Cutaneous reactions to chemotherapeutic drugs and targeted therapies for cancer: part I. Conventional chemotherapeutic drugs.

Conventional chemotherapy continues to be an important part of cancer management, but may cause various cutaneous reactions because it disturbs specific cell cycle phases. The alkylating agents cyclophosphamide, ifosfamide, and thiotepa can produce hyperpigmentation, while hypersensitivity reactions can be seen with platinum alkylating agents. Antimetabolites vary in reactions from exanthematous to bullous skin lesions. 5-fluorouracil and its derivatives and liposomal doxorubicin and daunorubicin are characteristically known to cause hand-foot syndrome, while bleomycin can cause fibrosis and flagellate dermatitis. Several hypersensitivity reactions may also occur from mitotic inhibitors and topoisomerase inhibitors. These different characteristic presentations are important to dermatologists in identifying the correct diagnosis and management for the cancer patient.

Cutaneous reactions to chemotherapeutic drugs and targeted therapy for cancer: Part II. Targeted therapy.

Targeted drugs are increasingly being used for cancer management. They are designed to block specific cancer cell processes, and are often better tolerated than conventional chemotherapeutic drugs. Cutaneous reactions, however, are not uncommon, because some target molecules are also present in the skin. Tyrosine kinase inhibitors can cause edema and macular rash, whereas papulopustular rash, paronychia, regulatory changes in hair, itching, and dryness caused by epidermal growth factor receptor inhibitors (PRIDE) syndrome can be seen in patients treated with these drugs. Vismodegib may result in muscle spasms and alopecia. Multiple rashes can be seen with bortezomib, while sunitinib and sorafenib cause hand-foot skin reactions. New melanoma therapies, such as ipilimumab, cause immune-related adverse events of dermatitis and pruritus, while BRAF inhibitors can produce exanthematous rash and lead to an increased risk of squamous cell carcinoma. Dermatologists should be aware of these new therapies and their cutaneous reactions to be able to provide appropriate care and management for cancer patients.

A single-center, randomized double-blind, parallel-group study to examine the safety and efficacy of 3mg drospirenone/0.02 mg ethinyl estradiol compared with placebo in the treatment of moderate truncal acne vulgaris.

BACKGROUND: Acne is a common disease of the face, chest and back, initially triggered by androgens. 3mg Drospirenone (DRSP)/0.02 mg ethinyl estradiol (EE), an oral contraceptive and antiandrogen, has been effective in treatment studies of facial acne in women, but investigations on its efficacy for truncal acne are limited.
OBJECTIVE: In this study, we sought to evaluate the safety and efficacy of 3mg DRSP/0.02 mg EE versus placebo in the treatment of truncal acne in women.
METHODS: Females, age 18-45, with 10 to 50 truncal acne lesions, were randomized in this double-blind study to 3mg DRSP/0.02 mg EE (n=15) or placebo (n=10) administered in a 24/4 regimen given for 24 weeks. Noninflammatory, inflammatory and total truncal acne lesion counts were assessed from baseline to endpoint and mean percent change compared. Investigator Global Assessment (IGA) and Subject Global Assessment (SGA) were assessed based on scoring scales, and the percentage of subjects rated as success with clear (score 0) or almost clear (score 1) were computed.
RESULTS: The 3mg DRSP/0.02 mg EE group had significant reductions in mean percent change in noninflammatory, inflammatory and total lesions by 52.1%, 53.2%, and 57.3%, respectively, compared to placebo with -9.2%, 18.2% and 17.0 %, respectively, by week 24 (p = 0.02, 0.05 and 0.02, respectively). The percentage of subjects on 3mg DRSP/ 0.02 mg EE rated as treatment success were 53.3% and 60% based on IGA and SGA respectively. The regimen was also well tolerated by patients.
CONCLUSIONS: 3mg DRSP/ 0.02 mg EE is a safe and significantly effective treatment for moderate truncal acne.

