Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities

Background Epidermal growth factor receptor inhibitors (EGFRI) produce various dermatologic side effects in the majority of patients, and guidelines are crucial for the prevention and treatment of these untoward events. The purpose of this panel was to develop evidence-based recommendations for EGFRI-associated dermatologic toxicities. Methods A multinational, interdisciplinary panel of experts in supportive care in cancer reviewed pertinent studies using established criteria in order to develop first-generation recommendations for EGFRI-associated dermatologic toxicities. Results Prophylactic and reactive recommendations for papulopustular (acneiform) rash, hair changes, radiation dermatitis, pruritus, mucositis, xerosis/fissures, and paronychia are presented, as well as general dermatologic recommendations when possible. Conclusion Prevention and management of EGFRI-related dermatologic toxicities is critical to maintain patients’ health-related quality of life and dose intensity of antineoplastic regimens. More rigorous investigation of these toxicities is warranted to improve preventive and treatment strategies

Onychomycosis: Clinical Aspects

There are five types of onychomycosis based on pathogen mode of entry and clinical presentation: (1) distal and lateral subungual onychomycosis, (2) superficial onychomycosis, (3) proximal subungual onychomycosis, (4) endonyx onychomycosis, and (5) total dystrophic onychomycosis. Distal and lateral subungual onychomycosis is the most common type with infection starting in the hyponychium and distal or lateral nail bed and travelling proximally. This type has three main clinical features: subungual hyperkeratosisSubungual hyperkeratosis, onycholysis, and paronychia, albeit paronychia is uncommon. Superficial onychomycosis has two subtypes: superficial white onychomycosis and the rare superficial black onychomycosis (brown-black pigmentation known as fungal melanonychia). In both types, infection begins in the nail plate and then moves to the nail bed and hyponychium, with spots of discoloration that may gradually cover the whole nail plate. Proximal subungual onychomycosis is rare and begins in the stratum corneum, infecting the proximal nail plate and lunula. The infection moves distally and generally remains in the deeper layers of the nail. Endonyx onychomycosis also begins in the hyponychium; however, the hyponychium remains free of hyphae and the pathogen does not infect the nail bed or cause subungual hyperkeratosis or onycholysis. Instead, the pathogen infects the keratin, resulting in milky-white patches and lamellar splitting. Total dystrophic onychomycosis may be secondary or primary. Secondary total dystrophic onychomycosis is the complete progression of any of the previous types of onychomycosis. This presents with a crumbling nail plate and complete dystrophy. Primary infection occurs in immunocompromised patients and impacts all parts of the nail, often with swelling of the digits

Avaliação clínica e micológica de onicomicose em pacientes brasileiros com HIV/AIDS

INTRODUÇÃO: Onicomicoses são comuns em pacientes imunocomprometidos embora espécies emergentes tenham sido verificadas, modificado o perfil epidemiológico desta micose. Assim, o objetivo desta pesquisa é avaliar o perfil clínico e micológico da onicomicose em pacientes com infecção pelo HIV/AIDS. MÉTODOS: Amostras clínicas foram coletadas, processados para exame direto e a cultura mantida a temperatura de 30°C e 37ºC durante 15 dias. RESULTADOS: Dos 100 pacientes, 32 apresentavam onicomicose. Os agentes isolados foram Candida albicans, C. parapsilosis, C. tropicalis, C. guilliermondii, Trichophyton rubrum, T. mentagrophytes, Fusarium solani, Scytalidium hialinum, S. japonicum, Aspergillus niger, Cylindrocarpon destructans e Phialophora reptans. CONCLUSÕES: Onicomicoses em HIV/AIDS apresentam variadas manifestações clínicas e podem ser causadas por fungos emergentes. As peculiaridades apresentadas pelos diferentes agentes de origem fúngica justificam a necessidade de identificação ao nível da espécie, com a finalidade de orientar uma melhor abordagem terapêutica e minimizar a exposição desses pacientes a condições de risco de uma infecção disseminada

A multinational pharmacoeconomic analysis of oral therapies for onychomycosis

Arikian SR, Einarson TR, Kobeltnguyen G, et al. A multinational pharmacoeconomic analysis of oral therapies for onychomycosis. British Journal of Dermatology. 1994;130(Suppl. 43):35-44.Due to increased interest in economic evaluation and the rapid international spread of new healthcare technologies across borders, there is a need to interpret economic evaluations on a worldwide basis. We conducted a multinational cost-effectiveness analysis, from a government payer perspective, comparing four primary oral treatment regimens for onychomycosis of the fingernails and toenails: griseofulvin, itraconazole, ketoconazole and terbinafine. We used a four-step pharmacoeconomic research model which includes all relevant factors affecting costs in 13 countries: Austria, Belgium, Canada, Finland, France, Germany, Greece, Italy, The Netherlands, Portugal, Spain, Switzerland and the U.K. A worldwide meta-analysis of published clinical data served as the statistical input for the pharmacoeconomic model, and demonstrated that terbinafine had the highest success rates (95.0% and 78.3%) of the clinical comparators for fingernails and toenails, respectively. We found that terbinafine was the most effective therapy in relation to cost (therefore giving it the lowest cost-effectiveness ratio) for both infections in all health-care systems analysed