“Tineariasis” (or plaque-psoriasis induced by Terbinafine)

Terbinafine is an anti fungal drug used worldwide to treat dermatophytosis. Although generally is well tolerated, several cutaneous side effects have been described. One of them is the induction or exacerbation of psoriasis, especially the pustular type. We describe a case of plaque-psoriasis induced by terbinafine in a young patient. Skin biopsy was performed to confirm the diagnosis and the suspected drug was discontinued. Biopsy showed regular epidermal hyperplasia with parakeratoses and neutrophils in the corneal layer. No fungal elements were observed. Improvement was observed after discontinuation of terbinafine. We present a new case of the induction of plaque-psoriasis after the use of oral terbinafine and conclude that this drug should be used with caution in predisposed patients. Keywords: psoriasis; pustular posriasis; plaque-psoriasis; terbinafine

Cutaneous adverse reactions of COVID-19 vaccines: a systematic review

Background: Numerous vaccines are implementation for the prevention of severe course and lethal outcome of coronavirus disease 2019 (COVID-19).Objective: This systematic review aims to summarize and integrated the findings of studies regarding cutaneous side effects of COVID-19 vaccines. Methods: This systematic review conducted by searching the scientific databases of PubMed, Scopus, Science direct, and Web of knowledge from the beginning of the COVID-19 to10/5/2021. Articles were reviewed and analyzed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.Results: Seventeen studies were included after the screening of search results based on to the eligibility criteria. The results showed that injection site reactions and delayed large local reactions were the most common side effects arising from all vaccine types. Most cutaneous reactions occurred in middle-aged women, after the first dose of vaccine, and 1-21 days after vaccination. Most cutaneous reactions were self-limiting, need little or no therapeutic intervention, and were not regarded as a barrier to injecting a second dose.Limitations:Conclusion: In certain groups such as patients with allergies and a history of local injection reactions, pre-vaccination counseling and the use of appropriate medications may be helpful. However, more studies are needed to investigate the side effect profile of all COVID-19 vaccines.

Single-Center Clinico-Pathological Case Study of 19 Patients with Cutaneous Adverse Reactions Following COVID-19 Vaccines

(1) Background: Coronavirus disease 2019 (COVID-19) vaccines are currently employed on a population-wide scale in most countries worldwide. Data about unusual cutaneous adverse drug reactions (ADR) are scant, though. (2) Methods: We retrospectively analyzed moderate to severe vaccine-related ADR in the Department of Dermatology and Allergy of the University Hospital Bonn between May to June 2021 and analyzed related skin biopsies. (3) Results: As a specialized dermatological academic center, we encountered a total of n = 19 clinically and pathologically heterogeneous cutaneous ADR with a female predominance. Delayed cutaneous ADR occurred as late as 30 days after vaccination. The majority of ADR were mild, though a few patients required systemic treatment (antihistamines, glucocorticosteroids). (4) Conclusions: The clinico-pathological spectrum of cutaneous side effects with COVID-19 vaccines is wide; however, the benefits outweigh the risks by far. More dermatopathological studies on cutaneous ADR not limited to COVID-19 vaccines are desirable to enable a better understanding of underlying pathophysiological mechanisms.

Prevalence of dermatological toxicities in patients with melanoma undergoing immunotherapy: Systematic review and meta-analysis

Background Checkpoint inhibitors have revolutionized advanced melanoma care; however, their cutaneous side effects have not been definitively elucidated. Objective To identify the prevalence of cutaneous toxicity in patients with melanoma treated with immune checkpoint inhibitors as monotherapy and/or in combination with chemotherapy and/or radiotherapy. Materials and methods We performed a systematic review and meta-analysis, which encompassed both clinical trials and observational studies describing the dermatological toxicities in patients treated with immune checkpoint inhibitors. The protocol was registered in the International Prospective Register of Systematic Review under the number CRD42018091915. The searches were performed using the CINAHL, Cochrane CENTRAL, LILACS, LIVIVO, PubMed, Scopus, and Web of Science databases. The methodological quality of the studies was evaluated with the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data Results A total of 9,802 articles were identified in the databases. The final sample comprised 39 studies. The evaluated drugs were ipilimumab, tremelimumab, pembrolizumab, and nivolumab. The results suggest that the most prevalent side effect was grade 1 and 2 pruritus (24%), followed by grade 1 and 2 rash (21%) and grade 1 and 2 vitiligo (10%). Conclusion The most prevalent side effects in patients treated with checkpoint inhibitors are pruritus, rash, and vitiligo, and they are rated mostly as grades 1 and 2 adverse events. Remarkably, vitiligo is most commonly found in patients treated with PD-1 inhibitors.

