHOD: Retrospective review of anti-Dsg1 and anti-Dsg3 antibody ELISA test results from 48 serum samples collected from 27 patients with PV seven patients with PF and 14 controls. RESULTS: The sensitivity of Dsg1 and Dsg3 ELISA for all patients with PV was 64% and 77.8% respectively. When subgrouped into only PV patients with new diagnosis, the sensitivity of Dsg 1 and Dsg 3 ELISA increased to 85.7% and 100%. In all PF patients, the sensitivity of anti-Dsg 1 ELISA was 71.4% and 100% for newly diagnosed PF cases. Anti-Dsg 3 was not detected in the PF group. The specificity of ELISA for anti-Dsg 1 and anti-Dsg 3 in both types of pemphigus was 85.7% and 92.3% respectively. CONCLUSIONS: Dsg 1 and Dsg 3 ELISA is a simple, highly sensitive and specific test in Thai pemphigus patients with 100% sensitivity in the diagnosis of both new pemphigus vulgaris and foliaceus patients.

Skin diseases during floods in Thailand.

BACKGROUND: Floods are natural disasters that occur occasionally in Thailand. The most common form skin diseases due to floods are infectious dermatoses especially superficial fungal infection. However the microbiologic evidences have not been evaluated. OBJECTIVE: To evaluate the most common skin diseases during floods and identify the organism that causes skin maceration at web space(s) of toes (Hong Kong foot). MATERIAL AND METHOD: Patients who complained of skin problems were evaluated at the temporary outpatient clinic during October 2006. Skin specimens from all patients who had itches and skin maceration at web space(s) of toes were cultured. RESULTS: Ninety-six patients were evaluated (38 males and 58 females). Eczema was the most prevalent dermatosis, which accounted for 34.5% of the total skin problems and the great majority of these cases were irritant contact dermatitis. Sixteen cases presented with itch and skin maceration at web space(s) of toes. All of them were colonized with various microorganisms. Gram-negative bacilli were the most prevalent ones and were found in 14 out of 16 specimens. Fungal culture was positive in only two specimens. CONCLUSION: Eczema is the most common dermatosis during floods. Skin maceration at web space(s) of toes, which were thought to be fungal infection, are chronic irritant dermatitis with secondary bacterial colonization. Only a few cases were fungal infection. Microbiologic investigation should be done in these patients. Unfortunately, it is not practical in such a situation. Topical medications that have the combination of antiinflammatory, antibacterial and antifungal properties are the most suitable medications.