The Philippine General Hospital experience with extramammary Paget's disease from 1997 to 2006

BACKGROUND: Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma seen in areas with high density of apocrine glands such as the vulva, perianal area, scrotal and penile regions. Clinically the lesions appear to be well-defined erythematous or white plaques accompanied by pruritus; often misdiagnosed as inflammatory or infectious conditions i.e. psoriasis, candidiasis or dermatitis. At present, there is no retrospective study on the prevalence of EMPD in the Philippines. OBJECTIVE: This study aimed to conduct a ten-year retrospective review of histologically diagnosed extramammary Paget's disease in the Philippine General Hospital from 1997 to 2006, and confirm the diagnoses by carcinoembryonic antigen immunostain (CEA). METHODS: Histopathology logbooks and organ files of the PGH Section of Dermatology and PGH Department of Pathology from January 1997 to December 2006 were searched. Records and specimen paraffin blocks of EMPD patients were retrieved for review and CEA immunostain, respectively. RESULTS: Nine EMPD patients were seen in a ten-year period, eight were positive for CEA, and one had no paraffin block available for review. The vulva was the most common site (89 percent) followed by the perianal area (11 percent), and all patients were females, aged 47 to 86 years old. The most common complaint was pruritus, often misdiagnosed as fungal infection, contact dermatitis, vulvar carcinoma or malignant melanoma; with one week to seven years before a final diagnosis of EMPD was made. Lesions were mostly erythematous, indurated plaques ranging from 0.48 cm to 299 cm with a mean of 120.67 cm . Malignancy was noted in one patient who had breast cancer prior to appearance of vulvar lesions. Surgical removal of the lesion was the main mode of-treatment. Vulvectomy, wide excision or local excision has been done with surgical flaps or grafts depending on the size of the lesion. CONCLUSION: From 1997 to 2006 the Philippine General Hospital had nine histopathologically diagnosed EMPD, eight of which in the vulvar area and eight had CEA positive staining. Recurrence of lesions and appearance of concomitant malignancy could not be assessed due to the poor follow up of patients and incomplete records.

The Philippine General Hospital experience with extramammary Paget's disease from 1997 to 2006

BACKGROUND: Extramammary Paget's disease (EMPD) is a rare intraepidermal adenocarcinoma seen in areas with high density of apocrine glands such as the vulva, perianal area, scrotal and penile regions. Clinically the lesions appear to be well-defined erythematous or white plaques accompanied by pruritus; often misdiagnosed as inflammatory or infectious conditions i.e. psoriasis, candidiasis or dermatitis. At present, there is no retrospective study on the prevalence of EMPD in the Philippines. OBJECTIVE: This study aimed to conduct a ten-year retrospective review of histologically diagnosed extramammary Paget's disease in the Philippine General Hospital from 1997 to 2006, and confirm the diagnoses by carcinoembryonic antigen immunostain (CEA). METHODS: Histopathology logbooks and organ files of the PGH Section of Dermatology and PGH Department of Pathology from January 1997 to December 2006 were searched. Records and specimen paraffin blocks of EMPD patients were retrieved for review and CEA immunostain, respectively. RESULTS: Nine EMPD patients were seen in a ten-year period, eight were positive for CEA, and one had no paraffin block available for review. The vulva was the most common site (89 percent) followed by the perianal area (11 percent), and all patients were females, aged 47 to 86 years old. The most common complaint was pruritus, often misdiagnosed as fungal infection, contact dermatitis, vulvar carcinoma or malignant melanoma; with one week to seven years before a final diagnosis of EMPD was made. Lesions were mostly erythematous, indurated plaques ranging from 0.48 cm to 299 cm with a mean of 120.67 cm . Malignancy was noted in one patient who had breast cancer prior to appearance of vulvar lesions. Surgical removal of the lesion was the main mode of-treatment. Vulvectomy, wide excision or local excision has been done with surgical flaps or grafts depending on the size of the lesion. CONCLUSION: From 1997 to 2006 the Philippine General Hospital had nine histopathologically diagnosed EMPD, eight of which in the vulvar area and eight had CEA positive staining. Recurrence of lesions and appearance of concomitant malignancy could not be assessed due to the poor follow up of patients and incomplete records.