Search Results (52)

Introduction: In the treatment of hormone receptor-positive (HR+), HER2-negative (HER2−) metastatic breast cancer (MBC), the current guidelines recommend endocrine therapy combined with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors as the preferred first-line treatment to preserve quality of life. Ribociclib is a CDK4/6 inhibitor that has been used in combination with aromatase inhibitors or fulvestrant in patients with HR+, HER2− metastatic breast cancer. Various adverse drug reactions associated with ribociclib have been reported, including cutaneous reactions, hepatotoxicity, and hematologic toxicity. In this study, we aimed to evaluate the clinical manifestations and risk factors of dermatologic toxicities in patients with metastatic breast cancer treated with ribociclib. Methods: This retrospective study included patients with metastatic/recurrent breast cancer who were prescribed ribociclib from April 2021 to December 2024 at a single institution. We retrospectively reviewed the medical records of these patients to identify the frequency of cutaneous adverse events, the time of onset, and the clinical characteristics of skin reactions. Logistic regression analysis was performed on several clinical factors, including body surface area (BSA) and concomitant medications, to identify risk factors associated with the occurrence of cutaneous adverse events. Results: A total of 110 patients with MBC were enrolled during the study period. The median age was 53 years (range, 28–82); all 110 patients (100.0%) were female; the median BSA was 1.56 m² (range, 1.29–2.07); and 32 patients (29.1%) were premenopausal. Ribociclib plus letrozole was administered in 48 patients (43.6%) and ribociclib plus fulvestrant in 29 patients (26.4%). An additional 33 patients (30.0%) received ribociclib plus letrozole with a gonadotropin-releasing hormone (GnRH) agonist. Cutaneous adverse events occurred in 29 patients (26.4%), and the median time to onset was 84 days (range, 3–498). The cutaneous adverse event patterns included pruritus, erythematous macular rash, eczematous rash/contact dermatitis, vitiligo, urticarial reactions, polymorphous light eruption, toxic epidermal necrolysis (TEN), and desquamation. Grade 1 or 2 cutaneous adverse events occurred in 93.1% of patients; Grade 3 toxicity occurred in one patient; and Grade 4 toxicity, namely toxic epidermal necrolysis (TEN), was reported in one patient. Dose reduction was required in three patients (10.3%), and permanent discontinuation of ribociclib occurred in one patient. Clinical improvement was achieved in the majority of patients (86.2%) with cutaneous adverse events following supportive care. Logistic regression analysis revealed that age, Eastern Cooperative Oncology Group (ECOG) performance status, body surface area (BSA), treatment regimen, and use of cholesterol-lowering medications were not independently associated with the development of cutaneous adverse events. Conclusion: CDK4/6 inhibitors represent one of the most important treatment options for HR+/HER2− metastatic breast cancer. Regardless of their clinical efficacy, cutaneous adverse events remain a common source of patient discomfort. Therefore, careful clinical attention and appropriate supportive care are essential to improve patients' quality of life. Full article

Background: Acute radiation-induced skin injury (aRISI) is one of the most frequent adverse effects of radiotherapy (RT) in patients with head and neck cancer (HNC) and may compromise treatment delivery and quality of life. Topical glucocorticosteroids (GCS) are commonly used in clinical practice for aRISI management; however, evidence supporting their proactive use remains inconsistent. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of proactive topical GCS therapy during RT for HNC. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was conducted from database inception to July 2025 in accordance with PRISMA 2020 guidelines. Randomized controlled trials comparing topical GCS with placebo or standard skin care in adult patients undergoing curative RT or RChT for HNC were included. The primary outcomes were incidence of clinically significant aRISI (grade ≥ 2) and severe aRISI (grade ≥ 3), assessed using validated grading systems (RTOG or CTCAE). Random-effects meta-analyses were performed to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs). Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Three randomized controlled trials comprising 459 patients were included. Proactive topical GCS did not significantly reduce the pooled incidence of grade ≥ 2 aRISI compared with placebo or standard skin care (RR 0.87, 95% CI 0.60–1.27). Similarly, no statistically significant reduction in grade ≥ 3 aRISI was observed in pooled analysis (RR 0.81, 95% CI 0.22–3.06). Qualitative synthesis of secondary outcomes reported in individual trials suggested potential benefits of topical GCS, including delayed onset or slower progression of aRISI, and, in one large double-blind study, a reduced risk of severe reactions. No increase in treatment-related adverse events was observed in any included trial. Conclusions: Proactive topical GCS do not significantly reduce the overall incidence of aRISI in pooled analysis. Individual studies showed trend towards delayed onset, slower progression, and reduced severe aRISI without compromising safety. These findings support the judicious use of topical GCS as part of proactive supportive care in HNC RT, while highlighting the need for larger, standardized trials to define optimal regimens and patient selection. Full article

