Email this article Evaluation of effectiveness of combined supportive treatment for paronychia and pyogenic granulomas, associated with targeted anticancer therapy
- Authors: Polonskaia A.S.1, Shatokhina E.A.1,2, Kruglova L.S.1
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Affiliations:
- Central State Medical Academy of Department of Presidential Affairs
- Lomonosov Moscow State University, Medical Scientific and Educational Center
- Issue: Vol 25, No 6 (2022)
- Pages: 41-53
- Section: DERMATOLOGY
- URL: https://rjsvd.com/1560-9588/article/view/112268
- DOI: https://doi.org/10.17816/dv112268
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Abstract
BACKGROUND: Paronychia and pyogenic granulomas occur in 10–50% of patients treated with epidermal growth receptor (EGFR) inhibitors. Supportive therapy for periungual lesions is challenging, since these adverse reactions are prone to torpidity and frequent relapses.
AIM: to evaluate the effectiveness of supportive treatment for paronychia and pyogenic granulomas ― dermatologic adverse events of EGFR inhibitors, with a combined cream with betamethasone dipropionate, clotrimazole, gentamicin, and betaxolol solution.
MATERIALS AND METHODS: 16 patients with paronychia and pyogenic granulomas associated with EGFR inhibitor therapy were included in a 12-week open-label prospective study. Paronychia and pyogenic granulomas severity assessment was performed with the NCI-CTCAE v. 5.0, a developed 10-point scale. The intensity of pain was assessed with a visual-analogue scale (VAS). The quality of life was assessed with the Dermatology Life Quality Index (DLQI).
RESULTS: A significant improvement of all parameters (p <0.05) was evaluated from week 1, indicating the effective reduction of dermatologic adverse event objective and subjective symptoms, improvement of patient’s quality of life. By the end of the study, 37.5% of patients had complete resolution of lesions, 62.5% of patients had minimal residual erythema. Decrease of pain sensation in the affected periungual folds was observed throughout the study (p <0.05). DLQI score indicated the "small effect" of paronychia and pyogenic granulomas on patient’s life by the end of the study.
CONCLUSIONS: Supportive treatment of paronychia and pyogenic granulomas with a combined cream with betamethasone dipropionate, clotrimazole and gentamicin and a betaxolol 0.25% solution is effective in the management of paronychia and pyogenic granulomas objective and subjective symptoms, has a high tolerability, allows to improve patient’s quality of life and continue targeted therapy without dose reduction. Long-term maintenance of pain sensation after paronychia and pyogenic granulomas resolution underlines the need for additional treatment options that will improve the effectiveness of pain management.
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About the authors
Aleksandra S. Polonskaia
Central State Medical Academy of Department of Presidential Affairs
Author for correspondence.
Email: dr.polonskaia@gmail.com
ORCID iD: 0000-0001-6888-4760
SPIN-code: 8039-4105
Assistant Lecturer
Russian Federation, MoscowEvgeniya A. Shatokhina
Central State Medical Academy of Department of Presidential Affairs; Lomonosov Moscow State University, Medical Scientific and Educational Center
Email: e.a.shatokhina@gmail.com
ORCID iD: 0000-0002-0238-6563
SPIN-code: 3827-0100
MD, Dr. Sci. (Med.), Professor, Senior Research Associate
Russian Federation, Moscow; MoscowLarisa S. Kruglova
Central State Medical Academy of Department of Presidential Affairs
Email: kruglovals@mail.ru
ORCID iD: 0000-0002-5044-5265
SPIN-code: 1107-4372
MD, Dr. Sci. (Med.), Professor
Russian Federation, MoscowReferences
- Bolotina LV, Vladimirova LY, Dengina NV, et al. Practical recommendations for the treatment of malignant tumors of the head and neck. Malignant Tumors. 2020;10(3s2-1):93–108. (In Russ). doi: 10.18027/2224-5057-2020-10-3s2-06
- Gordeev SS, Besova NS, Glebovskaya VV, et al. Practical recommendations for the treatment of cancer of the anal canal and skin of the perianal region. Malignant Tumors. 2020;10(3s2-1):440–449. (In Russ). doi: 10.18027/2224-5057-2020-10-3s2-24
