Dermatological side effects of immunotherapy drugs and targeted cancer therapies: Importance of dermatology and oncology collaboration.

INTRODUCTION: Novel anti-cancer drugs such as targeted cancer therapies and immune check-point inhibitors (ICIs) have adverse events, especially concerning the skin. The aim of this study is to report an overview of the commonly consulted dermatological side effects of ICIs and targeted cancer therapies in clinical practice, along with their management. METHODS: In this single-center study, we evaluated consecutive oncological patients who were referred from the oncology outpatient clinic to the dermatology outpatient clinic due to skin side effects of ICIs and targeted therapies. All patients were examined and treated at the same day of referral by experienced dermatologists. Patient characteristics, clinical findings, diagnostic workups and treatments were retrieved from outpatient records. RESULTS: Sixty three patients were enrolled. Most common diagnoses were lung carcinoma, melanoma and colon carcinoma. Fifty patients (79%) were using targeted therapies while 13 (21%) were using ICIs. Xerosis was the most common side effect (44%), followed by acneiform rash, paronychia, eczema and pruritus. Majority of the side effects were grade 2 and 3. Psoriasis was a common side effect of ICIs. One patient had a newly developed dysplastic nevus on vemurafenib treatment. Oncological treatment was not withheld in any of the patients. CONCLUSIONS: This study revealed the most commonly consulted skin side effects of novel anti-cancer drugs and their management in daily practice. We underlie the importance of collaborative work of oncology and dermatology professionals as early management of cutaneous side effects of targeted therapies and ICIs improves patient outcomes.

Case report: Treatment failure in a case of aquagenic syringeal acrokeratoderma.

Aquagenic syringeal acrokeratoderma (ASA) is a rare, acquired, recurrent, and transient type of keratoderma that may occur after a few minutes of exposure to water. Herein, an 18-year-old male patient who had bilateral swelling and whitish plaques on his palms and soles is presented. The lesions on soles and heels developed within short time of immersion in water and resolved after 30 min with drying. In this case, all treatment methods, previously described in the literature in similar cases (i.e., aluminum salts, urea-salicylic acid including ointments, iontophoresis, and botulinum toxin) were ineffective. ASA is a condition that has an adverse effect on life quality. Alternative treatments are needed in ASA cases who are resistant to treatment modalities mentioned in the literature.

Psychiatric Features in Neurotic Excoriation Patients: The Role of Childhood Trauma.

INTRODUCTION: Neurotic excoriation is a psychodermatological disease of primary psychological/psychiatric genesis, responsible for self-induced dermatological disorders. Childhood traumatic events are closely related with self-injurious behaviors. The aim of this study is to evaluate the psychiatric features of neurotic excoriation and to investigate the effect of childhood traumatic events on the disease. METHODS: Thirty-eight neurotic excoriation patients who did not receive any psychiatric treatment within the past year and 40 healthy individuals having similar sociodemographic features were included in the study. For clinical evaluation, the Structured Clinical Interview for DSM-IV Axis I Disorders, Beck Depression Inventory, Beck Anxiety Inventory, and Childhood Trauma Questionnaire-Short Form were applied to all the individuals. RESULTS: In this study, we observed that 78.9% of neurotic excoriation patients were diagnosed with at least one Axis I psychiatric disorder, the most frequent diagnoses of which were major depressive disorders and anxiety disorders. The anxiety and depression levels were significantly higher in the patient group than in the healthy individuals. Regarding the Childhood Trauma Questionnaire, emotional neglect, emotional abuse, and physical abuse subscales and weighted average total scores were found to be significantly higher in the patient group (p<.05). CONCLUSION: Our study has shown a close relationship between neurotic excoriation and childhood traumatic events as well as the accompanying psychiatric problems. We suppose that early interventions by both dermatologists and psychiatrists and especially a detailed investigation of childhood traumatic events by establishing a therapeutic collaboration are highly important and that using psychotherapeutic interventions can result in better treatment outcomes in many patients.

Usefulness of the autologous serum test for the diagnosis of chronic idiopathic urticaria.

BACKGROUND: The majority of chronic urticaria cases are chronic idiopathic urticaria (CIU) with no specific identifiable etiology. The role of autoantibodies in such cases remains controversial. OBJECTIVE: This study determined the positivity rate of autologous serum tests in CIU patients. METHODS: This study was performed on 30 patients with CIU and 30 individuals without any systemic or dermatologic disease. After the volar parts of right and left forearms were cleansed, 0.05 ml serum physiologic and 0.05 ml autologous serum were injected intradermally on the right forearm 5 cm apart from each other, resulting in the formation of small papules; meanwhile, 0.05 ml histamine alone was injected to the left forearm. The test results were evaluated after 30 minutes as positive in positive cases. RESULTS: The autologous serum test produced significant and non-significant results in patients with CIU and controls, respectively. The positivity rates of the autologous serum test in the CIU and control groups were 53.3% and 26.6%, respectively. There was no relationship between autologous serum test positivity and sex in either group. In male patients with CIU, positive results ranged widely with age, while in female patients, positive results were mainly observed at younger ages with a narrow age range. CONCLUSION: The autologous serum test is a useful test in the diagnosis and treatment of CIU as well as the selection of immunotherapy, especially in patients refractory to classic therapy.

