Cutaneous Reactions to Chemotherapeutic Agents (original) (raw)
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The Prospective Observational Study on Cutaneous Adverse Drug Reactions to Chemotherapy
Journal of Evidence Based Medicine and Healthcare, 2016
INTRODUCTION There are a wide spectrum of adverse cutaneous drug reactions (ACDRs) varying from transient maculopapular rash to fatal toxic epidermal necrolysis (TEN). With the advent of newer and targeted therapy in the field of dermatology, the pattern of cutaneous adverse drug eruptions and the drugs responsible for them keep changing every year. Hence, this study was undertaken to ascertain the clinical spectrum of ACDRs and the causative drugs, in a tertiary care centre in South India. MATERIALS AND METHODS This study was a prospective, observational study conducted in Department of Medical Oncology, Government Rajaji Hospital, Madurai Medical College, Madurai during the period of March 2015-August 2015 (6 months). Severity of the reaction was assessed using CTCAE (Common Terminology Criteria for Adverse Events) scale version 4.1. Causality of the drug was assessed using Naranjo Causality Assessment Scale. The scale was calculated first for the regimen and then for individual drugs separately. The adverse events with score of 6 or more (probable and definite adverse events) were taken for the study. RESULTS AND CONCLUSION The overall incidence of ACDRs found in this study was 85%. Alopecia was the commonest ACDR occurring in 51.6% of patients. Nail pigmentation and supravenous pigmentation were the next common ACDRs, recorded in 35% and 16% of patients respectively. Imatinib caused generalised hypopigmentation in 40% of patients. Bleomycin induced, flagellate erythema and pigmentation in 17% of patients and stomatitis was seen in 11% of patients. Acneiform eruptions were recorded with erlotinib and gefitinib therapy. Supravenous pigmentation was common with 5-fluorouracil and docetaxel, occurring in 53% & 48% respectively. Newer targeted therapies like EGFR (Epidermal growth factor receptor) inhibitors recorded low incidence of ACDRs like alopecia as against conventional antineoplastic agents. The cancer chemotherapeutic drugs are associated with varied adverse effects. Knowledge of these drug eruptions, the causative drugs and the prognostic indicators are essential for the treating clinician.
Cutaneous reactions to chemotherapeutic drugs and targeted therapy for cancer
Journal of the American Academy of Dermatology, 2014
The following is a journal-based CME activity presented by the American Academy of Dermatology and is made up of four phases: 1. Reading of the CME Information (delineated below) 2. Reading of the Source Article 3. Achievement of a 70% or higher on the online Case-based Post Test 4. Completion of the Journal CME Evaluation CME INFORMATION AND DISCLOSURES Statement of Need: The American Academy of Dermatology bases its CME activities on the Academy's core curriculum, identified professional practice gaps, the educational needs which underlie these gaps, and emerging clinical research findings. Learners should reflect upon clinical and scientific information presented in the article and determine the need for further study.
Adverse mucocutaneous reactions to chemotherapeutic agents: part I
Anais brasileiros de dermatologia
The local and systemic treatment of tumors can cause changes in the skin, mucous membranes, hair and nails. Accurate diagnosis and appropriate treatment of side effects require knowledge about the patterns of the most common adverse reactions to drugs the patient may be using. The dermatologist must be familiar with the manifestations of certain soft tissue neoplasms, as well as with the adverse mucocutaneous forms of cancer treatment.
Chemotherapy and skin reactions
Journal of Experimental & Clinical Cancer Research, 2012
Background: New chemotherapic agents and new protocols in oncology have led to an increasing survival rate in patients affected by tumors. However, this increased use has been accompanied by a growth in the incidence of cutaneous side effects and a worsening of patients' quality of life. Appropriate management of skin toxicity associated with chemotherapic agents is therefore necessary for suitable drug administration and to improve quality of life and clinical outcomes. Methods: We have clinically examined 100 patients affected by cancer, determining type, frequency, treatment, and evolution of side effects related to chemotherapy. Results: The prevalent cutaneous side effects in patients undergoing chemotherapy are skin rash, xerosis, pruritus, paronychia, hair abnormality, and mucositis. The clinical cases are reported in detail. Conclusion: Oncological therapies have become more selective and have low systemic toxicity because of their high specificity, but cutaneous side effects are common and may worsen the quality of life of these patients.
Clinical and Translational Oncology
Progress in the understanding of many tumors has enabled the development of new therapies, such as those targeted at specific molecules involved in cell growth (targeted therapies) or intended to modulate the immune system (immunotherapy). However, along with the clinical benefit provided by these new treatments, new adverse effects have also appeared. Dermatological toxicities such as papulopustular eruptions, xerosis, and pruritus are common with EGFR inhibitors. Other adverse effects have also been described with PDGFR, BCR-ABL, and MAPK tyrosine kinase inhibitors, antiangiogenic drugs, and inhibitors at immune checkpoints such as CTLA-4 and PD-1/PD-L1. Onset of these adverse effects often causes dose reductions and/or delays in administering the prescribed therapy, which can affect patient survival and quality of life. It is, therefore, important to prevent the occurrence of these adverse effects, or to treat unavoidable ones as soon as possible. This requires cooperation between medical oncologists and dermatologists. This article reviews the various dermatological toxicities associated with targeted therapies and immunotherapies, along with their diagnosis and therapeutic management.
