Management of dermatological adverse events during nivolumab treatment

Programmed death 1 receptor (PD-1) inhibitors, such as nivolumab, are effective in the treatment of advanced and metastatic melanoma, as well as in kidney, bladder, and non-small cell lung carcinomas. Adverse events of PD-1 inhibitors result mostly from autoimmune mechanisms, include gastrointestinal inflammatory diseases, hepatotoxicity, neurotoxicity, endocrinopathies, and skin toxicities. In this article, we highlight the main cutaneous adverse events associated with PD-1 inhibitors and provide a set of practical guidelines about their management. Additionally, we report a case of nivolumab-induced bullous pemphigoid in a patient with metastatic melanoma.Programmed death 1 receptor (PD-1) inhibitors, such as nivolumab, are effective in the treatment of advanced and metastatic melanoma, as well as in kidney, bladder, and non-small cell lung carcinomas. Adverse events of PD-1 inhibitors result mostly from autoimmune mechanisms, include gastrointestinal inflammatory diseases, hepatotoxicity, neurotoxicity, endocrinopathies, and skin toxicities. In this article, we highlight the main cutaneous adverse events associated with PD-1 inhibitors and provide a set of practical guidelines about their management. Additionally, we report a case of nivolumab-induced bullous pemphigoid in a patient with metastatic melanoma

The direct costs of drug-induced skin reactions

Objective The aim of the study was an assessment of direct costs of patients hospitalised for for skin adverse drug reactions during 2002–2012 in the Department of Dermatology at the Military Institute of Medicine (Ministry of Defence) in Warsaw. The analysis was carried out from the perspectives of the public payer and service provider. Material and Methods The retrospective study was carried out in a group of 164 adult patients due to skin adverse drug reactions. Analysis was based on data from patient medical records and medical orders which provided information on the used resources, including diagnostic tests, medical consultations, medicinal products, hospitalisation duration, together with cost estimation, regardless of the treatment being the cause of the skin reaction. Results According to the International Statistical Classification of Diseases and Related Health Problems(ICD) diagnosis and scores, assigned by the National Healthcare Fund, it has been estimated that patient hospitalisation at the Department of Dermatology for skin drug reaction incurred costs at the average amount of €717.00 per patient. The complex diagnostics and pharmacotherapy of the same group of patients generated costs for the hospital at the average amount of €680 per patient. Conclusions As a result of the analysis, the therapy for skin adverse drug effects generates significant costs, both for the payer and the service provider. Since the costs are comparable, it seems that the pricing of medical procedures by the public payer is adequate for the costs incurred by the medical service provider

Leczenie biologiczne łuszczycy w Polsce

Psoriasis biological treatment in PolandBiologics are an important, but expensive treatment option in certain inflammatory diseases. Psoriasis is chronic disease that is a major public health problem in all countries. The paper shows the practical applicability of biological agents in this disease therapy. Many aspects of the clinical, cost and availability of biological treatment of psoriasis in Poland were discussed

Tubercular inflammation of cervical lymph nodes with a colliquative tuberculosis focus - a case study

Gruźlica skóry jest szczególną postacią gruźlicy, o zróżnicowanym obrazie klinicznym wynikającym z wewnątrz- lub zewnątrzpochodnej drogi zakażenia, mechanizmów odpornościowych oraz niekorzystnych warunków rozwoju dla prątka. Nietypowy przebieg i objawy mogą powodować trudności w postawieniu prawidłowego rozpoznania oraz odpowiednio wczesnego rozpoczęcia leczenia. Przy rozpoznaniu gruźlicy skóry należy brać pod uwagę szeroką diagnostykę różnicową obejmującą między innymi leiszmaniozę, promienicę, trąd, grzybice głębokie. W pracy przedstawiono przypadek gruźlicy węzłów chłonnych i gruźlicy rozpływnej skóry, początkowo mylnie rozpoznanej jako promienica i powikłanej rumieniem wielopostaciowym. W opisywanym przypadku w badaniach bakteriologicznych bioptatów ze zmian skórnych prątków gruźlicy nie wykryto. Rozpoznanie choroby ustalono na podstawie obecności ziarniny swoistej w ostatnim z wykonanych badań histopatologicznych, nadwrażliwości na tuberkulinę oraz obecności DNA prątków w badaniu łańcuchowej reakcji polimerazy (PCR). Zdaniem autorów w przypadku klinicznego podejrzenia gruźlicy skóry wydaje się być uzasadnione nawet kilkukrotne wykonywanie badania histopatologicznego ze zmian. Wynik powinien być uzupełniony jedną z metod badania materiałów skąpoprątkowych, na przykład przez identyfikację materiału genetycznego prątków za pomocą amplifikacji kwasów nukleinowych metodą PCR.Cutaneous tuberculosis is a specific form of tuberculosis, characteristic of a differentiated clinical picture and resulting from either endo- or exogenous way of infection, immunological mechanisms and unfavourable conditions for mycobacterium development. The untypical course and symptoms of the disease may cause certain difficulties in obtaining a proper diagnosis and, in consequence, result in delayed onset of appropriate treatment. When diagnosing cutaneous tuberculosis, a broad apparatus of differential diagnostics should be applied, taking into account other diseases such as leishmaniasis, actinomycosis, leprosy or deep mycoses. We report a case of lymph node tuberculosis and of colliquative tuberculosis of the skin, at first erroneously diagnosed as actinomycosis, complicated by multiform erythema. In the reported case, no tuberculous bacilli were identified in bacteriological evaluations of bioptates collected from the skin changes. The final diagnosis of the disease was determined by the presence of specific granulation tissue in the last performed histopathological studies, as well as by hypersensitivity to tuberculin and the presence of mycobacterial DNA in PCR evaluation. According to the authors, in case of clinically suspected cutaneous tuberculosis, repeated (several) histopathological studies of samples from observed changes seem to be fairly justified. The results of histopathological studies should be completed by one of the methods of oligomycobacterial material evaluation, e.g. by identification of mycobacterial genetic material by means of nucleic acid amplification in the PCR method