Case Report: Predicting the Range of Lamotrigine Concentration Using Pharmacokinetic Models Based on Monte Carlo Simulation: A Case Study of Antiepileptic Drug-Related Leukopenia

Lamotrigine (LTG), a wide-spectrum antiepileptic drug, is frequently associated with cutaneous side-effects, whereas hematological side-effects such as leukopenia have rarely been reported for it. We report the case of a 15-year-old Chinese female epileptic patient weighing 60 kg who developed combined asymptomatic leukopenia after receiving concomitant therapy with LTG and valproate acid (VPA). In this case report, antiepileptic drug-related leukopenia may have occurred in definite relation to an increase in LTG concentration and reversed with the discontinuation of VPA. Monte Carlo (MC) simulations were performed to estimate the steady-state serum concentrations (Css) of LTG for different dosing regimens in adolescent Chinese epileptic patients weighing the same as the patient considered in the case study, based on pharmacokinetic (PK) models published in past research. Adjustments to the dosage of LTG for the patient were analyzed to illustrate the application of MC simulations and verify the results. The predicted LTG concentrations within a prediction interval between the 10th and 90th percentiles that represented 80% of the simulated populations, could adequately capture the measured LTG concentrations of the patient, indicating that MC simulations are a useful tool for estimating drug concentrations. Clinicians may benefit from the timely probabilistic predictions of the range of drug concentration based on an MC simulation that considers a large sample of virtual patients. The case considered here highlights the importance of therapeutic drug monitoring (TDM) and implementing model-informed precision dosing in the course of a patient’s individualized treatment to minimize adverse reactions.

D-α-Tocopherol-Based Micelles for Successful Encapsulation of Retinoic Acid

All-trans-retinoic acid (ATRA) represents the first-choice treatment for several skin diseases, including epithelial skin cancer and acne. However, ATRA’s cutaneous side effects, like redness and peeling, and its high instability limit its efficacy. To address these drawbacks and to improve ATRA solubilization, we prepared ATRA-loaded micelles (ATRA-TPGSs), by its encapsulation in D-α-tocopheryl-polyethylene-glycol-succinate (TPGS). First, to explore the feasibility of the project, a solubility study based on the equilibrium method was performed; then, six ATRA-TPGS formulations were prepared by the solvent-casting method using different TPGS amounts. ATRA-TPGSs showed small sizes (11–20 nm), low polydispersity, slightly negative zeta potential, and proved good encapsulation efficiency, confirmed by a chemometric-assisted Fourier transform infrared spectroscopy (FTIR) investigation. ATRA-TPGS stability was also investigated to choose the most stable formulation. Using Carbopol® 980 as gelling agent, ATRA-TPGS-loaded gels were obtained and analyzed for their rheological profiles. Ex vivo release studies from ATRA-TPGSs were performed by Franz cells, demonstrating a permeation after 24 h of 22 ± 4 µ cm−2. ATRA-TPGSs showed enhanced cytotoxic effects on melanoma cells, suggesting that these formulations may represent a valid alternative to improve patient compliance and to achieve more efficacious therapeutic outcomes.

Cosmetically disfiguring side effects of cyclosporine A in an adolescent population

Cyclosporine A (CsA) is a potent immunosuppressive agent commonly used in nephrotic syndrome and in organ transplanted patients. However, its applications are limited, due to undesirable adverse effects. The cutaneous manifestations of the drug are well documented in the western countries and some studies indicate a higher incidence among Asian populations. However, there is paucity of data about its cutaneous side effects on Asian patients thus making it difficult to counsel patients and parents before its use. We recruited children and adolescents between 12 and 20 years attending the nephrology clinic at a tertiary care hospital in Sri Lanka who have been receiving CsA more than a year. Patients who received other medication which may aggravate gingival hyperplasia, acne or hypertrichosis were excluded from the study. The dermatological manifestations of the selected children were assessed and recorded by experienced clinicians. Our study consisted of 64 patients who satisfied the inclusion criteria. There were 41 male and 23 females with a median age of 16.6 years. All of them received CsA at a dose between 5-10 mg/kg/day at induction, which was tapered towards a dose of 3 mg/kg/day, based on clinical status as well as serum level of the drug. Among the clinical features observed, hypertrichosis was seen in 32 males (78%) and in all 23 female patients (100%); Gum hypertrophy was seen in 34 patients (53%) and acne was noted only in 8 patients. The commonest cutaneous side effect was hypertrichosis, significantly seen among female subjects, which is a serious point of distress to patients and their families. Gum hypertrophy was also observed among a significant number but could be reduced by regular dental care. These findings will be remarkably useful when counselling before commencing on CsA therapy in adolescent patients.

The relevancy of patch testing in the exploration of the cutaneous side effects of herbal medicine

Background: Data on the cutaneous side effects of herbal medicine is scarce, especially with regard to allergy skin testing. Our objective was to determine the relevancy of patch testing in the exploration of the cutaneous side effects of herbal medicine. Material and Methods: A prospective study was conducted in the Department of Dermatology of the Hospital Institute of Social Hygiene of Dakar over a one-year period. Patch tests were given to patients with cutaneous side effects related to the exclusive use of herbal medicine. The plants recovered were turned into macerates and powders and mixed with Vaseline at concentrations of 5%, 20%, and 30%. Results: Patch tests were given to 31 of the 53 patients included. They were positive in 11 patients (35.48%). Positive patients displayed systemic eczema (n = 7/15 of cases), Stevens–Johnson syndrome (n = 2/3), contact eczema (n = 1/1), and fixed pigmented erythema (n = 1/2). Positive tests were obtained for 11 medicinal plants identified: Jatropha chevalieri (n = 2), Terminalia avicennoïde (n = 2), Detarium microcarpum, Acacia seyal, Acacia albida, Acacia italic, Sesamum indicum, Mangifera indica, Momordica charantia, Nauclea latifolia, and Anogeisius leiocarpus (in one case each). There was no statistically significant relationship between the type of cutaneous side effect and the test result (p = 0.388) and between the nature of the plant used and the test result (p = 0.402). Conclusion: In view of their high rates of positivity, patch tests could prove promising in the exploration of the cutaneous side effects of herbal medicine.