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Current Problems in Dermatology

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https://www.readbyqxmd.com/read/29131041/skin-manifestations-of-targeted-antineoplastic-therapy
#1
Onofre Sanmartín
The management of oncology patients has changed significantly over recent years, with the development of new targeted anticancer therapies. Cutaneous adverse effects are among the most frequently observed toxicities with many targeted agents; their intensity can be dose-limiting or lead to the discontinuation of therapy. Tyrosine kinase inhibitors can cause maculopapular rash and hand-foot reaction, whereas papulopustular rash, paronychia, regulatory changes in hair, and dryness are caused by epidermal growth factor receptor inhibitors...
2018: Current Problems in Dermatology
https://www.readbyqxmd.com/read/29131040/adverse-reactions-to-biologics-melanoma-ipilimumab-nivolumab-pembrolizumab
#2
Shelley Ji Eun Hwang, Pablo Fernández-Peñas
With increasing use of immunotherapies such as anti-cytotoxic T cell lymphocyte antigen-4 and anti-programmed cell death 1 antibodies, various skin toxicities have emerged. Severity of skin toxicities varies from mild lichenoid reaction to severe toxic epidermal necrolysis. Appropriate diagnosis and management of these skin toxicities are essential for optimal patient care and to avoid unnecessary cessation of anti-cancer therapies. This review summarises a wide range of cutaneous manifestations associated with immunotherapy usage in patients with metastatic melanoma...
2018: Current Problems in Dermatology
https://www.readbyqxmd.com/read/29131039/adverse-reactions-of-antibody-therapy-for-primary-cutaneous-lymphomas-rituximab-brentuximab-vedotin-alemtuzumab-and-mogamulizumab
#3
I Saulite, E Guenova, W Hoetzenecker
Treatment of advanced PCLs is limited and rarely reaches complete remission despite aggressive treatment modalities, such as polychemotherapy with various adverse effects. However, several monoclonal antibodies drug agents in patients with advanced primary cutaneous lymphomas demonstrate promising efficacy and manageable safety profiles. The monoclonal antibodies drug agents have favourable tolerability compared with multi-agent cytotoxic chemotherapy. However, adverse effects manifest with a broad clinical spectrum, hence the markers of targeted therapies are not limited to tumour cells but found on tumour cells and also on benign T and/or B cells...
2018: Current Problems in Dermatology
https://www.readbyqxmd.com/read/29131038/bullous-diseases
#4
Caroline Corbaux, Pascal Joly
Autoimmune bullous diseases are a heterogeneous group of blistering diseases affecting the skin and/or mucous membrane. Systemic corticosteroids, which are often associated with immunosuppressants, are the main treatment option for these diseases. The 2 main biologics used in the treatment of autoimmune bullous diseases are rituximab, especially in pemphigus and mucous membrane pemphigoid, and omalizumab in bullous pemphigoid. Rituximab is a promising therapeutic option in pemphigus and mucous membrane pemphigoid...
2018: Current Problems in Dermatology
https://www.readbyqxmd.com/read/29131037/paradoxical-reactions-anti-tumor-necrosis-factor-alpha-agents-ustekinumab-secukinumab-ixekizumab-and-others
#5
Lluís Puig
Paradoxical reactions during treatment with a biologic agent can be defined as the appearance or exacerbation of a pathological condition that usually responds to this class of drug while treating a patient for another condition, which usually remains under control (even though there may be a change in morphology or phenotype). Paradoxical reactions were initially described as isolated case reports or case series in patients treated with anti-tumor necrosis factor (TNF) α agents, first in inflammatory rheumatic diseases, later in psoriasis and inflammatory bowel disease...
2018: Current Problems in Dermatology
https://www.readbyqxmd.com/read/29131036/the-immunogenicity-of-biologic-therapies
#6
Sandra Garcês, Jocelyne Demengeot
Virtually all therapeutic proteins (biologics) elicit an immune response with the consequent production of anti-drug antibodies (ADA). The majority of ADA to therapeutic monoclonal antibodies (mAbs) are directed against the antigen-binding site of the therapeutic mAb, and hence are neutralizing. This nature of the ADA response explains why fully human antibodies can still be highly immunogenic. The detection of ADA is technically challenging and all assays have limitations, namely a limited capacity in detecting ADA in the presence of a drug due to immune complex (IC) formation, which may underestimate the ADA incidence...
