Toxic erythema of chemotx

Question 1

Initial manif

Answer 1

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.

Question 2

tx

Answer 2

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

Question 3

Histo:

Answer 3

Horizontal layers of necrotic keratinocytes. within the epidermis (if biopsy taken in 1st 30 days) or stratum corneum (later biopsies)

Question 4

Causes cutaneous hyperpigmentatuon ( Chemo drugs)

Answer 4

BDD- CD

Bleomycin 
Doxorubicin 
Daunorubicin 
cyclophosphamide 
busulfan

Question 5

Causes marked hyperpigmentation of nails skin tongue

Answer 5

Adriamycib (doxrubicin)

Question 6

chemo tx causing transverse bands

Answer 6

Cyclophosphamide
Bleomycin
5FU

Trans- CBS.

Question 7

Multikinass inh like cabozantinib, pazopanib, sorafenib, sunitinib) may inhibit ____ which is a regulator of melanogenesjs.

Answer 7

C-kit

Question 8

Sunitinib causes wht color of pigmentation

Answer 8

yellow

Question 9

What is Palifermin?

Answer 9

a recombinant human keratinocyte growth factor. red severity of mucositis in pxs undergoing hematopoietic stemm cell transplantation.

Question 10

causes bilateral bright leg syndrome

Answer 10

Gemcitabine

Question 11

What drug causes scleroderma like reactions?

Answer 11

Taxanes ( Docetaxel, paclitaxel) or pemetrexed. causes acute diffuse infiltrated edema of extremities and or head

Question 12

What drug causes Exudative hyponychial dermatitis.

Answer 12

Beau lines.
Taxanes spex docetaxel.
Frozen gloves during chemo prevent the rxn.

Question 13

EGFR inhibitors lesions

Answer 13

Xerosis (19%), pruritus (24%), trichomegaly, Hair curling and signs of skin aging, paronchyia.

Question 14

EGFR inhibitors most common side effect

Answer 14

acneiform rash.

Question 15

Effective topical tx fOR EGFR inh.

Answer 15

Topical Metro; clinda, hydrocort, pimecro; tretinoin, dapsone.
tx is oral tetracycline antibiotics and corticosteroid.

Question 16

what mutation is common in melanoma?

Answer 16

BRAF MUTATION

Question 17

what are the braf inhibitors?

Answer 17

vemurafenib.

Dabrafenib.

Question 18

a multikinass inh w BRAF inhibitory activitt has also been assoc w rapid developmnt of multiple keratoacanthomas or scc

Answer 18

Sorafenib

Question 19

Tx for sorafenib induced squamoproliferative lesions.

Answer 19

Bexarotene.

Question 20

is an anti CTLA 4 antibody used for metastatic melanoma and can cause maculopapular rash , alopecia, and vitiligo.

Answer 20

Ipilimumab.

Question 21

PD1 receptor inhibitors

Answer 21

Pembrolizumab, nivolimumab.

Reaftions are: non specific rash (15-29%), pruritus (12%), vitiligo (7-9%)

Question 22

a sign that px is taking anmid week dose of methotrexate.

Answer 22

Ulceration or erosion of psoriatic plaques.

Question 23

G CSF- are assoc w induction w what neutrophil mediated disorders

Answer 23

sweet syndrome
bullous pyoderma gangrenosum

rare complicarion:
thrombotic and necrotizing panniculitis.

Question 24

TNF inhibitors assoc w what cutaneous reactions

Answer 24

TNF- PUS.

Palmoplantar pustulosis, pustular folliculitis; new or worsening of psoriasis, interface dermatitis. hydradentitis. sweet syndrome, lupus, granulomatous rxn, vasculitis. what

Question 25

most common agent to induce vasculitis

Answer 25

Etancercept

Question 26

JAK inh skin reactions

Answer 26

JAK- VAAP

vitiligo
alopecia areata
atopic derm
Psoriasis

Question 27

classic syndrome for mercury

Answer 27

Acrodynia usually in infancy also known as calomel disease, pink disease, erythrodermuc polyneuropathy.

Question 28

Bromoderma and fluoroderma prod distinctive what reactions?

Answer 28

distinctive follicular eruptions, acneiform, papuler, pustular.

Question 29

most common type of iododerma

Answer 29

Acneiform eruption w numerous acutley inflamed follicular pustules each surrounded by a ring of hyperemia.

usually from oral and IV contrast materials.

Question 30

iododerma tx

Answer 30

Prednisone

Question 31

Chronic use of hydroxyurea is assoc w decelopment of cutaneous lesions characteristic of

Answer 31

H/D

Dermatomyositis

Question 32

Linear IgA disease is freq assoc w medication exposure spec ___ what medicarion?

Answer 32

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.

Question 33

Bullous dermatosis/ Linear IgA disease histology.

Answer 33

Subepidermal blistering; neutrophils, eosinophils.

Question 34

tx bullous dermatoses: linear IgA disease

Answer 34

stop offending drug.
systemic steroid in severe cases.
dapsone 100-200 mg daily.

Question 35

Asthma pxs being tx w leukotriene receptor antagonists may dev a syndrome resembling what disease?

Answer 35

Churg Strauss vasculitis.

occurs 2 days to 10 months after LRA has been started.

Question 36

topical steroid side effects most common seen

Answer 36

Atrophy 
striae
telangiectasia 
skin fraggility 
purpura

Question 37

long term effect of long term use of 1% hydrocortisone cream

Answer 37

Steroid rosacea

Question 38

repeated application if steroid on scrotum side effect

Answer 38

red scrotum syndrome

Question 39

All pxs w anticipated long term intake of steroid should be supplemented with.

Answer 39

Vit D (1- q.5g calcium and 400-800U Cholecalciferol daily)