Facial vascularized composite allotransplantation (fVCA) is one of the most complex forms of vascularized composite allotransplantation and requires lifelong immunosuppression to ensure graft survival. Despite significant advances in surgical techniques and postoperative care over the past two decades, the true incidence of cutaneous malignancies in fVCA recipients remains poorly characterized due to the limited number of procedures, heterogeneous immunosuppressive protocols, and relatively short follow-up. This narrative review summarizes current evidence on oncologic risk in facial VCA, focusing on the effects of different immunosuppressive regimens and the challenges posed by the high immunogenicity of skin and mucosa. Available data indicate that malignancies, including cutaneous and other neoplasms, occur in approximately 10% of recipients, based on heterogeneous case-series data with immunosuppressive therapies largely extrapolated from solid organ transplantation. Calcineurin inhibitors, corticosteroids, and azathioprine are associated with increased oncologic risk, whereas mycophenolate mofetil and mTOR inhibitors may confer a more favorable profile. Overall, fVCA, unlike solid organ transplantation, is a life-enhancing procedure, highlighting the need for tailored immunosuppressive strategies, rigorous dermatologic surveillance, and further research supported by dedicated registries to better define long-term malignancy risk. Full article

Background: Taiwan’s transition to a super-aged society presents challenges in managing elderly patients with refractory metastatic colorectal cancer (mCRC). This study evaluated the real-world effectiveness of trifluridine/tipiracil (FTD/TPI) plus bevacizumab versus regorafenib in this specific geriatric population. Methods: A retrospective study analyzed patients aged ≥ 65 treated between 2019 and 2023. Patients received regorafenib (n = 46) or FTD/TPI plus bevacizumab (n = 35). Primary endpoints included overall survival (OS) and time to treatment failure (TTF). Results: FTD/TPI plus bevacizumab was associated with significantly longer median OS compared to regorafenib (12.5 vs. 6.5 months; p = 0.039). In multivariate analysis, the combination regimen was identified as an independent predictor of favorable TTF (adjusted HR 0.44, 95% CI 0.22–0.91, p = 0.028). Regorafenib was associated with symptomatic toxicities like hand–foot skin reaction (58.7%), while the combination primarily caused asymptomatic neutropenia. Crucially, permanent discontinuation due to adverse events was significantly lower in the combination arm (2.9% vs. 30.4%, p < 0.001), facilitating a higher proportion of patients receiving subsequent systemic therapy (45.7% vs. 17.4%, p = 0.011). Conclusions: FTD/TPI plus bevacizumab is associated with improved survival outcomes and better tolerability than regorafenib. By demonstrating a manageable safety profile and minimizing treatment attrition, this regimen ensures a sustainable continuum of care, representing a favorable therapeutic option for elderly patients. Full article

