Dermatosurgery in Dermatology

Glavne prednosti dermatokirurgije jesu njezina jednostavnost i djelotvornost. Ipak, zahvati učinjeni bez prave indikacije mogu rezultirati zaostajanjem ožiljaka i mogućim komplikacijama. Autorica opisuje niz dermatokirurških tehnika i postupaka kojima se koristimo za tretiranje dobroćudnih i malignih kožnih poremećaja. Ispravan odabir postupka ovisi o diferencijalnoj dijagnozi, tipu i veličini zahvata. U radu se opisuju i moguće komplikacije u dermatokirurškoj praksi.The main quality of dermatosurgery lies in its simplicity and effectiveness. Nevertheless, interventions without adequate indication may result in unnecessary scaring and various complications. A range of techniques for treating benign and malignant skin disorders are described in the article. The correct surgical procedure depends on the differential diagnosis, and the type and extent of treatment. The author provides an overview of basic dermatosurgical techniques and possible complications in dermatosurgical practice

Kožne nuspojave u bolesnika na ciljanoj terapiji raka kolorektuma

Research in cancer development has led to the new treatment strategies based on gene and protein changes in cells that cause cancer. Such targeted drugs work differently than standard chemotherapy agents, and have different and usually less severe side effects. Targeted chemotherapies have, however, enormous cutaneous adverse events which may lead to poor adherence, dose interruption and discontinuation of these therapeutic regimens. Skin changes have a significant influence on the quality of life of affected patients. In colorectal cancer, several targeted drugs are currently employed. Agents administered in colorectal cancer that have resulted in significant cutaneous side effects include primarily the epidermal growth factor receptor inhibitors (EGFRIs) and capecitabine. Common EGFRIs dermatologic adverse events are acneiform rash and xerosis. Less common findings are paronychia, regulatory abnormalities of hair growth, maculopapular rash, mucositis and postinflammatory hyperpigmentation. Management of skin rash should be individualized for each patient, depending on the type, severity and location of the skin toxicity caused by EGFRIs. Hand-foot syndrome (HFS), or palmar-plantar erythrodysestesia, is the most common dose-limiting toxicity and the only clinically significant adverse event that frequently occurs with capecitabine compared to 5-FU/leucovorin intravenous administration. Cutaneous side effects affect compliance, patients’ quality of life, as well as the therapy regimen. It is important to recognize and treat, as well as to administer efficacious prophylactic and therapeutic measures in a timely manner. This enables regular administration of adequate chemotherapy regimens and prolongs lives of oncology patients. Studies have demonstrated a positive correlation between treatment efficacy and cutaneous side effects for both EGFRI and capecitabine. Therefore, cutaneous side effects can serve as a predictor of improved survival in these patients. Since frequency and severity of skin lesions are dose-dependent, a gradual increase in dose until a cutaneous side-effect develops might be a good strategy to maximize the efficacy of EGFRIs and capecitabine.Istraživanja nastanka zloćudnih tumora dovela su do novih vrsta liječenja koje se zasnivaju na promjenama gena i proteina u stanicama zloćudnih tumora. Takvi ciljani lijekovi imaju drugačiji mehanizam djelovanja od standardnih citostatika, te obično blaže nuspojave. Ciljani lijekovi međutim imaju značajne nuspojave na koži koje mogu dovesti do slabije suradljivosti bolesnika, izostavljanja pojedinačne doze ali i prekida liječenja. Promjene na koži znatno utječu na kvalitetu života bolesnika. U liječenju kolorektalnog karcinoma primjenjuje se nekoliko ciljanih lijekova. Od njih značajne nuspojave na koži imaju inhibitori epidermalnog čimbenika rasta (EGFRI), te kapecitabin. Česte dermatološke nuspojave EGFRI su akneiformni osip i suhoća kože, dok su manje česti paronihija, poremećaji u rastu dlaka, makulopapulozni osip, mukozitis i postinflamatorne hiperpigmentacije. Liječenje nuspojava na koži treba biti prilagođeno svakom bolesniku, ovisno o vrsti, težini i mjestu nastanka promjena. Hand-foot syndrom (HFS, sindrom šaka i stopala) ili palmo-plantarna eritrodizestezija je najčešća toksičnost koja ograničava doziranje lijeka i jedina klinički značajna nuspojava koja se često javlja tijekom liječenja kapecitabinom u usporedbi s intravenskom primjenom 5-FU/ leukovorina. Nuspojave na koži utječu na suradljivost, kvalitetu života bolesnika te provođenje terapije. Važno je na vrijeme prepoznati, liječiti te primijeniti učinkovite profilaktičke i terapijske mjere. Na taj način se osigurava redovita primjena odgovarajuće terapije i produžava život onkoloških bolesnika. Kliničkim studijama je dokazana pozitivna povezanost učinkovitosti liječenja onkoloških bolesnika i nuspojava na koži kod uporabe EGFRI i kapecitabina. Stoga nuspojave na koži mogu poslužiti kao prediktor boljeg ishoda bolesnika. Budući su učestalost i težina nuspojava na koži ovisne o dozi lijeka, postupno povišenje doze do pojave nuspojava na koži može biti dobar način povećanja učinkovitosti kako EGFRi tako i kapecitabina

Adverse Reaction to Cetuximab, an Epidermal Growth Factor Receptor Inhibitor

No abstract availabl

The Most Common Cutaneous Side Effects of Epidermal Growth Factor Receptor Inhibitors and Their Management

The use of epidermal growth factor receptor inhibitors (EGFRI) for the treatment of solid tumors is increasing due to elevated expression of epidermal growth factor receptors (EGFR) in the stimulation of tumor development. EGFR inhibitors have shown to be effective in the treatment of neoplasms of the head, neck, colon, and lung. Inhibition of EGFR may cause cutaneous reactions in more than 50% of patients. The most common skin manifestations are papulopustular lesions in the seborrhoeic areas (upper torso, face, neck, and scalp). Other cutaneous side effects include xerosis and hair and nail changes. The onset of eruption is usually within one to three weeks after starting therapy, although in some cases it may occur much later. All dermatologic side effects are reversible and generally resolve after adequate therapy. However, for a minority of patients side effects are severe and intolerable, demanding dose reduction or even interruption of therapy. A positive correlation has been demonstrated between the degree of cutaneous toxicity and the antitumor response. For dermatologists the goal is to provide treatment of symptoms, so that the patient may continue to benefit from the EGFRI therapy. However, frequent cutaneous manifestations, even though related to a better antitumor response, may limit use of the therapy considering the interference with patient quality of life. Early management of cutaneous side effects of EGFRI may prevent severe, extensive symptoms, the need for dose reduction, or antitumor therapy interruption. This indicates a dermatologist should play a role in early stages of treatment. </p