A narrative review of management of wounds in palliative care setting.

BACKGROUND AND OBJECTIVE: A chronic wound is one that is physiologically compromised as a result of a disturbance of the wound-healing cycle brought on by, among other parameters, poor angiogenesis, innervation, or cellular migration. Given the high frequency and incidence rates of different wound categories in clinical practice in the setting of chronically ill patients, wound management is becoming an increasingly important component and pillar of the overall care of patients with terminal illnesses. The purpose of this narrative review is to provide an overview and evaluation of the assessment methods and management of chronic wounds in the clinical practice of palliative care. METHODS: Papers on the management of wounds in palliative care have been retrieved using PubMed to July 2023. The search terms used included "wounds", "ulcers", "palliative care", "palliative management", and "end of life". KEY CONTENT AND FINDINGS: The review highlights the importance of early palliative care referral and total pain management in the management of wounds. Patients with wounds often report multiple symptoms, and pain is one of the most common and distressing among them. Despite the availability of multiple guidelines about treatment to relieve pain, almost half of all cancer patients still receive inappropriate care for pain. The review also discusses the etiology of pain and provides strategies for managing the painful wound once it has been identified. The greatest need today in the treatment of chronic wounds is consensus-based knowledge vetted by practical experience and backed up by scientific evidence, which is easily communicated and available to all wound care practitioners. CONCLUSIONS: High-quality research together with wound care practice that leads to the best outcomes might include pain reduction, exudate management, odor management, and/or other quality-of-life benefits to wound care. There is a need for specialized palliative care teams to manage expectations throughout the process while maintaining hope.

Childhood Acute Urticaria and Seasonal Patterns Presenting in the Emergency Department of a Teaching Hospital in London, United Kingdom.

OBJECTIVES: To characterize the clinical presentation, possible trigger factors and seasonality of acute urticaria (AU) in children referred to the emergency department in a teaching hospital in London, United Kingdom. METHODS: This was a retrospective descriptive study. One hundred and sixty-three consecutive patients younger than 18 years with the diagnosis of AU who attended accident and emergency department from January 2018 until January 2020 at Chelsea and Westminster Hospital in London, United Kingdom, were included in the study. Descriptive statistics were performed using IBM SPSS 25. RESULTS: In total, 163 patients younger than 18 years, 82 (50.3%) boys and 81 (49.7%) girls. The median age of patients with AU was 4 years (interquartile range, 6 years). In 120 of (73.6%) 163 patients, there was no clear trigger of AU, in 17 (10.4%) of 163 patients, upper respiratory infection was considered as a potential trigger of AU, followed by food in 14 (8.6%) cases, medications in 9 (5.5%) cases, hymenoptera sting in 1 (0.6%) case, and contact urticaria 2 (1.2%) cases. Seventeen (10.4%) of the patients were admitted into the hospital as a result of their urticaria. The majority of AU urticaria cases were reported in autumn with 76 (46.6%) cases with most of AU cases occurring in November (34/163, 20.9%). CONCLUSIONS: A total of 163 cases of AU were identified between January 2018 and January 2020. A seasonal trend of AU in autumn was observed. Respiratory infections were found to be the most commonly associated potential trigger of AU cases.

Pruritic annular and vesicular eruption on trunk and extremities.

We report a case of linear IgA bullous dermatosis, a rare autoimmune blistering disorder that usually presents with the abrupt onset of tense bullae. We also emphasize the importance of direct immunofluorescence for the definitive diagnosis.

Hydroxychloroquine-induced erythema multiforme.

Hydroxychloroquine is a commonly used medication and rarely may result in development of erythema multiforme. This potential cutaneous side effect should be highlighted in information given to patients prior to hydroxychloroquine commencement.

Panitumumab-Induced Eruptive Seborrhoeic Keratosis in a Patient with Metastatic Colorectal Cancer.

OBJECTIVES: Agents targeting the epidermal growth factor receptor (EGFR)-mediated signalling pathway are increasingly being used for the treatment of advanced lung, pancreatic, colorectal and head and neck cancers. CASE PRESENTATION: Here, we report the first case of eruptive seborrhoeic keratosis following panitumumab treatment, an anti-EGFR monoclonal antibody, in a 73-year-old patient with stage 4 (IV) colorectal cancer with hepatic metastasis. CONCLUSION: While panitumumab is an emerging therapy for RAS wild-type metastatic colorectal cancer, physicians should consider panitumumab as a potential cause of eruptive seborrhoeic keratosis. LEARNING POINTS: Panitumumab is a fully human monoclonal antibody targeting the epidermal growth factor receptor (EGFR), indicated for the treatment of wild-type RAS metastatic colorectal cancer.Dermatologic toxicity of all grades occurs in more than 90% of patients treated with EGFR inhibitors.To the best of our knowledge, we have reported here a rare side effect; panitumumab-induced eruptive seborrhoeic keratosis.