2018: Current Problems in Dermatology
https://www.readbyqxmd.com/read/29131035/immunosuppression-infections-across-indications
#7
Ayida Al-Khalili, Jan P Dutz
There is increasing use of cytokine inhibitors (including biologics) in the treatment of psoriasis as their efficacy and safety have been demonstrated. Cytokines are important signaling molecules evolved to coordinate a response to infectious threat. In this study, we review available trial, registry and cohort study data pertaining to the immunosuppressive effects of these medications when used to treat psoriasis. The risk of infection associated with these medications is small. Special considerations include the use of these agents in the setting of granulomatous infections, viral hepatitis, human immunodeficiency virus infection, fungal infection and in the perioperative state...
2018: Current Problems in Dermatology
https://www.readbyqxmd.com/read/29131034/clinical-trial-and-registry-data
#8
Melinda Gooderham, Kim Papp
Physicians rely on safety and efficacy data from pivotal trials to guide treatment decisions and manage patients. Even with robust clinical trial data, there remain questions regarding rare safety events and generalizability. Registries complement clinical trials. By evaluating effectiveness and safety in broad patient populations and often providing longer term or larger numbers of patients or both compared to clinical trials, registries consolidate and may extend the safety observations derived from pivotal trials...
2018: Current Problems in Dermatology
https://www.readbyqxmd.com/read/29131033/adverse-reactions-to-biologics-in-psoriasis
#9
Stephen J Lockwood, Lisette M Prens, Alexa B Kimball
Psoriasis is a chronic autoimmune disease which affects millions of people worldwide. Not only can psoriasis itself be debilitating and significantly reduce an individual's quality of life, but it is also a risk factor for other systemic disorders, such as metabolic syndrome, cardiovascular disease, and malignancy. Tremendous strides were made in the treatment of psoriasis during the mid-to-late-20th century, including the emergence of topical corticosteroids and vitamin D analogs, methotrexate, systemic retinoids, and phototherapy...
2018: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288469/individual-risk-and-prevention-of-complications-doctors-advice-to-persons-wishing-a-new-tattoo
#10
Jørgen Serup
Doctors who are consulted about health and tattoo risks have an important role in the prevention of an individual's tattoo complications. Tattooing is a tremendous exposure of the human body to needle operation, particles, and chemicals. The risk is related to a person's health condition, level of insight, decision-making, and to the operation of tattooing, tattoo inks and utensils, tattoo parlour, and the aftercare. Tattooing is painful minor surgery performed without anesthesia. It can be associated with syncope...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288468/surgical-treatment-of-tattoo-complications
#11
Mitra Sepehri, Bo Jørgensen
With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288467/tattoo-infections-personal-resistance-and-contagious-exposure-through-tattooing
#12
Jørgen Serup
Bacterial infection of tattoos remains a common complication. Pyogenic bacteria can cause infections shortly after the tattoo is made. Severity of infection varies from minor to major, ultimately with life-threatening septicemia. Viral infections may be introduced, i.e. HVB, HVC, and HIV. The risk of infection depends on the following triad: microbial pathogen and its aggressiveness, individual resistance of the tattooed, and inoculation and exposures by the tattoo needle and in the tattoo parlor. Some infectious risks can be controlled...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288465/atlas-of-illustrative-cases-of-tattoo-complications
#13
Jørgen Serup
Tattoos, and tattoo complications as well, are colorful and visually flashy. A clinical outlook provides important clues to diagnosis by pattern recognition. This atlas,which is a report of 79 case illustrations, is made as a practical tool and vade mecum for the clinician. The atlas can be used in the office and as a bedside tool. It includes characteristic photos, and each case is accompanied with a brief medical history, a comment with learning points, the final diagnosis, and a review of therapeutic options...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288463/guide-to-treatment-of-tattoo-complications-and-tattoo-removal
#14
Jørgen Serup, Wolfgang Bäumler
Clinicians in the fields of general medicine, dermatology, and plastic surgery are in their work now and then confronted with tattoo complications. Recognizing the rather few important diagnostic groups and urgencies, the medical 'decision tree' of treatment becomes quite simple. Acute conditions are dominated by bacterial infections needing antibiotic treatment. Systemic infection is a matter of urgency and requires intravenous treatment in a hospital without delay to prevent septic shock. Inflammatory reactions are a real challenge...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288459/new-and-advanced-picosecond-lasers-for-tattoo-removal
