Subject(s)
Pemphigoid, Bullous , Pityriasis Rubra Pilaris , Humans , Pityriasis Rubra Pilaris/chemically induced , Pityriasis Rubra Pilaris/diagnosis , Pityriasis Rubra Pilaris/drug therapy , Pemphigoid, Bullous/chemically induced , Pemphigoid, Bullous/diagnosis , Pemphigoid, Bullous/drug therapy , Antibodies, Monoclonal, Humanized/adverse effectsABSTRACT
Numerous cutaneous side effects associated with COVID-19 vaccines have been described since their clinical approval. These include, among others, injection site reactions, urticarial, maculopapular and pityriasiform rashes or temporary exacerbations of a pre-existing chronic inflammatory skin disease. Herein we report about three cases of pityriasis rubra pilaris that occurred for the first time in close temporal relationship with the administration of a COVID-19 vaccine.
Subject(s)
COVID-19 Vaccines , COVID-19 , Pityriasis Rubra Pilaris , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , Pityriasis Rubra Pilaris/chemically induced , Skin , Vaccination/adverse effectsSubject(s)
2019-nCoV Vaccine mRNA-1273/adverse effects , BNT162 Vaccine/adverse effects , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Erythema Multiforme/chemically induced , Pityriasis Lichenoides/chemically induced , Pityriasis Rubra Pilaris/chemically induced , Sweet Syndrome/chemically induced , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , SARS-CoV-2ABSTRACT
We describe a case of a pityriasis rubra pilaris (PRP)-like eruption occurring following administration of the Pfizer-Biontech mRNA COVID-19 vaccine, with worsening of the condition following the second dose. To our knowledge, this is the first reported case of a PRP-like eruption as a cutaneous adverse event of the Pfizer-Biontech mRNA COVID-19 vaccine.
Subject(s)
BNT162 Vaccine/adverse effects , COVID-19/prevention & control , Drug Eruptions/etiology , Pityriasis Rubra Pilaris/chemically induced , Drug Eruptions/pathology , Humans , Male , Middle Aged , Pityriasis Rubra Pilaris/pathology , SARS-CoV-2Subject(s)
Imidazoles/adverse effects , Pityriasis Rubra Pilaris/chemically induced , Protein Kinase Inhibitors/adverse effects , Pyridazines/adverse effects , Aged , Antineoplastic Agents/adverse effects , Drug Eruptions/etiology , Drug Eruptions/pathology , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Pityriasis Rubra Pilaris/pathologyABSTRACT
Abstract Topical use of immune response modifiers, such as imiquimod, has increased in dermatology. Although its topical use is well tolerated, it may be associated with exacerbations of generalized cutaneous inflammatory diseases, possibly through the systemic circulation of pro-inflammatory cytokines. This report describes a case of development of pityriasis rubra pilaris, a rare erythematous-papulosquamous dermatosis, in a woman aged 60 years during treatment with imiquimod 5% cream for actinic keratosis. It evolved with erythrodermic conditions and palmoplantar keratoderma, presenting progressive clinical resolution after the introduction of methotrexate. The authors emphasize the importance of recognizing possible systemic reactions associated with the topical use of imiquimod.
