Severe cutaneous reaction to cetuximab with possible association with the use of over-the-counter skin care products in a patient with oropharyngeal cancer.
Cutan Ocul Toxicol. 2009; 28(1): 41-4Waris W, Naik S, Idrees I, Taha H, Camosino L, Mehrishi A, Saif MWBACKGROUND: The management of locally advanced head and neck cancer remains a challenge to most oncologists and their patients. Treatment with epithelial growth factor receptor inhibitors (EGFRIs) is associated with a good response. Cetuximab, a chimeric monoclonal antibody directed against epithelial growth factor receptor (EGFR), in combination with radiation therapy is indicated for the treatment of locally advanced squamous cell carcinoma of the head and neck. Although a mild acneiform skin rash (Grade 1, 2) is very common in these patients, severe rash (Grade 3) is uncommon. CASE REPORT: A 61-year-old African American man with locally advanced oropharyngeal cancer was treated with cetuximab and radiation. He developed a sudden flare-up of a skin rash after the 5th cycle of cetuximab following use of over-the-counter (OTC) skin care remedies. The rash manifested with severe maculopapular eruption and erythematous rash, along with desquamation and exfoliation of the skin, mainly on the face and neck area. The patient denied any extraordinary sun exposure. Cetuximab and radiation therapy were held for 1 week and the rash was treated with doxycycline, diphenhydramine, and continued use of natural emollient (Vaseline petroleum jelly). After 1 week, a dramatic improvement of the facial rash was noticed. DISCUSSION: Our report describes a sudden flare-up of a skin rash (Grade 3) after the 5th cycle of cetuximab following use of OTC skin care remedies, which was unusual for this patient, suggesting a possible relation to the therapy. Skin crucially depends on EGFR for its normal function and becomes extremely sensitive during cetuximab therapy. Topical OTC acne and dry skin remedies can suddenly change the mild acneiform rash into severe skin toxicity associated with marked desquamation and exfoliation. Avoidance of further skin damage caused by topical applications and the use of doxycycline and diphenhydramine show a significant success in the management of skin toxicity.
Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome and acne fulminans: are they part of the same disease spectrum?
Clin Exp Dermatol. 2009 Mar 14; Chua SL, Angus JE, Ravenscroft J, Perkins W
Acne vulgaris: review and guidelines.
Dermatol Nurs. 2009 Mar-Apr; 21(2): 63-8; quiz 69Ramos-e-Silva M, Carneiro SCAcne is a chronic disease of the pilosebaceous follicle that affects mainly adolescents. It causes polymorph cutaneous lesions that may leave scars after regression. It is characterized by alternation of periods of exacerbation and stability. Spontaneous regression usually occurs after age 20, but some patients may continue suffering during adult life. Diagnosis is clinical and based on the patient's age at the time that the lesions first appear, and on its polymorphism and type of lesions and location. Some patients also need a hormonal and, sometimes, psychological evaluation. The right treatment for the right patient is key to treating acne safely.
Item Reduction and Psychometric Validation of the Oily Skin Self Assessment Scale (OSSAS) and the Oily Skin Impact Scale (OSIS).
Value Health. 2009 Mar 10; Arbuckle R, Clark M, Harness J, Bonner N, Scott J, Draelos Z, Rizer R, Yeh Y, Copley-Merriman KABSTRACT Introduction: Developed using focus groups, the Oily Skin Self Assessment Scale (OSSAS) and Oily Skin Impact Scale (OSIS) are patient-reported outcome measures of oily facial skin. Objective: The aim of this study was to finalize the item-scale structure of the instruments and perform psychometric validation in adults with self-reported oily facial skin. Methods: The OSSAS and OSIS were administered to 202 adult subjects with oily facial skin in the United States. A subgroup of 152 subjects returned, 4 to 10 days later, for test-retest reliability evaluation. Results: Of the 202 participants, 72.8% were female; 64.4% had self-reported nonsevere acne. Item reduction resulted in a 14-item OSSAS with Sensation (five items), Tactile (four items) and Visual (four items) domains, a single blotting item, and an overall oiliness item. The OSIS was reduced to two three-item domains assessing Annoyance and Self-Image. Confirmatory factor analysis supported the construct validity of the final item-scale structures. The OSSAS and OSIS scales had acceptable item convergent validity (item-scale correlations >0.40) and floor and ceiling effects (
