Head and Neck Medicine by Alexandros G.Sfakianakis

Die Systemtherapie des rezidivierten bzw. metastasierten Kopf-Hals-Plattenepithelkarzinoms (RM-SCCHN) ist aktuell im Wandel. Neben Chemotherapie und Inhibitoren des epidermalen Wachstumsfaktorrezeptors (EGFR) stehen mittlerweile auch Checkpointinhibitoren (CPI) in der Klinik zur Verfügung.

Fragestellung

Wie fügen sich die aktuellen Daten in die Behandlungsrealität des RM-SCCHN ein?

Material und Methoden

Es erfolgte eine Literaturrecherche zur Systemtherapie des RM-SCCHN.

Ergebnisse

CPI sind ein Standard bei der Behandlung nach Platin-Versagen beim RM-SCCHN. Aktuelle Studien belegen den Stellenwert dieser neuen Therapieoption in der Erstlinie und werden in Kürze zu einem Umdenken in der Behandlungsrealität führen.

Schlussfolgerung

CPI sind das Rückgrat der Systemtherapie des RM-SCCHN und werden sich zukünftig auch in frühen Stadien der Behandlung wiederfinden.

http://bit.ly/2FYOHp4

The management and genetic background of pityriasis rubra pilaris: a single‐center experience

Abstract

Background

Pityriasis rubra pilaris (PRP) is a rare chronic inflammatory dermatosis with multifactorial etiology. It is known that particular caspase recruitment domain family member 14 (CARD14) gene mutations are associated with familial PRP and certain forms of psoriasis. Additionally, few data are available about the role of CARD14 genvariants in sporadic PRP. The clinical picture is variable for the different types of PRP, therefore choosing the adequate treatment is often difficult, furthermore there are no specific guidelines for therapy.

Objective

Our aim was to survey the efficacy of the applied therapies and to screen the CARD14 gene variants in our PRP patients.

Methods

In this retrospective study patients diagnosed with PRP between 2006 and 2016 at our clinic were involved. Besides the follow‐up study of the treatments, the genetic analysis of CARD14 gene was performed.

Results

We analyzed 19 patients, among whom 17 were diagnosed with type I, one with type III, and one with type V PRP. The majority of the patients were successfully treated with acitretin in combination with systemic corticosteroids and the remaining patients were treated with other systemic therapies with diverse effects. The genetic screening of CARD14 gene revealed two previously described mutations (rs114688446, rs117918077) and six polymorphisms (rs28674001, rs2066964, rs34367357, rs11653893, rs11652075, rs2289541). Ten of 19 patients carried different CARD14 genetic variants either alone or in combination.

Conclusion

Based on our experience we propose that acitretin and an initial combination of short term systemic corticosteroid therapy could be a successful treatment option for PRP. Although we identified several CARD14 variants in almost half of our cases, we did not find a correlation between the therapeutic response and the genetic background. Our data support the previous observation that CARD14 genetic variants are not specific to PRP, although they may indicate chronic inflammation.

http://bit.ly/2DJ4Exq

Contact allergy to methylchloroisothiazolinone/methylisothiazolinone in north‐eastern Italy: a temporal trend from 1996 to 2016

Summary

Background

Methylchloroisothiazolinone (MCI)/ methylisothiazolinone (MI) (Kathon^® CG) is a common preservative used in industrial products, owing to its strong biocide effect. Contact allergy to MCI/MI has been reported in different occupations, including mechanics, hairdressers and healthcare workers.

Objective

To retrospectively analyze the temporal trend of MCI/MI sensitization in north‐eastern Italy and to evaluate the associations with occupations in our geographical area.

Methods

From 1996 to 2016, 27381 patients with suspected allergic contact dermatitis were patch tested in eight departments of Dermatology or Occupational Medicine in North‐eastern Italy. Individual characteristics were collected through a standardized questionnaire.

Results

The overall prevalence of MCI/MI sensitization was 4.2%, with the highest prevalence found in women and in patients younger than 25 years. MCI/MI sensitization was significantly associated with atopic eczema (OR 1.34, 95%CI 1.10‐1.70), hand/forearm dermatitis (OR 1.20, IC 1.05‐1.36) and face dermatitis (OR 1.30, IC 1.10‐1.40). There was a significant association between MCI/MI sensitization and chemical processing workers (OR 1.74 IC 1.03‐2.94), while mechanics and health care workers resulted more sensitized to this hapten only in the last 3 years.

Conclusion

Sensitization to MCI/MI is rising in the last years in Triveneto region, the "epidemic" of sensitization to MCI/MI is mainly driven by extra occupational dermatitis and sensitization in some occupational groups is emerging only in the last years. A full labelling is compulsory for all products that contain isothiazolinones, to permit to identify the culprit agent.

http://bit.ly/2Unngsc

Cutaneous eruptions associated with hematologic malignancies: the need for a unifying nomenclature

Abstract

we read with interest the study by Visseaux et al., entitled "T‐cell papulosis associated with B‐cell malignancies: a distinctive clinicopathologic entity". Herein, the authors reviewed retrospectively 37 patients with B‐cell malignancies, mostly B‐cells chronic lymphocytic leukaemia (B‐CLL), showing recurrent episodes of pruritic papules, papulo‐vesicles or nodules. Since the specific association with lymphoproliferative disorders and the lack of eosinophils in some of the histopathologic slides, the authors designated the term "T‐cell papulosis associated with B‐cell malignancies" instead of the so‐called "eosinophilic dermatosis of hematologic malignancies" (EDHM).¹ Moreover, the condition was previously referred to as "insect bite‐like reactions" or "exaggerated delayed hypersensitivity to mosquito bites".

http://bit.ly/2DJlfBg

Outcomes following radiation for cutaneous squamous cell carcinoma of the head and neck: Associations between immune suppression and recurrence

Abstract

Background

Data evaluating outcomes and patterns of recurrence following radiation therapy (RT) for cutaneous squamous cell carcinoma (cSCC) of the head and neck are limited.

Methods

We performed a retrospective analysis of 111 head and neck cSCC patients treated with RT at 4 affiliated institutions.

Results

With median follow‐up of 7 months, there were 29 (26%) recurrences, 73% of which were nodal (n = 21). Immunosuppression (IS) was the only factor associated with recurrence (47% in IS, 22% in non‐IS, P = .04), and also with time to recurrence in multivariate analysis (HR 5.5; P = .03). No factors were associated with recurrence among patients who received definitive RT. The majority of patients who recurred were salvaged with surgery (n = 20, 69%).

Conclusion

In a cohort of cSCC treated with radiotherapy, there was an association between IS and increased failure risk. The majority of failures were salvaged surgically.

http://bit.ly/2HN5Jsm