Cutaneous Side-Effects of Antiblastic Chemotherapy: An Emerging Problem
Journal of applied cosmetology, 1998
Locai cutaneous complications following chemotherapeutic agents administration are generally due to accidental extravasation of drugs, while systemic toxicity may be caused by: i) a direct toxic effect, ii) hypersensitivity reactions and iii) dissemination of inflammatory response mediators by necrotic cells. Alopecia is the most common cutaneous systemic effect of antiblastic chemotherapy. Other lesions are maculo-papular eruptions, cutaneous plaques, bullae, hyperpigmentation, folliculitis and nail dystrophy (e.g. red and brown transverse lines, Mees' strips, Beau-Reil lines and onycholisis). Dermatological side effects rarely represent the dose-limiting toxicity of antiblastic drugs. Nevertheless, some of these agents, even when used at standard dose, may cause severe cutaneous side effects requiring treatment modification. With the introduction into clinical practice of new drugs and innovative treatment st:rategies and the implementation of effective hematological support, the toxic profile of chemotherapy has changed with non-hematological side-effects being the most common dose-limiting toxicity. In particular, dermatologica! toxicity involves the patient body image, with a peculiar influence on the patient's quality of life. Therefore, cutaneous side-effects increasingly involve the oncology clinical practice and require a multidisciplinary team for an adequate treatment. Controlled clinica! trials are worthwhile to explore effective means of prevention and therapy. Riassunto La tossicità cutanea da terapia antiblastica può manifestarsi a livello locale e sistemico. Le complicanze cutanee locali sono dovute a stravaso accidentale del farmaco antiblastico mentre la tossicità sistemica può essere causata da: I) un effetto tossico diretto, 2) una reazione di ipersensibilità e 3) una liberazione dei mediatori della risposta infiammatoria da parte delle cellule necrotiche. L'alopecia è l'effetto sistemico cutaneo più comune causato dalla terapia antiblastica. Altre lesioni comprendono eruzioni maculo-papulari, placche e bolle cutanee, aree di iperpigrnentazione, follicolite e distrofia ungueale (linee marroni e rosse trasversali, linee di Mees, linee di Beau-Reil e onicolisi). La tossicità dermatologica raramente rappresenta un fattore dose-limitante della chemioterapia. Tuttavia alcun i agenti antiblastici, anche se a dosi standard, possono causare effetti collaterali, a carico
Cutaneous adverse effects of chemotherapy in cancer patients: A clinico epidemiological study
Panacea Journal of Medical Sciences
With chemotherapy being the major modality of treatment, cutaneous and systemic side effects have been a concern for not only the patients, but also the treating clinicians. Because chemotherapy target not only the cancer cells, but also the other rapidly proliferating cells, skin and skin appendages like hair and nails are most commonly affected.: To study the cutaneous adverse events associated with the commonly used cancer chemotherapy drugs.: 120 patients of clinically diagnosed cancer who underwent chemotherapy and satisfied the inclusion and exclusion criteria were included in this observational study. Photographic images of skin, hair and nails were taken before and after every cycle of chemotherapy were collected. Data were analysed using SPSS version 16.0.: 120 patients including 72 females and 48 males were included in this study with majority (56%) belonging to age group of 55-70 years. The common indications for chemotherapy were carcinoma breast (34%), carcinoma orophar...
Journal of the American Academy of Dermatology, 1996
Background: Patients who received recombinant interleukin-lc~ 0L-le~) before chemotherapy followed by autologous bone marrow transplantation had a characteristic intertriginous cutaneous eruption that has not previously been described. Objective: Our aim was to document these skin changes and to determine whether IL-lc~ as a sole agent caused recognizable changes in the skin. Methods: A prospective study of the skin changes in eight patients was performed. We characterized the clinical, histologic, and immunohistochemical features of the patients' skin after IL-lc~ infusions and after chemotherapy. Results: No specific cfinical or histologic changes were seen immediately after IL-lc~ infusions. Immunohistochemical studies showed significant upregulation of endothelial leukocyte adhesion molecule-1 (ELAM-1) expression. Within i day of the initiation of chemotherapy (ifosfamide, carboplatin, and etoposide), a cutaneous eruption consisting of mucositis and varying degrees of erythema progressing to painful erosions in body folds and under adhesive tape developed in all patients. Histologic features were consistent with a chemotherapeutic effect on the epidermis as well as eccrine and apoctine glands. Expression of keratinocyte intercellular adhesion molecule-1 and HLA-DR as well as of ELAM-1 on dermal endothelial cells was increased. The perivascular lymphocytic infiltrate consisted mainly of CD4 + T cells. Conclusion: High-dose chemotherapy with ifosfamide, carboplatin, and etoposide resulted in a characteristic cutaneous eruption that is consistent with a toxic reaction to chemotherapeutic agents. Its accentuation in skin folds and under taped areas suggests that eccrine excretion of the drugs or a toxic metabolite is an important contributing factor. IL-loL may induce the expression of ELAM-1 but does not cause a cutaneous eruption.