- Laktionov KK, Artamonova EV, Breder VV, et al. Practical recommendations on drug treatment of non-small cell lung cancer. Malignant Tumors. 2020;10(3s2-1):40–59. (In Russ). doi: 10.18027/2224-5057-2020-10-3s2-02
- Fedyanin MY, Achkasov SI, Bolotina LV, et al. Practical recommendations for the drug treatment of colon cancer and rectosigmoid compound. Malignant Tumors. 2020;10(3s2-1):350–391. (In Russ). doi: 10.18027/2224-5057-2020-10-3s2-22
- Polonskaya AS, Shatokhina EA, Kruglova LS. Dermatological adverse events of epidermal growth factor receptor inhibitors: A modern view on an interdisciplinary problem // Tumors Head Neck. 2021;11(4):97–109. (In Russ). doi: 10.17650/2222-1468-2021-11-4-97-109
- Lacouture ME, Sibaud V, Gerber PA, et al. Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines. Ann Oncol. 2021;32(2):157–170. doi: 10.1016/j.annonc.2020.11.005
- Robert C, Sibaud V, Mateus C, et al. Nail toxicities induced by systemic anticancer treatments. Lancet Oncol. 2015;16(4):e181–e189. doi: 10.1016/S1470-2045(14)71133-7
- Cubirо X, Planas-Ciudad S, Garcia-Muret MP, Puig L. Topical timolol for paronychia and pseudopyogenic granuloma in patients treated with epidermal growth factor receptor inhibitors and capecitabine. JAMA Dermatol. 2018;154(1):99–100. doi: 10.1001/jamadermatol.2017.4120
- Yen CF, Hsu CK, Lu CW. Topical betaxolol for treating relapsing paronychia with pyogenic granuloma-like lesions induced by epidermal growth factor receptor inhibitors. J Am Acad Dermatol. 2018;78(6):e143–e144. doi: 10.1016/j.jaad.2018.01.015
- Sibaud V, Casassa E, D’Andrea M. Are topical beta-blockers really effective “in real life” for targeted therapy-induced paronychia. Support Care Cancer. 2019;27(7):2341–2343. doi: 10.1007/s00520-019-04690-8
- Sollena P, Mannino M, Tassone F, et al. Efficacy of topical beta-blockers in the management of EGFR-inhibitor induced paronychia and pyogenic granuloma-like lesions: Case series and review of the literature. Drugs Context. 2019;(8):212613. doi: 10.7573/dic.212613
- Olamiju B, Bhullar S, Coleman EL, Leventhal JS. Management of paronychia with pseudopyogenic granulomas secondary to epidermal growth factor receptor inhibitors: An assessment of topical timolol and the need for multiple medical and procedural therapies. J Am Acad Dermatol. 2021;84(3):806–808. doi: 10.1016/j.jaad.2020.06.010
- Liu HL, Chuang CH, Chen CL, et al. Combination of available topical beta-blockers and antibiotic ointment for epidermal growth factor receptor tyrosine kinase inhibitor-induced paronychia and pseudopyogenic granulomas in Taiwan. J Oncol Pharm Pract. 2022;10781552221122051. doi: 10.1177/10781552221122051
- Finlay AY, Khan GK. Dermatology life quality index (DLQI) — A simple practical measure for routine clinical use. Clin Andexperimental Dermatology. 1994;19(3):210–216. doi: 10.1111/j.1365-2230.1994.tb01167.x
- Kochergin NG, Kochergin SN. Indices of the scale of symptoms and quality of life in dermatology. In: Abstracts of scientific papers of the VIII All-Russian Congress of Dermatovenerologists, June 19–22, 2001. Part 1. Moscow; 2001. Р. 148–149. (In Russ).
- Glanc S. Biomedical Statistics. Moscow: Praktika; 1998. 460 р. (In Russ).
- Segaert S, Van Cutsem E. Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors. Ann Oncol. 2005;16(9):1425–1433. doi: 10.1093/annonc/mdi279
- Filoni A, Ambrogio F, De Marco A, et al. Topical beta-blockers in dermatologic therapy. Dermatol Ther. 2021;34(4):e15016. doi: 10.1111/dth.15016
- Koroleva IA, Bolotina LV, Gladkov OA, et al. Practical recommendations on drug treatment of dermatological reactions in patients receiving antitumor drug therapy. Malignant Tumors. 2020;10(3s2-2):88–101. (In Russ). doi: 10.18027/2224-5057-2020-10-3s2-42
- Lu CW, Wang TY, Yen CF, et al. Using betaxolol for the prevention of paronychia induced by epidermal growth factor receptor inhibitors: A case-control cohort study. Int J Dermatol. 2021;60(2):179–184. doi: 10.1111/ijd.15099
- Chisholm KM, Chang KW, Truong MT, et al. β-adrenergic receptor expression in vascular tumors. Mod Pathol. 2012;25(11):1446–1451. doi: 10.1038/modpathol.2012
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