Acne vulgaris.

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit and it is observed equally in both sexes and nearly all races. It generally begins at puberty, but the healing period is variable. There is no known etiological factor, except genetic tendency. Androgens play a very limited role in some female patients. The effects of cosmetics, foods and drinks are also discussible and too limited. There are four factors in acne pathogenesis: Increase of the sebum excretionKeratinization of infrainfundibulumBacterial colonization of the follicleInflammation It is mainly observed on the face and back, shoulders and chest. Initial lesions are comedons. Papules, pustules and cysts of severe types follow it. The most important factor in treatment is a very good patient-physician communication. Topical or systemic treatment or both can be used depending on the severity of acne. Benzoyl peroxyde, azelaic acid, AHA's antibiotics, retinoic acid and derivatives are the topical choices. For systemic treatment antibiotics are the most commonly used medicines, but isotretinoine has a very spesific place with the possibility of permanent healing. All kind of treatments need approximately six months for a good result.

Scientific productivity of OECD countries in dermatology journals within the last 10-year period.

BACKGROUND: Scientific productivity is closely related to gross income, population, and cultures of the countries. Every country, more or less, has a responsibility of contributing to science. MATERIALS AND METHODS: The publications, citations received, and the h-index under the category of "dermatology" in 43 journals between the years of 1999-2003 and 2004-2008 according to the ISI JCR data of 2008 were examined individually for each OECD country. RESULTS: In the journals under the category of "dermatology" between the years of 1999 and 2008, there were 89,319 publications, 76,899 of which were published by OECD countries. USA ranks first with 27,109 publications and 196,002 citations; Germany, Japan, England, and France are the other countries among the top five, respectively. Regarding the number of publications, Turkey and Korea are among the top 10 by surpassing many Northern European countries. With regard to h-index and citations, Northern European countries and Canada rank among the top 10, while Japan, Spain, Turkey, and Korea rank behind. The number of publications showed a significant correlation with the number of citations, population, gross domestic product, and h-index. CONCLUSIONS: Nearly half of all publications were performed by the European origin OECD countries, and one-third of all publications were performed by USA. Journals from Germany and France, which are published in their own language, receive fewer citations, but they contribute a lot to these countries with respect to the number of publications.

Experimental Koebner phenomenon in patients with psoriasis.

BACKGROUND: The Koebner phenomenon is defined as 'the development of psoriasis at sites of traumatized skin'. The 'all-or-none principle' means that, if psoriasis occurs in one area of injury, all injured areas develop psoriasis or vice versa. The aim is to demonstrate the concordance of patients with the all-or-none principle when a standard method of trauma is employed. METHODS: Sixty-two patients with psoriasis were enrolled in the study. Demographic data and disease characteristics were recorded. The medial aspects of both forearms, devoid of lesions, were pricked using two sets of five 30-gauge needles at an angle of 30 degrees , with 2-cm intervals. On days 14 and 28, the patients' forearms were checked for the presence of a typical psoriatic plaque of white scales on an erythematous papule. RESULTS: On day 28, 45 patients (72.5%) had a negative Koebner response in all prick sites whereas 1 patient (1.6%) had psoriatic papules in 10 out of 10 prick sites. The rest of the patients (n = 16, 25.8%) had between 1 and 9 papules in number. CONCLUSION: Using standard methods of trauma, it is possible to induce psoriasis lesions as a Koebner response but this response is not always in concordance with the all-or-none principle previously described.

Quantitative effect of anodal current in the treatment of primary hyperhidrosis by direct electrical current.

AIM: To determine the quantitative effect and technique of use of the anodal current for the treatment of palmoplantar hyperhidrosis on local areas of the palms and soles. METHODS: Twelve patients (four males and eight females) with idiopathic palmoplantar hyperhidrosis were enrolled in this study. Having determined the initial sweat intensities of both hands using the pad glove method, direct electrical current (d.c.) treatment was applied to the palms of the patients using a complete regulated d.c. unit for which the current and potential ranges were 0-30 mA and 0-90 V, respectively. Electrodes were placed into two separate water plates, and covered with pad made from gauze and cotton material. The pads were moisturized with tap water for current conduction. The anodal current was applied to the right hands of six patients (group I) and to the left hands of the remainder (group II). After seven treatments had been completed for the palms, the final sweat intensities of the hands were measured. RESULTS: In both groups, the final sweat intensities of the hands subjected to the anodal current were significantly decreased in comparison with the initial values, regardless of whether the anodal current was applied to the right or left hand (P < 0.05). In contrast, the final sweat intensities of the other hands subjected to the cathodal current were not significantly decreased (P > 0.05). CONCLUSIONS: It can be concluded that the anodal current is more effective in reducing sweating on the palms when applied either to the right or left hand. In the treatment of palmoplantar or localized hyperhidrosis, the anodal current should be referenced first to treat the sweatier hand or foot, or a local hyperhidrotic area of the skin. The selection of the anodal current for one hand for the first five or seven sessions appears to be more effective than the use of polarity changes for each session.

