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Radiation-induced skin damage (RID) is the most prevalent, significant side effect of radiotherapy (RT). Nearly 95% of patients experience moderate to severe skin reactions after receiving radiation therapy. However, criteria for acute radiation dermatitis (ARD) treatment remain unavailable. Topical agents with anti-inflammatory properties may protect the skin and facilitate tissue regeneration in patients with RID. Many of these topical agents function through nuclear factor kappa B pathway regulation. They either reduce the levels of inflammatory factors or elicit anti-inflammatory properties of their own, thus preventing oxidative stress and inflammatory responses and thus enabling RID prevention and management. Herein, we explore the 25 topical agents investigated for RID prevention and management thus far and evaluate their mechanisms of action. These agents include 11 natural agents, 3 miscellaneous agents, 9 topical nonsteroidal agents, and 2 topical corticosteroids.

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Background: The use of personal protective equipment (PPE) reduces the risk of transmission of infectious agents significantly among healthcare workers (HCWs). The study aimed to investigate the prevalence and characteristics of PPE-related adverse skin reactions among HCWs working at the main COVID-19 isolation center in Barbados. Methods: A cross-sectional web-based online survey was conducted during April to June 2021 which recorded demographic information, details of PPE use and adverse skin reactions including severity and duration of onset of symptoms. Results: Most of the respondents used PPE for consecutive days (77.9%), 1-6 h/day (59.2%), and more than a year (62.5%). Fewer than half of the participants (45.6%) experienced adverse skin reactions from the use of PPE. The reactions were mostly observed in the cheeks (40.4%) and nose bridges (35.6%). Females had more reactions than their male counterparts (p = 0.003). The use of N95 masks and a combination of surgical and N95 masks produced adverse effects predominantly in the ears (60%) and cheeks (56.4%). Binary logistic regression showed that female HCWs (OR = 5.720 95% CI: 1.631, 20.063), doctors (OR = 5.215 95% CI: 0.877, 31.002), and longer duration of PPE use (>1 year) (OR = 2.902 95% CI: 0.958, 8.787) caused a significantly higher prevalence of adverse skin reactions. Conclusion: The PPE-related skin reactions were common among HCWs which mainly occurred due to prolonged use. Preventive measures inclusive of appropriate training of HCWs on the use of PPE are recommended to minimize these adverse events.

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OBJETIVE: To assess cutaneous reactions after Pfizer-BioNTech COVID-19 vaccine administration. METHODS: A cross-sectional observational study was carried out in health workers belonging to the city of Guayaquil-Ecuador, from March to May 2021. The participants were contacted through a local registry established by the Universidad Espíritu Santo. Frequencies and percentages were used to represent the proportions of nominal variables, while the mean and standard deviation were used for continuous data, given a normal sample distribution. RESULTS: Local skin reactions were the most frequent, and included redness, edema, and itching. On the other hand, delayed large local skin reactions (generalized rash and pruritus, angioedema, urticaria, eczema, petechiae) were rare and occurred in less than 1.4% of participants, (95% CI = 0.69-1.00). Finally, we did not find cases of anaphylaxis or other life-threatening reactions requiring urgent attention after vaccination. CONCLUSIONS: Our findings suggest that local skin reactions occur in a minority of recipients and are often mild and self-limited.

OBJECTIVO: Evaluar las reacciones cutáneas tras la administración de la vacuna COVID-19 de Pfizer-BioNTech. MÉTODOS: Se realizó un estudio observacional transversal en trabajadores de la salud, pertenecientes a la ciudad de Guayaquil-Ecuador, de marzo a mayo de 2021. Los participantes fueron contactados a través de un registro local establecido por la Universidad Espíritu Santo. Se utilizaron frecuencias y porcentajes para representar las proporciones de las variables nominales, mientras que la media y la desviación estándar se usaron para datos continuos, dada la distribución de muestra normal. RESULTADOS: Las reacciones cutáneas locales fueron las más frecuentes e incluyeron enrojecimiento, edema y prurito. Por otro lado, las reacciones cutáneas locales grandes retardadas (exantema y prurito generalizados, angioedema, urticaria, eccema y petequias) fueron raras y ocurrieron en menos de 1.4 % de los participantes, (IC 95 % = 0.69-1.00). Finalmente, no encontramos casos de anafilaxia u otras reacciones potencialmente mortales que requieran atención urgente después de la vacunación. CONCLUSIONES: Nuestros hallazgos sugieren que las reacciones cutáneas locales ocurren en una minoría de personas y que a menudo son leves y autolimitadas.

