Chemotherapy-induced acral erythema or palmoplantar erythrodysesthesia syndrome is a well-defined reaction to some of the chemotherapeutic agents such as methotrexate, cytarabine, doxorubicin, fluorouracil (5-FU), cytosine arabinoside and bleomycin.
More recently, HFS has been reported in association with regimens using targeted agents, in particular the multikinase inhibitors (MKI) sorafenib and sunitinib (1). The HFS associated with MKI has a different distribution and clinical appearance than the traditional disorder.
This reaction is characterized by symmetric, well-demarcated, painful erythema of the palms and soles, which may progress to desquamation or blisters.
It appears to be dose dependent. It is likely a direct toxic effect of the drug.
Tingling on the palms and soles is followed in a few days by painful, symmetric, well-defined swelling and erythema.
Histologically, the HFS is characterized by a toxic keratinocyte reaction. Furthermore, there is sub-basal edema with a tendency to bullae, dilated blood and lymph capillaries and usually only mild perivascular lymphocytic infiltration (2).
Depending on the severity, HFS requires dose reduction, interruption or switch in the antineoplastic chemotherapy (2-3).
(1) Degen A, Alter M, Satzger I, et al. The hand-foot-syndrome associated with medical tumor therapy- classification and management. J Dtsch Dermatol Ges. 2010 Sep; 8(9):652-61.
(2) Janusch M, Fischer M, Marsch WCh, et al. The hand-foot syndrome - a frequent secondary manifestation in antineoplastic chemotherapy. Eur J Dermatol. 2006 Sep-Oct; 16(5): 494-9.
(3) Habif TP. Clinical Dermatology. 5th edition. USA: Elsevier Science 2010.
Sunday, September 26, 2010
Cryotherapy May Be Most Effective for Removal of Common Warts
Canadian Medical Association Journal, September 13 2010 (Published online)
A randomized controlled trial that compared the effectiveness of common wart treatments (Liq Nitrogen Vs Salicylic Acid) as well as a wait-and-see approach.
Introduction:
"Cryotherapy is widely used for the treatment of cutaneous warts in primary care"
"However, evidence favours salicylic acid application"
Method:
Between May 1, 2006, and January 26, 2007, all eligible patients with new cutaneous warts were recruited from 30 primary care practices in the Netherlands and were randomly assigned to 1 of 3 groups: cryotherapy with liquid nitrogen every 2 weeks, daily self-application of salicylic acid, or a wait-and-see approach.
The proportion of participants with cure of all warts at 13 weeks was the main study endpoint, and analysis was by intent-to-treat. Treatment adherence, adverse effects, and satisfaction with treatment were secondary endpoints. At 4, 13, and 26 weeks, research nurses evaluated outcomes during home visits.
Results:
Of the 250 participants, 122 (49%) were stratified into the common wart group and 128 (51%) into the plantar wart group.
Age range of the participants was 4 to 79 years.
At 13 weeks, 10 patients (4%) were lost to follow-up, and 240 were included in the analysis.
In the cryotherapy group, cure rate was 39(95% confidence interval [CI], 29% - 51%) vs 24% (95% CI, 16% - 35%) in the salicylic acid group and 16% (95% CI, 9.5% - 25%) in the wait-and-see group.
For participants with common warts (n = 116), these differences in efficacy were most pronounced. Cure rates were 49% with cryotherapy (95% CI, 34% - 64%), 15% with salicylic acid (95% CI, 7% - 30%), and 8% with the wait-and-see approach. The different treatments were not associated with significant differences in cure rates among participants with plantar warts (n = 124).
Limitation:
Limitations of this study include self-application of salicylic acid and lack of blinding of participants, family practices, and research nurses.
Conclusion:
"Although earlier evidence favoured salicylic acid application above cryotherapy, the present randomized controlled trial is the first that provides evidence to support the use of cryotherapy above salicylic acid, however, for common warts only,"
A randomized controlled trial that compared the effectiveness of common wart treatments (Liq Nitrogen Vs Salicylic Acid) as well as a wait-and-see approach.
Introduction:
"Cryotherapy is widely used for the treatment of cutaneous warts in primary care"
"However, evidence favours salicylic acid application"
Method:
Between May 1, 2006, and January 26, 2007, all eligible patients with new cutaneous warts were recruited from 30 primary care practices in the Netherlands and were randomly assigned to 1 of 3 groups: cryotherapy with liquid nitrogen every 2 weeks, daily self-application of salicylic acid, or a wait-and-see approach.
The proportion of participants with cure of all warts at 13 weeks was the main study endpoint, and analysis was by intent-to-treat. Treatment adherence, adverse effects, and satisfaction with treatment were secondary endpoints. At 4, 13, and 26 weeks, research nurses evaluated outcomes during home visits.
Results:
Of the 250 participants, 122 (49%) were stratified into the common wart group and 128 (51%) into the plantar wart group.
Age range of the participants was 4 to 79 years.
At 13 weeks, 10 patients (4%) were lost to follow-up, and 240 were included in the analysis.
In the cryotherapy group, cure rate was 39(95% confidence interval [CI], 29% - 51%) vs 24% (95% CI, 16% - 35%) in the salicylic acid group and 16% (95% CI, 9.5% - 25%) in the wait-and-see group.
For participants with common warts (n = 116), these differences in efficacy were most pronounced. Cure rates were 49% with cryotherapy (95% CI, 34% - 64%), 15% with salicylic acid (95% CI, 7% - 30%), and 8% with the wait-and-see approach. The different treatments were not associated with significant differences in cure rates among participants with plantar warts (n = 124).
