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Prevention and Management of Complications
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana, Nicholas Moellhoff
Prolonged erythema in the treated area could originate from infection, skin surface irritation, bleeding, and allergic tissue reaction, worsening of erythematous skin conditions, or vascular occlusion. The associated symptoms of pain, tenderness, swelling, warmness, stinging, vesicles, or pustules are valuable for a differential diagnosis. Allergic reactions or irritation usually are related to injection preparation and postinjection cares. Maneuvers of bleeding control should proceed by compression instead of wipes, especially in sensitive thin skin. Cleansing of injection fields could be accomplished with different choices of disinfectant based on the patient's previous history of contact allergy. Using commercial-pack facial masks or skincare products immediately after injection should be discouraged. Some behaviors involving repeated contact of contaminated hands and gauzes with the injection fields are problematic. Repeated wipe-pattern maneuvers to stop bleeding can also result in surface skin disruption.
Chronic erythematous rash and lesions on trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Inflammation of hair follicles is very common. One (seeFig. 7.30, p. 136) or several follicles may be involved. Pustules are often present. It is usually due to an infection with Staphylococcus aureus, particularly if the patient also has eczema. Treatment involves taking a swab to determine the organism involved and its sensitivity to antibiotics (see p. 135).
Skin
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
This chapter begins by defining the symptom and key characteristics of Pustules encountered in primary care. It then lists the likely diagnosis, subdivided ‘Common’, ‘Occasional’ and ‘Rare’. A quick guide to the key distinguishing features of the most likely diagnoses is also listed. Further, the chapter outlines those investigations likely to assist the reader in making these diagnoses. The emphasis is upon tests performed in primary care or usually arranged by the general practitioners. All investigations discussed are categorized according to the likelihood that they will be performed, the three categories being, ‘Likely’, ‘Possible’ and ‘Small print’. The chapter ends with potpourri of management nuggets appropriate to the symptom of Pustules.
A review of disease burden and clinical management for generalized pustular psoriasis in China
Published in Expert Review of Clinical Immunology, 2022
No GPP-specific therapies are currently available worldwide. Targeted therapy, such as IL-36R inhibition, is a novel and specific approach. Spesolimab is a humanized monoclonal antibody that binds IL-36R with high affinity to inhibit the IL-36 signaling pathway and downstream inflammatory activities. A phase I study involving seven patients with GPP flares who received a single dose of spesolimab showed that all patients achieved a GPPGA score of 0 or 1 (clear or almost clear skin) by Week 4, with five patients achieving this by Week 1. Mean improvements from baseline in GPPASI score of all seven patients were 59.0% at Week 1, 73.2% at Week 2 and 79.8% at Week 4. Three, five and six patients achieved complete pustule clearance within 48 hours, 1 week and 2 weeks after treatment, respectively; improvements were maintained through 20 weeks [70]. A phase II, double-blind, placebo-controlled trial, Effisayil 1, is the first RCT conducted in patients with GPP and showed that a single dose of spesolimab rapidly cleared pustules by Week 1 in patients presenting with flare, with improvements maintained throughout the 12-week study period and with an acceptable safety profile [71]. A phase IIb, double-blind, placebo-controlled RCT, Effisayil 2, is investigating the efficacy and safety of three different doses of spesolimab in preventing GPP flares in patients with GPP (NCT04399837). Another humanized monoclonal antibody, imsidolimab (IL-36R antagonist), is under investigation for GPP (NCT03619902).
A review of IL-36: an emerging therapeutic target for inflammatory dermatoses
Published in Journal of Dermatological Treatment, 2022
Jonwei Hwang, Jonathan Rick, Jennifer Hsiao, Vivian Y. Shi
Emerging trials for treatment are summarized in Table 4. Spesolimab (BI 655130) is a humanized monoclonal immunoglobulin G1 anti-IL36R antibody that binds to domain 2 of the human IL-36R protein (53). Spesolimab was studied for safety, tolerability, pharmacokinetics, pharmacogenomics, and efficacy in a phase 1 open-label, single-arm study of seven adults with a history of GPP. No serious adverse events (AEs) were reported and a GPP Physician Global Assessment (GPPGA) score of clear or almost clear (0 or 1) was achieved in all patients by week 4. Mean percent improvement in Generalized Pustular Psoriasis Area and Severity Index (GPPASI) scores from baseline was 59.0% at week 1, 73.2% at week 2, and 79.8% at week 4. Pustules were completely cleared in six patients by week 2 [54]. For palmoplantar pustulosis (PPP), a phase 2a RCT found no significant difference between spesolimab treatment and control, a phase 2b study is planned (55,56). Spesolimab once monthly is currently recruiting phase 2b trials for efficacy and safety in 120 adults with GPP (57). Another 5-year study to assess long-term efficacy and safety in patients who have completed trials for spesolimab is recruiting (58). Imsidolimab (ANB019), a humanized monoclonal antibody against IL-36R, has completed a phase 2 study for efficacy and safety in eight adults with GPP, no results are published (59).
Dermatologic adverse events associated with targeted therapies for melanoma
Published in Expert Opinion on Drug Safety, 2022
Luigi Scarpato, Lucia Festino, Vito Vanella, Gabriele Madonna, Massimo Mastroianni, Marco Palla, Paolo Antonio Ascierto
These are skin adverse events mostly related to MEK inhibitors and they represent a different grade of aseptic immune-cell invasion of epidermis and hair follicles that often lead to bacterial suprainfections. The follicular/maculo-papular/acneiform eruption could be considered an evolution of hair follicle immune infiltration and consists of itchy follicles and papules that could evolve into pustules or acneiform eruption. Pustules may lead to crusts and hyperkeratosis. The head, neck, trunk, and proximal upper extremities are the main distribution areas [66]. The morbilliform eruption is characterized by diffuse itching and symmetric eruption of erythematous macules or small papules, mainly involving the trunk and the upper and lower extremities. Grade severity is based on the body surface area (BSA) involved and the degree of limitation in performing daily living activities (ADL) [72]. Maculo-papular exanthem covering 10–30% of BSA with systemic symptoms and lymphadenopathy can be treated with topical emollients, oral antihistamines and medium-to-high strength topical corticosteroids. Sometimes it is possible to add prednisone (or equivalent) 0.5–1 mg/kg when tapered over at least 4 weeks. The mucosal involvement with mucous membrane detachment warrants a burn consultation with attention to supportive care including fluid and electrolyte, and administration of a methylprednisolone (or equivalent) i.v. 0,5–1 mg/kg converting to oral corticosteroids on response. The use of immunosuppressants should be considered in the case of steroid resistance.