Dissociative identity disorder presenting as dermatitis artefacta.

Dermatitis artefacta is a rare psychiatric condition characterized by rubbing of skin blisters and denial of self-infliction. Dissociation may be comorbid with self-injurious behavior. A background of emotional disturbances during formative years and in later life often results in feelings of isolation and insecurity, which can lead to dissociation as a primary defense mechanism used to overcome traumatic events. In this case report, we describe a female patient with dermatitis artefacta associated with dissociative identity disorder. The patient was a 14-year-old girl. Multiple large, deep ulcerations with unnatural shapes were seen on her left forearm. The ulcerations were thought to be self-inflicted. Psychiatric examination revealed that she had a different identity, and inflicted the lesions when this was assumed. This case leads us to suggest that patients with dermatitis artefacta might have comorbid dissociative experiences, which cannot be identified easily.

Placebo-controlled evaluation of direct electrical current administration for palmoplantar hyperhidrosis.

BACKGROUND: Direct electrical current (d.c.) administration based on tap water iontophoresis has been used as a therapeutic option for palmoplantar hyperhidrosis. The placebo effect of this technique has not been investigated adequately. AIM: To investigate whether d.c. administration has a possible placebo effect in the treatment of palmoplantar hyperhidrosis. METHODS: As a placebo, low alternating electrical current (a.c.; 9-12 mA, 10-15 V, and 8-10 Hz) was applied to the palms of 15 patients with idiopathic palmoplantar hyperhidrosis. The placebo effect was evaluated by inspection and sweat intensity measurements performed before and after placebo application. Patients then received d.c. treatment (18-22 mA, 40-60 V) according to the same procedure as applied for placebo. The final sweat intensity measurements of the patients were performed 1 week after the last session of d.c. treatment. Sweat intensities measured before and after placebo and at the end of d.c. treatment were analyzed statistically by paired t-test. RESULTS: The initial sweat intensity measurements of the palms, before placebo application, were 3.12 +/- 0.39 g/h on the right side and 3.17 +/- 0.28 g/h on the left side. The second sweat intensity measurements, 1 week after the last session of placebo, were 3.08 +/- 0.46 g/h on the right side and 3.16 +/- 0.21 g/h on the left side. There were no significant differences between the initial and second sets of sweat intensity measurements of the hands (P > 0.05 for both sides). The final sweat intensity measurements, 1 week after the last session of d.c. treatment, were 0.38 +/- 0.06 g/h on the right side and 0.39 +/- 0.07 g/h on the left side. CONCLUSIONS: Statistical evaluation of sweat intensity measurements and inspections revealed that d.c. administration had no placebo effect in the treatment of palmoplantar hyperhidrosis.

Safe control of palmoplantar hyperhidrosis with direct electrical current.

BACKGROUND: Primary (idiopathic) hyperhidrosis is a benign disease of unknown etiology, leading to the disruption of professional and social life and emotional problems. A variety of treatment methods have been used to control or reduce the profuse sweating. In this study, we report the efficacy of direct current (d.c.) administration in the treatment of idiopathic hyperhidrosis. METHODS: One hundred and twelve patients with idiopathic hyperhidrosis were enrolled in the study. Initial sweat intensities of the palms were measured by means of the pad glove method. The patients were treated in eight sessions with d.c. administration using a complete regulated d.c. unit based on tap water iontophoresis. The final sweat intensities of responders were determined 20 days after the last treatment. Nonresponders returned earlier than 20 days, with final sweat intensities measured at least 5 days after the last treatment. In 26 responders, plantar hyperhidrosis was also treated. After the first remission period, the second of eight treatments was applied to the palms of 37 responders. RESULTS: This therapy controlled palmar hyperhidrosis in 81.2% of cases. The final sweat intensities of the palms of responders were significantly reduced after eight treatments (P < 0.001). The first average remission period was 35 days. Minimal undesirable effects were noted. CONCLUSIONS: This technique appears to control hyperhidrosis on the palms and soles only if regular treatment is applied. Plantar hyperhidrosis appeared to resolve simultaneously when palmar hyperhidrosis was successfully treated.