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RESUMEN Las reacciones cutáneas a drogas son cada vez más frecuentes en edades pediátricas, con un alto impacto en la salud de los niños. Pueden manifestarse en formas muy disímiles, desde un exantema transitorio hasta cuadros graves con afectación multisistémica potencialmente fatales. En la presente revisión se hace énfasis en las farmacodermias graves en la infancia, con el objetivo de promover el conocimiento por parte del personal médico para facilitar su diagnóstico y tratamiento oportuno. Se desarrolló una búsqueda en la Biblioteca Virtual de Salud de Infomed y en Google: se revisaron 28 trabajos científicos sin limitación de año y país, 24 de ellos pertenecen a los últimos cinco años y de estos 17 a los últimos tres. El dominio de los elementos para el diagnóstico precoz y las opciones terapéuticas son indispensables para elegir la conducta adecuada frente a estas reacciones cutáneas graves y disminuir la morbimortalidad por estas afecciones (AU).

ABSTRACT Skin reactions to drugs are increasingly common at pediatric ages, with a high impact on children's health. They can appear in very dissimilar forms, from a transient rash to serious pictures with potentially fatal multisystem involvement. This review focuses on severe pharmacodermies in the childhood, with the aim of promoting medical staff knowledge to facilitate their timely diagnosis and treatment. A search was led in the Infomed Virtual Health Library and in Google: 28 scientific papers were reviewed without limitation of year and country, 24 of them belong to the last five years and from these 17 to the last three. Mastery of the elements for early diagnosis and therapeutic options are indispensable to choose the appropriate behavior against these serious skin reactions and to decrease morbidity and mortality due to these conditions (AU).

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We present the case of a 73-year-old male patient with a history of tobacco use who presented with a central nervous system mass that was confirmed to be a lung adenocarcinoma metastasis. High PD-L1 expression as well as negativity to other targetable drivers led to initiation of pembrolizumab monotherapy and ablative stereotactic radiation therapy on oligo-residual disease, achieving a complete response after 2 years of therapy. Following discontinuation of systemic treatment, the patient developed widespread desquamative plaques. A skin biopsy revealed subepidermal blistering and eosinophilic infiltration in conjunction with C3 and IgG depositions on the basement membrane, detected by immunofluorescence. A diagnosis of bullous pemphigoid was obtained, and systemic corticosteroids were administered with lesion progression. Infliximab was also administered without meaningful clinical improvement. Metronomic cyclophosphamide achieved a complete resolution of skin lesions and up to this day the patient continues with tumor control and is free of dermatological findings. In conclusion, bullous pemphigoid is a very rare dermatological adverse effect related with pembrolizumab treatment. Only two cases, including this one, have been reported, especially with this medication for the treatment of non-small cell lung cancer. With more reported cases, management strategies can be optimized even in the steroid refractory setting.

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Psoriasis is a chronic inflammatory disease that directly affects the quality of life. Biologics are prescribed for patients unresponsive to conventional treatments and with severe forms of the disease. Ustekinumab is a fully human monoclonal antibody against the p40 subunit of interleukins 12/23 that is being used with satisfactory responses, achieving an improvement in the baseline Psoriasis Area and Severity Index of approximately 75% after 12 weeks of treatment. It has few side effects, including grater susceptibility to infections and development of reactions to the drug. Our report discusses a case of a cutaneous reaction to the use of ustekinumab in a 27 year-old male patient after the third dose of the medication. No similar case has been reported in the literature.

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As reações cutâneas a fármacos, também denominadas de erupção por fármacos, alergia a fármacos, dermatitemedicamentosa, hipersensibilidade medicamentosa ou farmacodermia são incomuns em cães e gatos.Clinicamente, se caracterizam por lesões cutâneas ou mucocutâneas pleomórficas, com ou sem sinaissistêmicos, resultantes da exposição a compostos químicos. O diagnóstico de reação cutânea a fármaco égeralmente difícil devido à ampla variedade de lesões cutâneas e semelhança com outras doenças. Este relato descreve um caso de reação a fármaco semelhante a pênfigo foliáceo em um cão, macho, Samoieda de quatromeses de idade, decorrente do uso de cefalexina. As lesões de pele incluíam: eritema, pústulas, descamação,crostas e hiperpigmentação na região periocular, focinho, face interna das orelhas, coxins, abdômen ventrale região perianal. O objetivo deste relato é alertar os clínicos de pequenos animais para a ocorrência dessetipo de reação cutânea e para a importância do total conhecimento de tratamentos previamente realizados.

Adverse skin reactions to drugs, also known as cutaneous drug eruptions, drug allergies, medication--associated dermatitis, drug hypersensitivity or pharmacodermia are uncommon in dogs and cats. Clinically,are characterized by skin or mucocutaneous pleomorphic lesions resulting from drug therapy, withor without systemic signs. The diagnosis of adverse skin reactions to drugs is usually challenging due tothe wide variety of cutaneous lesions involved and due to the similarity with lesions associated with otherconditions. This report describes a case of adverse skin reaction to a drug (cephalexin) resembling pemphigusfoliaceus in a 4-month old Samoyed dog. Skin lesions included erythema, pustules, scaling, crusts and hyperpigmentation in the periocular region, nose, internal aspect of the ears, palmar and plantar pads,ventral abdomen and perianal region. The purpose of the report is to draw the attention of small animalpractitioners to the occurrence of this special type of skin condition and stress the importance for thepractitioner to be fully aware of any kind of previous treatments his patient may have been submitted to.