Background: Numerous studies have demonstrated the impact of post-transplant immunosuppressive therapy on cancer development, particularly in the skin. Despite the growing number of observations, there is still a lack of comprehensive analyses assessing the influence of specific immunosuppressive regimens on the development of melanoma in kidney transplant recipients. The aim of this study was to describe the incidence and temporal patterns of cutaneous melanoma (CM) among kidney transplant recipients in Poland between 2010 and 2022, with particular focus on recipients treated with calcineurin inhibitor (CNI)-based immunosuppression, including cyclosporine (CsA) and tacrolimus (TAC). Methods: This nationwide, descriptive analysis was conducted using comprehensive national administrative data obtained from the Polish National Health Fund (PNHF) and the Polish National Cancer Registry (PNCR). The study assessed the incidence of cutaneous melanoma and temporal trends over the study period. Results: Melanoma skin cancer occurred in 27 cases observed in a population of 12,205 kidney transplant recipients over 13 years of follow-up, corresponding to a final cumulative incidence of 0.23% (95% CI: 0.15–0.34). Calcineurin inhibitor (CNI)-based regimens in kidney transplant recipients were associated with significantly lower risk profiles over 10 years, with only nine cases observed in a cohort of 7107 patients, culminating in a cumulative incidence of 0.13% (95% CI: 0.06–0.24). The stratified analysis of CM incidence under CNI-based immunosuppressive regimens by calcineurin inhibitor type revealed a modest cumulative risk in the TAC subgroup, reaching 0.14% (95% CI: 0.06–0.26) by year 10, with all nine observed cases occurring exclusively in this group, while the CsA subgroup reported zero events throughout the follow-up period. Risk differences progressively increased to 0.14% (95% CI: −0.20 to 0.26) by year 10, but they were not statistically significant in any year (p ≥ 0.230). Conclusions: Although all melanoma cases occurred in the TAC subgroup, the data do not allow us to conclude that TAC confers a higher risk than CsA. This lack of significance likely reflects both the rarity of events and the limited statistical power to detect small differences between TAC and CsA. These results highlight the need for careful dermatologic monitoring in all kidney transplant recipients, while the choice of calcineurin inhibitor should be individualized based on patient-specific factors. Full article

Zeolites are microporous aluminosilicate minerals widely recognized for their adsorption and ion-exchange properties. Their capacity to capture toxic heavy metals has prompted growing interest in their use as anti-pollution agents in skin care formulations. This study investigates zeolite-based creams through an in vitro permeation test using Franz diffusion cells within a Quality by Design (QbD) framework. A 2 × 2 × 2 full factorial design was applied to evaluate the effects of three critical factors: membrane type (Strat-M^® vs. silicone), dosage (10 vs. 20 mg), and dosage regimen. The adsorption and retention of five heavy metals, cadmium (Cd), cobalt (Co), chromium (Cr), lead (Pb), and nickel (Ni), were assessed over 12 h using an in vitro membrane model. The cream containing Zeolite demonstrated significantly higher adsorption of Cr, Co, and Cd compared to placebo and membrane controls, while Ni and Pb exhibited less consistent patterns. No sampling of the receptor compartment was performed; therefore, the analysis focused on metal residues in the donor and membrane compartments. Statistical analyses confirmed the significance of these findings, and graphical trends further supported zeolite’s selective adsorption behavior. Overall, the results provide mechanistic and statistical evidence supporting zeolite as a promising active ingredient for the development of anti-pollution skin care formulations and offer a methodological framework for assessing metal adsorption in topical products. Full article

Background/Objectives: Dalbavancin is approved for pediatric acute bacterial skin and skin structure infections (ABSSSIs), yet real-world practice frequently necessitates off-label use for deep-seated infections requiring prolonged suppression. While adult data support therapeutic drug monitoring (TDM)-guided maintenance, the pediatric evidence for repeated-dose pharmacokinetics (PK) is limited. We evaluated the efficacy, safety, multi-dose PK, and pharmacoeconomic impact of dalbavancin in a complex pediatric cohort. Methods: A retrospective study (2023–2025) of enrolled patients < 18 years treated with dalbavancin. A subgroup receiving ≥3 doses underwent PK analysis to assess concentration decay against conservative efficacy targets (4 and 8 mg/L). A pharmacoeconomic analysis compared resource utilization against the standard of care. Results: Sixteen patients (median age 12) were included, primarily treated for Staphylococcus aureus (S. aureus) osteoarticular infections (75%), and frequently device-associated (66.7%). Clinical success was 93.8% (15/16) with no adverse events. A PK analysis (n = 9; 78 samples) ruled out dangerous accumulation but revealed a significant concentration drop at week 4 (mean 6.06 mg/L; p = 0.005). Logistic regression identified the time since the previous dose as the sole predictor of sub-therapeutic levels, with >50% of the patients dropping below 8 mg/L by the fourth week. An analysis showed median net savings of EUR 3215.84 per patient (p = 0.004). Conclusions: Dalbavancin is effective and cost-saving for complex pediatric infections. However, due to distinct pediatric PK, dosing regimens extrapolated from adults may result in sub-therapeutic concentrations by week 4. We recommend TDM around week 3 to tailor dosing or limiting maintenance intervals to a maximum of 4 weeks. Full article