Subject(s)
Humans , Female , Pityriasis Rubra Pilaris/chemically induced , Pityriasis Rubra Pilaris/pathology , Keratosis, Actinic/drug therapy , Imiquimod/adverse effects , Antineoplastic Agents/adverse effects , Pityriasis Rubra Pilaris/drug therapy , Biopsy , Methotrexate/therapeutic use , Treatment Outcome , Adrenal Cortex Hormones/therapeutic use , Dermatologic Agents/therapeutic use , Middle AgedABSTRACT
Hyperkeratotic skin adverse events are a group of toxic effects, characterized by the disruption of epidermal homeostasis and interaction with keratinocyte proliferation/differentiation or keratinocyte survival, and frequently reported with systemic anticancer treatments. These types of reactions include hand-foot skin reaction or palmoplantar keratoderma, induced psoriasis, keratosis pilaris-like or pityriasis rubra pilaris-like rashes, Grover's disease, and contact hyperkeratosis. Cutaneous squamoproliferative lesions are also described because of the presence of abnormal keratinocyte proliferation. They are usually observed with tyrosine kinase inhibitors but have also been described in association with cytotoxic chemotherapeutic agents. Their pathogenesis is related mainly to the disruption of epidermal homeostasis and interaction with keratinocyte proliferation/differentiation or keratinocyte survival caused by anticancer treatment. Early recognition and adequate management are critical to prevent exacerbation of the lesions, to limit treatment interruption, and to minimize impairment of quality of life. This review summarizes the current knowledge concerning the presentation, pathogenesis, and management of secondary hyperkeratotic reactions to anticancer therapies. It also includes hyperkeratotic reactions that have been more recently described with newly approved targeted therapies or immune checkpoint inhibitors, such as keratosis pilaris-like exanthema with second-generation BCR-ABL inhibitors, lamellar ichthyosis-like lesions with ponatinib, pityriasis rubra pilaris with the newly approved selective phosphoinositide 3 kinase inhibitor idelalisib, or psoriasis with anti-programmed death-1 and programmed death ligand-1.
Subject(s)
Antineoplastic Agents/adverse effects , Pityriasis Rubra Pilaris/chemically induced , Skin/physiopathology , HumansABSTRACT
Topical use of immune response modifiers, such as imiquimod, has increased in dermatology. Although its topical use is well tolerated, it may be associated with exacerbations of generalized cutaneous inflammatory diseases, possibly through the systemic circulation of pro-inflammatory cytokines. This report describes a case of development of pityriasis rubra pilaris, a rare erythematous-papulosquamous dermatosis, in a woman aged 60 years during treatment with imiquimod 5% cream for actinic keratosis. It evolved with erythrodermic conditions and palmoplantar keratoderma, presenting progressive clinical resolution after the introduction of methotrexate. The authors emphasize the importance of recognizing possible systemic reactions associated with the topical use of imiquimod.
Subject(s)
Antineoplastic Agents/adverse effects , Imiquimod/adverse effects , Keratosis, Actinic/drug therapy , Pityriasis Rubra Pilaris/chemically induced , Pityriasis Rubra Pilaris/pathology , Adrenal Cortex Hormones/therapeutic use , Biopsy , Dermatologic Agents/therapeutic use , Female , Humans , Methotrexate/therapeutic use , Middle Aged , Pityriasis Rubra Pilaris/drug therapy , Treatment OutcomeABSTRACT
BACKGROUND: Phosphoinositide 3-kinase (PI3K) inhibitors are a class of small-molecule inhibitors approved for the treatment of certain leukaemias and lymphomas. Their dermatological adverse event profile is poorly described. AIM: To characterize a rare cutaneous adverse event from PI3K inhibitors in order to help dermatologists and oncologists identify and effectively manage such eruptions. METHODS: This was a retrospective analysis of patients receiving PI3K inhibitors referred to the Skin Toxicities Program in The Center for Cutaneous Oncology. RESULTS: Three patients on PI3K inhibitors for treatment of malignancy developed diffuse erythroderma and keratoderma. Clinical and histopathological findings were consistent with pityriasis rubra pilaris (PRP)-like reactions. All patients improved with topical and oral corticosteroids, oral acitretin, and drug discontinuation. CONCLUSIONS: PRP-like cutaneous eruptions may develop secondary to PI3K inhibition. Early dermatological evaluation of cutaneous toxicities to PI3K inhibitors as well as rapid initiation of disease-specific treatments may help keep patients on life-prolonging anti-cancer therapies.
