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Psoriasis and lichen planus
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
Pityriasis rubra pilaris is an uncommon skin disorder of unknown cause, which often has a superficial resemblance to psoriasis as it is characterized by redness and scaling patches, but has a distinctive natural history, histological appearance and a distinctive component of follicular involvement.
Inflammatory dermatoses affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Pityriasis rubra pilaris is a fairly common erythemato-squamous skin disorder. It is characterized by follicular keratotic papules, general mild hyperkeratosis, and a particular red color with an orange-yellow hue. It may involve large skin areas and characteristically leaves out islands of normal appearing skin, called nappes claires or Leredde's sign. Palms and soles develop diffuse hyperkeratoses, again with an orange hue, frequently with painful cracking.66 Five different clinical types were outlined, but without type-specific nail changes although most nail changes were described in type I.67 The nails develop longitudinal ridging and splinter hemorrhages, lose their shine, and hyperkeratosis of the distal nail bed may lift the nails. Distal yellow-brown discoloration is also seen. Trachyonychia is not a clinical feature of pityriasis rubra pilaris. The clinical differential diagnoses are erythroderma, drug eruption, Sézary's syndrome, and other cutaneous lymphomas with nail changes.
A case of topical imiquimod induced fatigue
Published in Journal of Dermatological Treatment, 2022
Justin Raman, Elizabeth Bisbee, Tricia A. Missall, Sami K. Saikaly
Other case reports of serious systemic effects have been reported. An 88-year-old man using topical imiquimod 0.625 mg for 3 days on nine total BCCs on chest and forehead developed myalgias, labored breathing, and generalized weakness (6). However, it is unclear if 0.625 mg was used on each of the nine lesions, or if 0.625 mg total was utilized for all nine lesions (which would equate to 1/20th of a packet of imiquimod). Another reported case describes a 69-year-old woman using a second course of imiquimod for two AKs on the forehead who developed dizziness, postural hypotension, and loss of appetite, 4 months after her first course (7). She required hospitalization for 4 days due to dehydration and muscle weakness with inability to stand up (7). Her appetite and balance returned slowly over the following months (7). A 67-year-old man developed fever and an exacerbation of pityriasis rubra pilaris after 2 weeks of three times weekly application to AKs on scalp, cheek, and neck that measured 2–5 cm in size (8). In a safety trial involving 800 individuals applying imiquimod to AKs, only 2.3% reported fatigue (6).
Cutaneous adverse events of immune checkpoint inhibitor therapy: incidence and types of reactive dermatoses
Published in Journal of Dermatological Treatment, 2022
Thomas K. Le, Subuhi Kaul, Laura C. Cappelli, Jarushka Naidoo, Yevgeniy R. Semenov, Shawn G. Kwatra
Of the 1857 patients treated with anti-PD-1 ICIs, there were 1079 patients treated with nivolumab, 821 patients treated with pembrolizumab, and 43 patients treated with both pembrolizumab and nivolumab. There were 254/1857 (13.7%) patients who developed one of the 28 different dermatoses identified from the literature review following anti-PD-1 ICIs. Eleven reactions, although reported in the literature, had an incidence n < 5: xerosis (n = 4), Stevens-Johnson syndrome (n = 2), paronychia (n = 2), panniculitis (n = 2), onycholysis (n = 2), maculopapular eruption (n = 2), bullous pemphigoid (n = 2), alopecia areata (n = 2), acral erythema (n = 2), Grover’s disease (n = 2), and erythema multiforme (n = 2), as reported in Table S1. 6 reactions had an incidence of n = 0. This included dermatomyositis, erythroderma/pityriasis rubra pilaris, granuloma annulare, hyperkeratosis, photosensitivity, and subacute cutaneous lupus erythematosus (Table S1).
Safety of topical interventions for the treatment of actinic keratosis
Published in Expert Opinion on Drug Safety, 2021
Elias A. T. Koch, Anja Wessely, Theresa Steeb, Carola Berking, Markus V. Heppt
Other uncommon side effects of topical IMQ have been reported in the literature. Many reports describe an exacerbation or manifestation of skin conditions such as generalized psoriasis, pityriasis rubra pilaris, subacute cutaneous lupus erythematosus, severe eczema, contact pemphigus, pemphigus foliaceus, pemphigus-like symptoms, erosive cheilitis, erosive pustular dermatosis, morbilliform exanthema, and eruptive epidermoid cysts [65–75]. Furthermore, vasodilatory AE such as angioedema and urticaria have been described [76]. Also several cases with cSCC development after IMQ treatment have been reported. Singh et al. described the case of an 80-year-old male receiving IMQ 5% for AK. Six weeks after the treatment, he developed a well‐differentiated cSCC in an area of radiodermatitis [77]. Two further cases of histologically verified cSCC in the application site after treatment of cSCC in situ with 5% IMQ once a day for 6 weeks were published by Goh et al. One Patient developed a cSCC along with cervical lymph node metastasis 2 months after treatment. Another cSCC was reported in a patient with chronic lymphocytic leukemia 4 months after treatment with IMQ [78].