Postępowanie w przypadku wystąpienia dermatologicznych działań niepożądanych przy stosowaniu leku niwolumab

Zastosowanie leków z grupy inhibitorów punktu kontrolnego PD-1 okazało się postępem w leczeniu chorych na zaawansowanego czerniaka. Udowodniono ich skuteczność również w leczeniu innych nowotworów, takich jak rak nerki, pęcherza moczowego czy niedrobnokomórkowy rak płuca. Działania niepożądane inhibitorów PD-1, wynikające przede wszystkim z mechanizmów immunologicznych, obejmują szerokie spektrum zaburzeń, w tym zaburzenia gastroenterologiczne, hepatotoksyczność, neurotoksyczność, endokrynopatie oraz szereg reakcji skórnych. W niniejszym opracowaniu zostaną omówione najczęstsze dermatologiczne działania niepożądane niwolumabu oraz zasady postępowania w przypadku ich wystąpienia. Ponadto przedstawiony zostanie przypadek pacjentki leczonej niwolumabem z powodu czerniaka, u której wystąpił pemfigoid pęcherzowy wywołany zastosowaniem leku

Leczenie biologiczne łuszczycy w Polsce

Psoriasis biological treatment in PolandBiologics are an important, but expensive treatment option in certain inflammatory diseases. Psoriasis is chronic disease that is a major public health problem in all countries. The paper shows the practical applicability of biological agents in this disease therapy. Many aspects of the clinical, cost and availability of biological treatment of psoriasis in Poland were discussed

Tubercular Inflammation of Cervical Lymph Nodes with a Colliquative Tuberculosis Focus—A Case Study

Cutaneous tuberculosis is a specific form of tuberculosis, characteristic of a differentiated clinical picture and resulting from either endo- or exogenous way of infection, immunological mechanisms and unfavourable conditions for mycobacterium development. The untypical course and symptoms of the disease may cause certain difficulties in obtaining a proper diagnosis and, in consequence, result in delayed onset of appropriate treatment. When diagnosing cutaneous tuberculosis, a broad apparatus of differential diagnostics should be applied, taking into account other diseases such as leishmaniasis, actinomycosis, leprosy or deep mycoses. We report a case of lymph node tuberculosis and of colliquative tuberculosis of the skin, at first erroneously diagnosed as actinomycosis, complicated by multiform erythema. In the reported case, no tuberculous bacilli were identified in bacteriological evaluations of bioptates collected from the skin changes. The final diagnosis of the disease was determined by the presence of specific granulation tissue in the last performed histopathological studies, as well as by hypersensitivity to tuberculin and the presence of mycobacterial DNA in PCR evaluation. According to the authors, in case of clinically suspected cutaneous tuberculosis, repeated (several) histopathological studies of samples from observed changes seem to be fairly justified. The results of histopathological studies should be completed by one of the methods of oligomycobacterial material evaluation, e.g., by identification of mycobacterial genetic material by means of nucleic acid amplification in the PCR method

Analiza stężeń eotaksyny 1/CCL11, eotaksyny 2/CCL24 i eotaksyny 3/CCL26 w surowicy dorosłych chorych na atopowe zapalenie skóry