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As reações cutâneas a fármacos, também denominadas de erupção por fármacos, alergia a fármacos, dermatitemedicamentosa, hipersensibilidade medicamentosa ou farmacodermia são incomuns em cães e gatos.Clinicamente, se caracterizam por lesões cutâneas ou mucocutâneas pleomórficas, com ou sem sinaissistêmicos, resultantes da exposição a compostos químicos. O diagnóstico de reação cutânea a fármaco égeralmente difícil devido à ampla variedade de lesões cutâneas e semelhança com outras doenças. Este relato descreve um caso de reação a fármaco semelhante a pênfigo foliáceo em um cão, macho, Samoieda de quatromeses de idade, decorrente do uso de cefalexina. As lesões de pele incluíam: eritema, pústulas, descamação,crostas e hiperpigmentação na região periocular, focinho, face interna das orelhas, coxins, abdômen ventrale região perianal. O objetivo deste relato é alertar os clínicos de pequenos animais para a ocorrência dessetipo de reação cutânea e para a importância do total conhecimento de tratamentos previamente realizados. (AU)

Adverse skin reactions to drugs, also known as cutaneous drug eruptions, drug allergies, medication--associated dermatitis, drug hypersensitivity or pharmacodermia are uncommon in dogs and cats. Clinically,are characterized by skin or mucocutaneous pleomorphic lesions resulting from drug therapy, withor without systemic signs. The diagnosis of adverse skin reactions to drugs is usually challenging due tothe wide variety of cutaneous lesions involved and due to the similarity with lesions associated with otherconditions. This report describes a case of adverse skin reaction to a drug (cephalexin) resembling pemphigusfoliaceus in a 4-month old Samoyed dog. Skin lesions included erythema, pustules, scaling, crusts and hyperpigmentation in the periocular region, nose, internal aspect of the ears, palmar and plantar pads,ventral abdomen and perianal region. The purpose of the report is to draw the attention of small animalpractitioners to the occurrence of this special type of skin condition and stress the importance for thepractitioner to be fully aware of any kind of previous treatments his patient may have been submitted to. (AU)

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La necrólisis epidérmica tóxica es un trastorno multifactorial, en el cual interactúan infecciones virales, medicamentosas y cierta susceptibilidad genética que se traduce en reacciones cutáneas adversas. Con este artículo se expone un caso de esta poco común entidad, la cual tiene un alto índice de morbimortalidad y secuelas. Se trata de un varón de 32 años, con antecedentes de síndrome convulsivo tratado con fenobarbital y fenitoína y con coinfección por virus de inmunodeficiencia humana de diagnóstico reciente pero sin seguimiento ni tratamiento, quien luego de consumir durante 12 días ciprofloxacino por fiebre elevada, presenta lesiones vesiculosas de fondo eritematoso, confluentes hasta formar flictenas en pared anterior tórax, de contenido seroso y con desprendimiento de la epidermis al ejercer suave presión sobre la piel afectada dejando áreas húmedas y rojas, con signo de Nikolsky positivo. La extensión de las lesiones compromete el 91% de su superficie corporal total, acompañada de prurito de moderada intensidad. Durante la estancia hospitalaria se realiza manejo terapéutico con ciclosporina A e inmunoglobulina G específica humana, cubrimiento antibiótico y antimicótico, con evolución satisfactoria del estado hemodinámico del paciente y las lesiones en piel. [Escalante E, Oliva J, Páez E. Necrólisis epidérmica tóxica en paciente infectado por virus de inmunodeficiencia humana. MedUNAB 2012; 15:68-72].

Toxic epidermal necrolysis is a multifactorial condition (viral infections, drug interactions, and genetics) generated by susceptibility to adverse reactions. In this paper we present a case of this rare disease, which has a high morbidity and mortality rate and sequelae. He is a 32 year-old male with a history of convulsive syndrome treated with phenobarbital and phenytoin, and untreated human immunodeficiency virus infection recently diagnosed. The patient was taking ciprofloxacin during 12 days by high fever, after that he presents confluent erythematous vesicles that form blisters on the anterior thorax with a positive Nikolsky sign. The extension of the injuries compromises 91% of their total body surface. While the patient was in hospital he was on a treatment with cyclosporin A and immunoglobulin G specific human, antibiotic and antifungal. It showed a satisfactory evolution of the patient's hemodynamic status and skin lesions. [Escalante E, Oliva J, Páez E. Toxic epidermal necrolysis in patient infected with human immunodeficiency virus. MedUNAB 2012; 15:68-72].

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