Background: Pin tract infections (PTIs) are a frequent complication of external fixation, yet pediatric trauma-specific data—particularly for open long bone fractures—remain limited and heterogeneous. This study evaluated the frequency, severity, timing, management, and outcomes of PTIs in children and adolescents treated with external fixation for open long bone fractures. Methods: This retrospective single-center study included patients younger than 18 years with open long bone fractures treated with external fixation between 2002 and 2023. PTIs were graded using the Checketts–Otterburn classification (grades I–VI). Management included antibiotic regimen and surgical interventions. Outcome was reported by time to bony consolidation. Results: In 40 patients, 16 patients exhibited PTIs (mild: eight; moderate: five; severe: three. A higher grade of Gustilo–Anderson (p = 0.47) and evident macroscopic contamination (p = 0.73) did not appear to influence the occurrence of PTIs by similar duration of initial antibiotic regimen (p = 0.3). The median time to PTI onset was 49 days (IQR 22–80), with the majority occurring after completion of initial systemic antibiotic therapy. The management of PTIs was predominantly conservative: all eight mild cases resolved with intensified local pin tract care, while all eight moderate and severe cases were treated with systemic antibiotics and five required pin exchange or premature fixator removal. Overall bony consolidation was achieved in all patients, and reoperations were related to trauma severity rather than PTIs except in one patient. No cases of osteomyelitis were observed. Conclusion: Pin tract infections are frequently identified in pediatric open long bone fractures treated with external fixation. Using strict diagnostic criteria, any documented inflammatory change or local secretion at the pin–skin interface is considered indicative of PTI. However, the majority of these infections were classified as superficial and manageable with conservative measures, and all affected fractures healed radiologically. Full article

Background: Systemic Sclerosis (SSc) is a heterogeneous autoimmune disease with variable clinical expression influenced by genetic, environmental, and sex-related factors. Understanding sex-based differences in disease phenotypes and severity can improve personalized management strategies, especially in underrepresented populations. This study aims to explore sex-based differences in disease phenotypes and severity in a population with a distinct genetic background. Materials and Methods: This cross-sectional study included 197 SSc patients (177 females and 20 males) enrolled from 5 tertiary care centres across Egypt. All participants met the 2013 ACR/EULAR classification criteria for SSc and the criteria proposed by LeRoy and Medsger. The demographic, clinical, and serological data were collected and defined according to the previously developed severity score and activity index. Results: This study highlights key sex-related differences in disease severity and management. Egyptian male patients exhibited more severe skin involvement and were more likely to receive more aggressive treatment regimens, including corticosteroids and phosphodiesterase inhibitors. Conversely, female patients demonstrated a higher frequency of moderate general systemic involvement and comparatively lower rates of pulmonary complications. Conclusions: Sex-related differences in Egyptian SSc patients appear limited, suggesting that population-specific genetic and environmental factors may play a more prominent role in disease expression than sex alone. Full article