Subject(s)
Antineoplastic Agents/adverse effects , Dermatitis, Exfoliative/chemically induced , Phosphoinositide-3 Kinase Inhibitors , Pityriasis Rubra Pilaris/chemically induced , Protein Kinase Inhibitors/adverse effects , Aged , Antineoplastic Agents/therapeutic use , Dermatitis, Exfoliative/pathology , Female , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Male , Middle Aged , Oligodendroglioma/drug therapy , Pityriasis Rubra Pilaris/pathology , Protein Kinase Inhibitors/therapeutic use , Retrospective Studies , Skin/pathologyABSTRACT
BACKGROUND: Pityriasis rubra pilaris (PRP) is a cutaneous syndrome of unknown origin. Most cases are sporadic and acquired. Herein we report a fifth case of PRP-like eruption associated with ponatinib, a tyrosine kinase inhibitor (TKI). PATIENTS AND METHODS: A 60-year-old woman presented at the dermatology department with an erythemato-squamous eruption present for 2weeks. The patient was also being treated in haematology for recurrence of acute lymphoblastic leukaemia. Treatment with ponatinib had been initiated 6weeks earlier. Despite the low specific cutaneous histology, a diagnosis of induced PRP-like eruption was made based on the characteristic clinical aspect. Treatment with local corticosteroids resolved the eruption. DISCUSSION: The literature contains 6 reported cases of PRP-like eruptions associated with TKI, including 4 with ponatinib. The eruption began from 2weeks to 2-3 months after treatment induction. Prescribed topical corticosteroids have yielded mixed results. A better understanding of the physiopathology of these eruptions associated with TKI could shed light on the pathogenic mechanisms in relation to idiopathic PRP.
Subject(s)
Imidazoles/adverse effects , Pityriasis Rubra Pilaris/chemically induced , Protein Kinase Inhibitors/adverse effects , Pyridazines/adverse effects , Drug Eruptions/etiology , Female , Humans , Middle Aged , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapySubject(s)
Dermatologic Agents/adverse effects , Drug Eruptions/etiology , Infliximab/adverse effects , Pityriasis Rubra Pilaris/chemically induced , Dermatologic Agents/administration & dosage , Drug Eruptions/pathology , Female , Humans , Infliximab/administration & dosage , Middle Aged , Pityriasis Rubra Pilaris/pathology , Takayasu Arteritis/drug therapyABSTRACT
Until 2011, the standard-of-care therapy for patients with hepatitis C consisted of interferon and ribavirin. The recent advent of new targeted therapies against this virus has provided more options of treatment for infected patients. Sofosbuvir, a nucleotide inhibitor of hepatitis C virus (HCV) RNA polymerase, was recently approved by the US Food and Drug Administration in 2013. Various Phase 3 trials with sofosbuvir combination therapy have reported an incidence of rash between 7% and 18%. We here describe a case of sofosbuvir-induced erythrodermic pityriasis rubra pilaris-like drug eruption.
Subject(s)
Antiviral Agents/adverse effects , Pityriasis Rubra Pilaris/chemically induced , Sofosbuvir/adverse effects , Antiviral Agents/therapeutic use , Drug Eruptions/etiology , Drug Eruptions/pathology , Hepatitis C/drug therapy , Humans , Male , Middle Aged , Pityriasis Rubra Pilaris/pathology , Sofosbuvir/therapeutic useABSTRACT
INTRODUCTION: Acantholysis is rarely reported histological feature of Pityriasis rubra pilaris (PRP), recently recognized as having diagnostic specificity for differentiating PRP from psoriasis. CASE REPORT: Adult male patient one week after the introduction of simvastatin had experienced pruritic erythemo-squamous eruption on head and upper trunk that in a month progressed to erythrodermia, with islands of sparing. Histological picture combined pemphigus-like acantholysis with alternating hyper- and parakeratosis, follicular plugs and dermal inflammation, and confirmed the clinical diagnosis of classic adult type 1 PRP. Acitretin therapy resulted in a resolution of skin disease. Patch test with simvastatin was negative, scratch test was positive, and it was estimated that potential risk of oral challenge with simvastatin outweighed actual need for it. Drug triggering PRP episode is the most likely explanation for temporal relation between the start of simvastatin treatment and skin eruption. CONCLUSION: In management of rare inflammatory skin disease, such as PRP, we have to carefully observe and evaluate not only diagnostic features but possible external influences on its course also.