Toxic erythema of chemotx Flashcards
Initial manif
Dysesthesia or tingling of palms and soles usually 2-3’weeks after admin of chemo. ff by painful, symmetric erythema and edema distal pads of digits.
Desquamation most prominent part of the syndrome.
tx
Most pxs local supportice care
cold compress
elevation.
pyridoxine 100-150mg daily dec pain of 5FU.
cox2inh
local and systemic steroids
lidocain patches- for pain.
IVIG- Methotrexate induced acral erythema.
cyclosporine- result to worsening of condition.
Sorafenib
Sunitinib
Histo:
Horizontal layers of necrotic keratinocytes. within the epidermis (if biopsy taken in 1st 30 days) or stratum corneum (later biopsies)
Causes cutaneous hyperpigmentatuon ( Chemo drugs)
BDD- CD
Bleomycin Doxorubicin Daunorubicin cyclophosphamide busulfan
Causes marked hyperpigmentation of nails skin tongue
Adriamycib (doxrubicin)
chemo tx causing transverse bands
Cyclophosphamide
Bleomycin
5FU
Trans- CBS.
Multikinass inh like cabozantinib, pazopanib, sorafenib, sunitinib) may inhibit ____ which is a regulator of melanogenesjs.
C-kit
Sunitinib causes wht color of pigmentation
yellow
What is Palifermin?
a recombinant human keratinocyte growth factor. red severity of mucositis in pxs undergoing hematopoietic stemm cell transplantation.
causes bilateral bright leg syndrome
Gemcitabine
What drug causes scleroderma like reactions?
Taxanes ( Docetaxel, paclitaxel) or pemetrexed. causes acute diffuse infiltrated edema of extremities and or head
What drug causes Exudative hyponychial dermatitis.
Beau lines.
Taxanes spex docetaxel.
Frozen gloves during chemo prevent the rxn.
EGFR inhibitors lesions
Xerosis (19%), pruritus (24%), trichomegaly, Hair curling and signs of skin aging, paronchyia.
EGFR inhibitors most common side effect
acneiform rash.
Effective topical tx fOR EGFR inh.
Topical Metro; clinda, hydrocort, pimecro; tretinoin, dapsone.
tx is oral tetracycline antibiotics and corticosteroid.
what mutation is common in melanoma?
BRAF MUTATION
what are the braf inhibitors?
vemurafenib.
Dabrafenib.
a multikinass inh w BRAF inhibitory activitt has also been assoc w rapid developmnt of multiple keratoacanthomas or scc
Sorafenib
Tx for sorafenib induced squamoproliferative lesions.
Bexarotene.
is an anti CTLA 4 antibody used for metastatic melanoma and can cause maculopapular rash , alopecia, and vitiligo.
Ipilimumab.
PD1 receptor inhibitors
Pembrolizumab, nivolimumab.
Reaftions are: non specific rash (15-29%), pruritus (12%), vitiligo (7-9%)
a sign that px is taking anmid week dose of methotrexate.
Ulceration or erosion of psoriatic plaques.
G CSF- are assoc w induction w what neutrophil mediated disorders
sweet syndrome
bullous pyoderma gangrenosum
rare complicarion:
thrombotic and necrotizing panniculitis.
TNF inhibitors assoc w what cutaneous reactions
TNF- PUS.
Palmoplantar pustulosis, pustular folliculitis; new or worsening of psoriasis, interface dermatitis. hydradentitis. sweet syndrome, lupus, granulomatous rxn, vasculitis. what
most common agent to induce vasculitis
Etancercept
JAK inh skin reactions
JAK- VAAP
vitiligo
alopecia areata
atopic derm
Psoriasis
classic syndrome for mercury
Acrodynia usually in infancy also known as calomel disease, pink disease, erythrodermuc polyneuropathy.
Bromoderma and fluoroderma prod distinctive what reactions?
distinctive follicular eruptions, acneiform, papuler, pustular.
most common type of iododerma
Acneiform eruption w numerous acutley inflamed follicular pustules each surrounded by a ring of hyperemia.
usually from oral and IV contrast materials.
iododerma tx
Prednisone
Chronic use of hydroxyurea is assoc w decelopment of cutaneous lesions characteristic of
H/D
Dermatomyositis
Linear IgA disease is freq assoc w medication exposure spec ___ what medicarion?
Vancomycin
Men and women equally
eruption begins within 2 weeks of vancomycin tx.
flaccid and tense bulla vesicles ery papules or plaques exan morbilliform eruptions targetoid papules.
Bullous dermatosis/ Linear IgA disease histology.
Subepidermal blistering; neutrophils, eosinophils.
tx bullous dermatoses: linear IgA disease
stop offending drug.
systemic steroid in severe cases.
dapsone 100-200 mg daily.
Asthma pxs being tx w leukotriene receptor antagonists may dev a syndrome resembling what disease?
Churg Strauss vasculitis.
occurs 2 days to 10 months after LRA has been started.
topical steroid side effects most common seen
Atrophy striae telangiectasia skin fraggility purpura
long term effect of long term use of 1% hydrocortisone cream
Steroid rosacea
repeated application if steroid on scrotum side effect
red scrotum syndrome
All pxs w anticipated long term intake of steroid should be supplemented with.
Vit D (1- q.5g calcium and 400-800U Cholecalciferol daily)