Recurrent erysipelas is a common and clinically significant condition that poses challenges for both patients and healthcare systems. Each episode may damage lymphatic vessels, leading to chronic lymphedema, which perpetuates the risk of further relapses. Recurrence rates remain high, ranging from 11% in outpatients during the first year to up to 46% of hospitalized patients within three years. The lower limbs are the most frequent site, although recurrences may also occur in other regions, such as the upper limb after mastectomy with lymph node dissection. This review summarizes current knowledge on risk factors, preventive measures, and chemoprophylaxis in recurrent erysipelas. Modifiable risk factors such as obesity, diabetes, venous insufficiency, tinea pedis, and poor hygiene play an important role, while non-modifiable factors include age, sex, and a history of prior episodes. Non-pharmacological strategies—weight reduction, glycemic control, smoking cessation, compression therapy, and meticulous skin care—form the cornerstone of prevention and may reduce the need for long-term antibiotics. Antibiotic prophylaxis, most commonly with oral penicillin V or intramuscular benzathine penicillin, has been shown to lower recurrence rates. However, efficacy may be reduced in patients with chronic edema or severe obesity. Macrolides serve as alternatives in penicillin-allergic patients, but concerns remain about resistance, adverse effects, and drug–drug interactions. In conclusion, recurrent erysipelas requires a multifaceted approach. While antibiotic prophylaxis is effective, its long-term success depends on simultaneous management of underlying conditions. Further studies are needed to define optimal regimens, treatment duration, and non-antibiotic alternatives. Full article

Background: Purpureocillium lilacinum (P. lilacinum) is an emerging filamentous fungus known to cause opportunistic infections, particularly in immunocompromised patients. Formerly known as Paecilomyces lilacinus, this pathogen is widespread in the environment and can lead to a range of infections, from superficial skin lesions to invasive diseases. This article presents a case of deep cutaneous hyalohyphomycosis caused by P. lilacinum in a liver transplant patient, followed by a review of the literature focusing on new antifungal agents. Methods: We reported a brief case description followed by a narrative review of the literature regarding P. lilacinum cutaneous and lymphangitic infections in immunocompromised patients. Results: We conducted a review of the literature over the past 20 years, focusing on the clinical features, diagnostic challenges, and therapeutic outcomes of cutaneous and lymphangitic P. lilacinum infections in immunocompromised hosts. Conclusions: This review highlights the critical importance of early diagnosis through the analysis of biopsy samples using standard microbiological and histological techniques, complemented by innovative molecular biology methods. We also emphasise the role of appropriate antifungal treatment, despite the absence of an established standard of care, particularly in high-risk patients. Furthermore, we review and discuss the current lack of a standardised therapeutic regimen and the potential of novel antifungal agents as promising treatment options for P. lilacinum infections. Full article

Background: Mycobacterium ulcerans causes Buruli ulcer (BU), a necrotizing skin disease endemic in over 30 countries. Its toxin, mycolactone, drives tissue destruction, and the infection is transmitted via environmental reservoirs or vectors. Disease patterns vary globally, and an improved understanding of their pathogenesis may enhance current antimicrobial and surgical treatments. Methods: A comprehensive literature search from 1901 to 2025 was conducted across major databases to explore antimicrobial and reconstructive surgical strategies for Mycobacterium ulcerans. Search terms included BU, key antibiotics, and surgical interventions. Relevant English-language studies on treatment outcomes were reviewed to summarize evolving management trends and emerging therapeutic approaches. Results and Discussion: This review highlights the importance of early diagnosis and timely antimicrobial therapy in preventing disease progression and limb loss. It reviews WHO-recommended antibiotic regimens and discusses the theoretical risk of drug resistance, although clinical resistance remains rare and unreported in Australia. Surgical interventions in select cases are crucial, with timing being a significant factor in functional outcomes. The review also covers pediatric-specific challenges, including growth preservation and psychosocial support for young patients. Reconstructive options focus on limb salvage and staged reconstructions, with multidisciplinary care essential for optimal outcomes. The paper advocates for RCTs to refine treatment protocols, surgical guidelines, and explore emerging antibiotic therapies such as telacebec. Conclusions: BU remains a global health challenge, requiring early diagnosis, timely antimicrobial therapy, and surgery in selected cases. Future research will refine treatment and reduce long-term impacts. Full article

