Dermatological adverse reactions to cancer chemotherapy.

The new targeted anticancer drugs as well as the older traditional chemotherapy agents are associated with adverse effects on skin, hair, nails and mucosa. These toxic effects can cause great distress to the patient leading to decreased quality of life and interruption in treatment. Aims: To study the mucocutaneous adverse effects of both single and combined chemotherapy regimens in cancer patients. Materials and Methods: We studied 53 cancer patients attending the oncology outpatient department or those admitted in the oncology ward of Father Muller Medical College Hospital, Mangalore between October 2012 and September 2013. The adverse effects of chemotherapy on skin, hair, nails and mucosa were noted. Results: The most common adverse effects observed in the study were nail changes in 33 (62.2%) patients, followed by hair changes in 20 (37.7%) patients, skin changes in 19 (33.9%) patients, and mucosal changes in 2 (3.7%) patients. The skin changes were acneiform rash in 5 (27.7%) patients, xerosis in 4 (22.2%) patients, hyperpigmentation in 4 (22.2%) patients, and toxic epidermal necrolysis, hand foot syndrome, extravasation, erythema nodosum, and supravenous hyperpigmentation in 1 patient each. The most common nail fi nding was melanonychia seen in 26 (78.7%) patients. Hair changes were in the form of anagen effl uvium seen in 20 (37.7%) patients. Mucosal changes seen were pigmentation of tongue and stomatitis in one case each. Limitations: Sample size is small. Conclusions: While these side effects are generally not life-threatening, they can be a source of signifi cant morbidity. Knowledge about the adverse effects of anti-cancer drugs will help in accurate diagnosis and management, thereby improving the quality of life.

Pseudo-acne fulminans associated with oral isotretinoin

Acne fulminans is a rare and serious condition characterized by the sudden onset of nodular and ulcerative acne lesions associated with systemic symptoms. It has been recognized a subset of patients with a sudden worsening of acne, often during treatment with oral isotretinoin, but without the strong presence of systemic involvement. Recognized by some authors as "pseudo-acne fulminans" or " acne fulminans sine fulminans," we report a case with these features in order to draw attention to the recognition and early management of this manifestation.

Drug-induced acne and rose pearl: similarities / Acne medicamentosa e a perola rosa: semelhancas

Drug-induced acne is a common skin condition whose classic symptoms can be similar to a rose pearl, as in the case of a male patient presenting with this condition after excessive use of a cream containing corticosteroids.

A acne medicamentosa é uma dermatose comum, que pode apresentar no seu quadro clássico semelhanças à pérola rosa, como no caso apresentado de um paciente do sexo masculino cujo quadro surgiu após uso intempestivo de creme contendo corticoesteróide.

Acne fulminans e isotretinoína: relato de caso / Acne fulminans and isotretinoin: case report

A acne fulminans é afecção rara e a forma mais grave de todo o espectro clínico da acne. Caracterizase pelo aparecimento súbito de nódulos inflamatórios dolorosos que ulceram, concomitantemente, a manifestações sistêmicas. Pode ser induzida pela isotretinoína e alguns autores acreditam que a ocorrência do quadro seja dose dependente. O tratamento é controverso, não havendo padronização até o momento. Apresenta-se caso desta rara doença, desenvolvida durante o uso de isotretinoína em baixas doses.

Acne fulminans (AF) is a rare disorder, the most severe form of the entire clinical spectrum of acne. It is characterized by emergence of painful inflammatory nodules that turn into ulcers, concomitant with systemic manifestations. It can be induced by isotretinoin and some authors believe that the occurrence of this condition is dose dependent. The treatment is controversial and there is no consensus up to this time. A case of this rare disease, developed during use of isotretinoin in low doses, is presented.

Acne induzida por amineptina / Acne induced by amineptine

Relata-se um caso grave de lesões acne-símile associada a amineptina (Survector®), proeminentes na face e dorso, acometendo outros sítios não afetados pela acne vulgar, como períneo, braços e pernas. As lesões apareceram após a auto-administração crônica de altas doses do medicamento. Lesões ceratoacantoma-símile também estavam presentes, tendo as lesões menores resposta satisfatória ao tratamento com imiquimod tópico. O relato é significativo pela raridade da doença.