Limitation:
Limitations of this study include self-application of salicylic acid and lack of blinding of participants, family practices, and research nurses.
Conclusion:
"Although earlier evidence favoured salicylic acid application above cryotherapy, the present randomized controlled trial is the first that provides evidence to support the use of cryotherapy above salicylic acid, however, for common warts only,"
Friday, June 18, 2010
19th Regional Conference of Dermatology 2010
The 19th RCD presents a unique opportunity for the dermatological profession in Asia to come together in fraternity and fellowship. This conference will also pave way for enhanced regional and international cooperation in the field of dermatology.
This conference will look at innovative medical technology - particularly new
drugs, therapeutic devices and biologics. It will also examine developments
in subspecialties dealing with gene therapy, immunodermatology,
paediatric dermatology, dermatopathology, dermatologic and laser surgery.
An impressive regional and international faculty will be assembled to make
this conference.
You will find Kota Kinabalu, on the mystic island of Borneo a truly exciting
destination full of things to do and to discover, from crystal clear seas to
majestic mountains. Come and enjoy the warm hospitality and the unique
culture of the people. Come and be fascinated by the fauna, the rain forest,
the orang utans, proboscis monkeys and other creatures that you will not see anywhere else in this world.
Malaysia welcomes you.
http://www.asianderm.org/
ECG refresher course 2010
Dear colleagues,
The Cardiology Society of Hospital Pulau Pinang is organising an ECG refresher course on the 1st Jul 2010 venued at ACC. It is a one-day event with lectures and discussions detailing right from the very fundamental technical issues with ECG, to the complex tracings pertaining to day to day practice.
Please feel free to forward this email and program brochure to your colleagues in your mailing list, who are currently practicing in the northern region ie Penang, Perak, Kedah and Perlis.
Kindly take note that the "Stump the cardiologist" session is held with the main purpose of stimulating discussions between the "frontline" ECG interpreters and us. Please feel free to post ECGs during the day.
We'll see you all during the meeting!
Sincerely,
Dr SK Ma
MD, MRCP(UK)
Clinical Cardiologist,
Dept of Cardiology
Hospital Pulau Pinang
sootkeng@gmail.com
The Cardiology Society of Hospital Pulau Pinang is organising an ECG refresher course on the 1st Jul 2010 venued at ACC. It is a one-day event with lectures and discussions detailing right from the very fundamental technical issues with ECG, to the complex tracings pertaining to day to day practice.
Please feel free to forward this email and program brochure to your colleagues in your mailing list, who are currently practicing in the northern region ie Penang, Perak, Kedah and Perlis.
Kindly take note that the "Stump the cardiologist" session is held with the main purpose of stimulating discussions between the "frontline" ECG interpreters and us. Please feel free to post ECGs during the day.
We'll see you all during the meeting!
Sincerely,
Dr SK Ma
MD, MRCP(UK)
Clinical Cardiologist,
Dept of Cardiology
Hospital Pulau Pinang
sootkeng@gmail.com
Saturday, June 12, 2010
4TH PENANG MRCP PACES PREPARATORY COURSE
This preparartory course is jointly organized by Penang Medical College, MOH Penang General Hospital and Seberang Jaya Hospital.
It is a 2 day intensive and examination orientated course.
Date : 31 July - 1 Aug 2010
Venue : ACC,Hospital Pulau Pinang
It is a 2 day intensive and examination orientated course.
Date : 31 July - 1 Aug 2010
Venue : ACC,Hospital Pulau Pinang
THE INSIDER'S GUIDE TO PASSING MRCP(UK) PACES
Dear all,
Please forward to those who are sitting for the PACES exam soon. I think it is useful since it is a Saturday and it is free.
Folliculitis Decalvans
Folliculitis decalvans is a rare inflammatory scarring scalp disorder.
It is characterized by follicular pustules, lack of ostia, diffuse perifollicular erythema, follicular tufting and sometimes, hemorrhagic crusts and erosions.
It is believed that this type of scarring alopecia is the end stage of various inflammatory processes resulting in fibrosis and constriction of multiple hair follicles within a common trajectory.
It is also known as cicatricial alopecia or tufted folliculitis.
Treatment is mainly focused on the eradication of S. aureus and the anti-inflammatory agents.
Combination of antibiotic (Oral Rifampicin and Oral Clindamycin) is useful for this rare inflammatory scarring scalp disorder. But patient might need to be on antibiotic for long term.
The scarring, alopecia and tufting persisted but there was no further active inflammation.
Early aggressive treatment should be instituted to prevent scarring.
Please find the poster presentation during Regional Conference of Dermatology 2010 for the details.
It is characterized by follicular pustules, lack of ostia, diffuse perifollicular erythema, follicular tufting and sometimes, hemorrhagic crusts and erosions.
It is believed that this type of scarring alopecia is the end stage of various inflammatory processes resulting in fibrosis and constriction of multiple hair follicles within a common trajectory.
It is also known as cicatricial alopecia or tufted folliculitis.
Treatment is mainly focused on the eradication of S. aureus and the anti-inflammatory agents.
Combination of antibiotic (Oral Rifampicin and Oral Clindamycin) is useful for this rare inflammatory scarring scalp disorder. But patient might need to be on antibiotic for long term.
The scarring, alopecia and tufting persisted but there was no further active inflammation.
Early aggressive treatment should be instituted to prevent scarring.
Please find the poster presentation during Regional Conference of Dermatology 2010 for the details.
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