Psoriasis, a chronic immune-mediated inflammatory skin disorder, presents complex pathogenetic mechanisms potentially influenced by viral infections. This comprehensive study explored the possible interplay of resistance and viral infections among psoriasis patients using serological screening techniques. The investigation involved 90 patients aged 23–45 years, systematically examining viral seropositivity for HSV (herpes simplex virus), HZ (herpes zoster), HBV (hepatitis B virus), HIV (human immunodeficiency virus), and HCV (hepatitis C virus) through ELISA testing. The findings revealed notable active or recent viral infection rates: 8.9% HSV positivity, 2.2% HZ antibody detection, 4.4% HCV positivity, and 4.4% HIV positivity. The research can contribute to current knowledge gaps, broaden the knowledge regarding the relationship between psoriasis and viral infection, and assess resistance, as it can mediate the interaction. The results can lead to improved diagnosis, treatment, and patient care options. This study emphasizes the importance of thorough viral testing for psoriasis patients, as well as focused therapeutic regimens that take into account viral co-infections. It elucidates the complex networks of biological relationships between immune factors, contributes information that is critical to our understanding of the multifactorial etiology of psoriasis, and concludes with a strong argument for investigating the mechanisms of viral involvement in this chronic-relapsing inflammatory disease. Full article

The expected cutaneous adverse effects (CAE) of oncology therapies can be disabling and even force the patient to discontinue treatment. The incorporation of cosmetics into skin care regimens (SCRs) as true therapeutic adjuvants can prevent, control, and avoid sequelae. However, cosmetics may also lead to adverse reactions in patients. The aim of our study was to assess the impact of the tolerability of cosmetics used in routine skin care on quality of life in this vulnerable population group through a survey. In addition, information was collected to improve the knowledge of the beneficial effects of cosmetics and the composition recommended. Hospital nurses guided the patients to fill in the surveys, which were done once. The main uses are related to daily hygiene care, photoprotection, and dermo-cosmetic treatment to prevent or at least reduce the skin’s adverse effects. More than 30% (36.36%) of patients perceived undesirable effects or discomfort with the use of cosmetics (27.27% in the facial area, 27.27% in the body and hands, and 22.73% in the scalp and hair). Intolerance was described for some soaps and creams used in the facial area. This study provides additional evidence on perceived tolerance supporting updates of clinical practice guidelines, highlights consolidated knowledge and evidence on the use of cosmetics, as well as new recommendations on the use and composition of cosmetics intended for oncological patients. There is a need for more knowledge about cosmetic ingredients and formulations, including ingredients of concern, such as endocrine disruptors. Full article

Background and Objectives: Pediatric patients can acquire scars from both accidental injury and surgical procedures. While scars cannot be avoided if a full-thickness injury occurs, scar visibility may be minimized through a variety of approaches. In this narrative review, we evaluate the current evidence and propose an algorithm for scar management in pediatric patients. Materials and Methods: A review of the literature was performed for scar management techniques for pediatric patients. Management modalities based on the type of scar and dosing, treatment regimen, and safety profiles are described in this article and used to create a scar management algorithm. Results: The initial step to scar management in the pediatric population involves ensuring minimal wound tension, which can be achieved through making the incision along relaxed skin tension lines, and early, minimal tension wound closure. Subsequent treatments to optimize scar care should begin 2–3 weeks following wound closure and involve the application of silicone gel or sheets and scar massaging. When topical products are insufficient, laser therapy can be utilized for the management of immature erythematous or thick scars. When mature, pathological scars form such as atrophic scars, hyperpigmentation, hypertrophic scars, or keloids, a combination of modalities is recommended. These modalities vary by scar type and include retinoids and dermabrasion for atrophic scars; retinoids, hydroquinone, and laser therapy for hyperpigmentation; and pressure therapy, corticosteroids, and laser therapy for hypertrophic scars and keloids. When mature, pathological scars persist following 12 months of non-invasive therapies, surgical excision should be considered. Conclusions: Several treatment options are available to manage scars in the pediatric population depending on scar type. Full article