Turicella otitidis as an Unusual Agent Causing Palmoplantar Eczema: An Emerging Pathogen.

INTRODUCTION: Turicella otitidis, described as a new species over 20 years ago, has been isolated mainly from the external ear canal and middle ear fluid. Here, we report the first case of palmoplantar eczema related to T. otitidis. CASE PRESENTATION: Here, we report the first case of palmoplantar eczema in a 74-year-old female related to T. otitidis. CONCLUSIONS: The question as to whether T. otitidis is a potential pathogen in cases of dyshidrotic eczema is still open, but this could be better elucidated if corynebacteria were speciated more often. LEARNING POINTS: The coryneform bacteria Turicella otitidis and Corynebacterium auris were recently detected for the first time in the middle ear of patients with acute otitis media and chronic otitis media.T. otitidis is a potential extraotic pathogen.T. otitidis may be implicated in the pathogenesis of palmoplantar dermatitis.

Generalized Lichen Planus-like Eruption Related to Trimebutine.

Trimebutine is a spasmolytic agent with antimuscarinic effects that is used for the treatment of irritable bowel syndrome (IBS) and lower gastrointestinal tract motility disorders. Lichenoid drug eruptions (LDE) to trimebutine maleate have not been previously reported. Here we present the case of a 50-year-old male patient who developed an extensive lichenoid eruption on his upper and lower extremities and trunk 4 weeks after starting treatment with trimebutine maleate 300 mg once daily for IBS. Two months after discontinuation of the drug and administration of topical treatment with emollients and corticosteroids, the LDE cleared completely with no recurrence. The diagnosis of LDE due to trimebutine was made, based upon the clinical features resembling lichen planus, the histological findings of interface dermatitis, the evidence of a temporal relationship between drug intake and the development of skin lesions, and resolution upon discontinuation of the drug. To the best of the authors' knowledge, LDE following trimebutine maleate intake has not been previously reported. Management of trimebutine-induced LDE includes withdrawal of the causative agent and treatment with potent topical corticosteroids. LEARNING POINTS: Cutaneous adverse events due to trimebutine maleate, an antispasmodic agent frequently used for the treatment of irritable bowel syndrome (IBS), have rarely been reported.Lichenoid drug eruption (LDE), also called drug-induced lichen planus, is an uncommon cutaneous adverse effect of several drugs.Here we report the first case of trimebutine maleate-induced LDE.

Fluoropyrimidine-induced toxicity and DPD deficiency.. A case report of early onset, lethal capecitabine-induced toxicity and mini review of the literature. Uridine triacetate: Efficacy and safety as an antidote. Is it accessible outside USA?

Fluoropyrimidine-based regimens are among the most commonly used chemotherapy combinations for the treatment of solid tumors. Several genetic polymorphisms that are implicated with fluoropyrimidine anabolism and catabolism have been associated with the development of life-threatening toxicities. Uridine triacetate is an FDA-approved antidote for 5-fluorouracil or capecitabine overdose and early-onset, life-threatening toxicity within 96 h of last chemotherapy dose. To date, it is not accessible for Greek patients as per the current summary of product characteristic's time restrictions. We report and discuss the course and outcome of capecitabine toxicity in a 66-year-old female colorectal cancer patient with heterozygous dihydropyrimidine dehydrogenase deficiency. This paper highlights the difficulty in timely access of this lifesaving medication for Greek and possibly other European patients.

Newborn with a solitary hairless skin defect on the scalp vertex.

Aplasia cutis congenita is a rare congenital disorder usually presenting as an isolated lesion on the scalp that may be associated with genetic syndromes and congenital anomalies. Therefore, it is important to be aware of this syndrome.

Multiple primary malignancies: a report of two cases.

The diagnosis of multiple primary malignancies (MPMs) in a patient has been reported rather frequently during the past decade. Here we present two cases with three synchronous primary malignant tumors. The first patient is a 66-year-old male with synchronous colorectal cancer, renal cell carcinoma (RCC) and non-small cell lung cancer (NSCLC). The second patient is a 64-year-old female with breast cancer, transitional cell carcinoma of the ureter and endometrial cancer. MPMs seem to be diagnosed in a higher incidence than that predicted only by the influence of hazard and, whenever found, they raise questions regarding not only possible common etiologic factors or same pathogenetic mechanisms but also they cause a lot of troubles to both clinicians and patients because the therapeutic options usually become limited.