We report one case of very severe acne-like lesions associated with amineptine (Survector®). They were most prominent on the face and back, but were also observed on sites not affected by acne vulgaris, such as perineum, arms and legs. The lesions appeared after long-term self-medication of high doses. Keratoacanthoma-like lesions were also present, and the small ones were successfully treated with topicalimiquimod. The case is significant since the disease is quite rare.

Phenytoin as the first option in female epileptic patients?

Objective: Phenytoin (PHT) is one of the first-choice drugs in several epileptic syndromes, mostly in partial epilepsies, in which case it is effective as carbamazepine and phenobarbital. However, like any other anti-epileptic drug (AED), unpleasant side-effects are not rare. The aim of this study is the evaluation of dermatological troubles related to chronic PHT usage in female patients. Method: Between 1990-93, 731 new patients underwent investigation for epilepty at the Multidisciplinary Clinic for Epilepsy in our State. In this sample 283 were AED users at the time of the first assessment. Sixty one female patients taking PHT were identified. They were taking PHT in a dosage ranging from 100 to 300 mg daily, in mono or polytherapy regimen, during 1-5 previous years. Results: More than 50 per cent of the sample showed coarse facial features made by the combination of several degrees of acne, hirsutisn and gingival hyperplasia. Conclusion: Except in emergency situations, PHT should not be prescribed as the first option to the treatment of female epileptic patients, because not uncommonly the cosmetic side-effects are more socially handicapping than the epileptic syndrome by itself.

Isotretinoína e seus efeitos clínicos tóxicos / Isotretinoin-toxicologic clinical studies

A isotretinoína (ácido 13-cis-retinóico) é um derivado da vitamina A (retinol) bastante utilizada, por via oral, no tratamento da acne nódulo-cística grave. Estudos toxicológicos revelaram que ao longo dos quase vinte anos de utilização deste fármaco, no tratamento da acne, surgiram inúmeros efeitos adversos, alguns dos quais já estão comprovados, como o efeito teratogênico e outros, que ainda estão em fase de pesquisa, como a indução da depressão. Neste estudo, serão relatados alguns dos mais importantes e recentes casos de efeitos colaterais induzidos pela isotretinoína, observando-se o risco-benefício no uso deste fármaco

Iatrogenias em dermatologia / Iatrogenics in dermatology

No 50§ Congresso Brasileiro de Dermatologia, realizado em setembro de 1995 em Belém, Pará, foi constituído um grupo de trabalho cujo tema de discussäo foi iatrogenias em dermatologia. Como o tema é muito extenso, foram selecionados pelo coordenador do grupo três assuntos considerados de maior interesse: 1. Iatrogenia no tratamento medicamentoso da acne; 2. Iatrogenia e corticosteróides sistemicos e tópicos; e 3. Iatrogenia em certos procedimentos cosmiátricos. Os relatores fizeram ampla revisäo bibliográfica que foi previamente entregue aos participantes do grupo para discussäo. Durante o congresso os temas foram apresentados pelos relatores e, após, discutidos com o grupo. Neste trabalho será apresentada uma sinopse da discussäo desse grupo.

Acne medicamentosa / Acne medicamentosa

Foram revistos os casos de acne medicamentosa atendidos em um período de 17 anos, sendo encontrados 66/22890 novas consultas (2,9:1.000 novas consultas). O quadro predomina em mulheres, na proporçäo 3,7 para cada homen. As drogas desencadeantes foram principalmente a vitamina B12 (29 casos - 43,9%) e os corticóides(17 - 25,7%); seguem-se iodo, bromo, hidrazida e lítio. Do ponto de vista clínico foram avaliados aspectos relacionados com duraçäo da erupçäo, presença de prurido, morfologia e distribuiçäo das lesöes, relaçäo com acne vulgar. Do ponto de vista histopatológico, foi discutida a possível sede de lesäo inicial, no folículo piloso