Introduction. Eosinophils play an important role in development ofallergic diseases. Recent studies indicate their many relevant functionsin the development of allergic inflammation related to both an effectorand immunomodulatory role. The recognition of factors responsible foreosinophil recruitment to tissues may be significant for understandingallergic diseases’ regulatory processes, including mechanisms leadingto skin changes in atopic dermatitis (AD). The most prominent chemotacticfactors influencing eosinophil accumulation are those actingselectively via the CCR3 eotaxin receptor. Many reports indicate a relevantrole of these chemokines in pathogenesis of allergic diseases.Objective. To measure the level of serum concentrations of eotaxin1/CCL11, eotaxin 2/CCL24 and eotaxin 3/CCL26 in AD patients andhealthy subjects in relation to disease intensity assessed by the SCORADscale.Material and methods. Hundred and one AD patients and 21 healthysubjects as the control group were investigated. The concentrations ofeotaxin 1/CCL11, eotaxin 2/CCL24 and eotaxin 3/CCL26 were measuredusing enzyme-linked immunosorbent assay (ELISA) with R&DSystems kits (USA).Results. It was found that in the group of AD patients the average serumconcentration of 1/CCL11 eotaxin was 123.86 pg/ml. The average serumconcentration of 2/CCL24 eotaxin was 1064.52 pg/ml and of 3/CCL26eotaxin 16.93 pg/ml. In healthy volunteers (control group), the meanserum concentration of 1/CCL11 eotaxin was 195.64 pg/ml, the meanserum concentration of 2/CCL24 eotaxin was 965.58 pg/ml, and of3/CCL26 eotaxin 0.79 pg/ml. Comparative analysis of serum eotaxin levelsbetween the group of AD patients and the healthy controls showedthat the mean serum concentration of 1/CCL11 eotaxin in patients withatopic dermatitis is significantly lower (p = 0.002), and of 3/CCL26 eotaxinhigher (p = 0.0000001) than in healthy controls. In the group of ADpatients the average severity of illness rated with the SCORAD scale was53.17. Regression analysis between the exacerbation of disease rated withthe SCORAD scale and serum levels of 1/CCL11 eotaxin, 2/CCL24 eotaxinand 3/CCL26 eotaxin showed a statistically significant correlation forall measured parameters (respectively p = 0.001, p = 0.01, p = 0.00001).Conclusions. The analysis of results showed that in the researchedgroup: 1. Mean eotaxin 3/CCL26 and eotaxin 2/CCL24 serum concentrationis higher in AD patients as compared to healthy subjects and inthe case of eotaxin 3/CCL26 the difference is statistically significant.2. Mean eotaxin 1/CCL11 serum concentration is statistically lower inAD patients as compared to healthy subjects. 3. Eotaxin 1/CCL11,eotaxin 2/CCL24 and eotaxin 3/CCL26 serum concentrations correlatewith AD intensity assessed by SCORAD

Mikroskopia konfokalna jako uzupełnienie badania dermoskopowego w codziennej praktyce dermatologicznej

Refleksyjna mikroskopia konfokalna (reflectance confocal microscopy, RCM) jest nieinwazyjną metodą diagnostyczną in vivo stosowaną komplementarnie do badania dermoskopowego i klinicznego. Znalazła zastosowanie w diagnostyce różnicowej zmian nowotworowych, wybranych chorób zapalnych oraz infekcyjnych i nienowotworowych zaburzeń barwnikowych skóry. Istotnym wsparciem dla klinicysty są liczne algorytmy RCM, charakteryzujące się wysokimi wskaźnikami czułości i swoistości w rozpoznawaniu czerniaka. Liczne badania wykazały, że RCM zwiększa dokładność diagnostyczną, oszczędza wielu niepotrzebnych wycięć chirurgicznych i może być stosowana w celu monitorowania leczenia lub progresji choroby. W oparciu o przegląd piśmiennictwa artykuł podsumowuje aktualne możliwości zastosowania RCM w praktyce klinicznej z uwzględnieniem ograniczeń metody

Coexistence of psoriasis and atopic dermatitis

Psoriasis and atopic dermatitis (AD) are diseases of still unknown precisely etiology. Concomitance of psoriasis and AD is relatively very rare, but it is constantly under discussion whether these disorders are etiopathologically connected. We report case of 55-year old patient, with a 25 year history of psoriasis, hospitalized in our Department because of exacerbation of atopic dermatitis diagnosed two years ago. We agree with previous reports that due to rare prevalence of concomitance of psoriasis and AD, those diseases are rather mutually exclusive