#15
Maurice A Adatto, Ruthie Amir, Jayant Bhawalkar, Rafael Sierra, Richard Bankowski, Doran Rozen, Christine Dierickx, Moshe Lapidoth
Early methods of tattoo removal ultimately resulted in unacceptable cosmetic outcomes. While the introduction of laser technology was an improvement over the existing chemical, mechanical, and surgical procedures, the use of nonselective tattoo removal with carbon dioxide and argon lasers led to scarring. Q-switched lasers with nanosecond (10-9) pulse domains were considered to have revolutionized tattoo treatment, by selectively heating the tattoo particles, while reducing the adverse sequelae to adjacent normal skin...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288456/from-technique-of-tattooing-to-biokinetics-and-toxicology-of-injected-tattoo-ink-particles-and-chemicals
#16
Jørgen Serup
Tattoo colourants are colourful nano- and microparticles, which are practically insoluble and thus permanent once installed in the dermis by the tattooist. Tattoo ink also has soluble ingredients and contaminants. Pigments can distribute via the lymph and possibly also directly to the blood, and a minute fraction may over time undergo metabolic breakdown and as hapten(s) induce allergic reactions of red tattoos. Carbon black of black tattoos has a tendency to agglomerate and form larger bodies that can elicit foreign body reactions in black tattoos and even granuloma formation with overlap to sarcoidosis in the clinic...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288455/diagnostic-tools-for-doctors-evaluation-of-tattoo-complications
#17
Jørgen Serup
Diagnosis of tattoo complications is a multi-facetted field since many clinical entities and disease mechanisms are represented. Infections, allergies, and pigment foreign body reactions with granuloma are the major groups. The clinician needs a structured approach to diagnosis and an armamentarium of standard tests. Diagnosis primarily builds on patient history, objective clinical examination, and punch biopsy, supplemented with microbiology testing, ultrasound scanning, and clinical photography. Evaluation of allergic tattoo reactions and allergy to pigments by patch testing is not applicable and has a falsely negative outcome except for the diagnosis of allergy to metals and preservatives...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288453/medical-treatment-of-tattoo-complications
#18
Jørgen Serup
Tattooing is a skin trauma and involves a special vulnus punctatum (with inserted tattoo ink, a vulnus venenatum), which should heal with no infection and no local complication. Local treatment in the healing phase ideally builds on the 'moist wound' principle using plastic film, hydrocolloids, silver dressing, and compression. Bacterial infections during healing are treated with oral antibiotics, and a list of first-line antibiotics is proposed. Notice is given to severe infections with affected general condition, and it is emphasized that intravenous antibiotic treatment must be instituted as early as possible to prevent septic shock and death...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288451/how-to-diagnose-and-classify-tattoo-complications-in-the-clinic-a-system-of-distinctive-patterns
#19
Jørgen Serup
Tattoo complications represent a broad spectrum of clinical entities and disease mechanisms. Infections are known, but chronic inflammatory reactions have hitherto been inconsistently reported and given many interpretations and terms. A clinical classification system of distinct patterns with emphasis on inflammatory tattoo reactions is introduced. Allergic reactions prevalent in red tattoos and often associated with azo pigments are manifested as the 'plaque elevation', 'excessive hyperkeratosis', and 'ulceronecrotic' patterns...
2017: Current Problems in Dermatology
https://www.readbyqxmd.com/read/28288450/laser-treatment-of-tattoos-basic-principles
#20
Wolfgang Bäumler
Tattooing has become very popular worldwide during the past decades, and millions of people have one or many tattoos at different anatomical sites. The color of tattoos is mainly black, followed by red, green, blue, and other colors. A part of the tattooed people regret tattooing or have permanent problems with tattoos and therefore seek for tattoo removal. Tattoos consist of solid pigment particles in the skin. Thus, tattoo removal requires fragmentation of these permanently incorporated particles. The gold standard of tattoo removal is laser therapy...
2017: Current Problems in Dermatology
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