Tinea incognito is a dermatophyte infection with atypical features, due to the use of topical or systemic steroids or other immunosuppressive medications. Delayed diagnosis, spread of the infection to critical body surfaces, resistance to antifungal drugs, and increased costs due to prolonged hospitalization and multiple treatment regimens often complicate tinea incognito. It can affect individuals of all ages and genders, but it is more common in children. Atypical clinical appearance often necessitates differentiation from other diseases such as eczema, seborrheic dermatitis, lupus erythematosus, psoriasis, or other non-fungal skin conditions. The treatment of tinea incognito usually involves discontinuation of topical steroids or other immunosuppressive medications. Preventive measures and management of the underlying fungal infection are necessary and can be achieved with antifungal drugs. Patients should wear loose cotton clothes, use boiling water for laundry, and iron their clothing before wearing them. Additionally, they should avoid sharing bed linens, towels, clothes, and shoes. This review aims to raise awareness of tinea incognito among health practitioners, provide tips for detecting the disorder, include it in the differentials, and evaluate the available diagnostic procedures.
1 December 2015 in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Immune checkpoint blockers (ICBs) have been widely used during the last decade for the treatment of various tumors, including advanced and metastatic melanoma. While these agents have improved melanoma patients’ survival rates, they have also been associated with various autoimmune toxicities, with the skin being most commonly affected. The severity of cutaneous toxicity can not only negatively affect patients’ quality of life but can also limit the proper treatment of cancer. Thus, the role of the dermatologist is substantial in early detecting and promptly treating these adverse events. Maculopapular rash, psoriasiform, lichenoid dermatoses and bullous pemphigoid are the most frequent cutaneous adverse events that require immediate intervention. Other rare autoimmune toxicities, e.g., sarcoidosis, dermatomyositis or subacute lupus, have also been reported. In this review, we summarize the aspects of ICB-induced cutaneous toxicities in patients with melanoma, emphasizing their management and treatment options in clinical practice.
Background: Allergic contact dermatitis (ACD) caused by (meth)acrylates used in nail products is being increasingly reported in nail technicians and consumers. Objectives: The aim of the study was to assess the incidence of sensitization to (meth)acrylates in technicians and users of nail products with ACD, referred for patch testing in a tertiary center, during the last 10 years. Methods: All patients with ACD, who reported a profession associated with cosmetic nail procedures or use of such services and were referred for patch tests in our department between January 2009 and December 2018, were identified. The incidence of positive sensitization to (meth)acrylates was assessed. Results: Contact allergy to 1 or more (meth)acrylates was found in 116 (74.4%) of 156 nail technicians or nail product users, all women. One hundred thirty-eight (88.5%) were occupationally exposed, and 18 (11.5%) were consumers. In addition, there was a statistically significant increase in (meth)acrylate ACD during 2014–2018 (100/127 cases [79%]) when compared with 2009–2013 (16/29 cases [55%]). The most common sensitizer among the 156 allergic individuals was ethylene glycol dimethacrylate, which was positive in 113 cases (72.4%), and among patients with acrylate-positive patch test, the rate was 97.4%. Conclusions: Our experience confirms the worldwide changing landscape of rising (meth)acrylate sensitization in nail technicians and nail products users with ACD. Efforts to improve prevention are needed, and clinicians should have a high index for suspicion in this occupational group.
The emergence of immune checkpoint inhibitors has revolutionized the landscape of cancer treatment in the modern era. However, cutaneous immune‐related adverse events (cirAEs) are common, significantly affecting patients' quality of life and often leading to treatment discontinuation, which may compromise oncological outcomes. Dupilumab, an immunoglobulin G4 (IgG4) human monoclonal antibody targeting interleukin (IL)‐4 and IL‐13 receptors, is widely used for dermatologic conditions but remains unapproved for cirAEs due to the limited and scattered supporting evidence. This review aimed to summarize the available evidence regarding the use of dupilumab for the management of cirAEs. A systematic review was conducted using MEDLINE/PubMed, Scopus, and Web of Science in adherence to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. In total, 25 publications met the eligibility criteria and were included, reporting 136 patients who were diagnosed with 140 cirAEs and were treated with dupilumab. The most frequently treated cirAEs were eczematous rashes, bullous pemphigoid, and maculopapular/morbilliform rashes. Dupilumab was found to be highly effective, with most patients achieving complete or partial responses, even when affected by two concomitant cirAEs. An acceptable safety profile was demonstrated regarding both adverse events and oncological safety, with no additional concerns to be raised. The findings may be encouraging but are limited by the relatively small number of patients treated and the nature of the included studies, with most of them being case reports and case series. More research is warranted, along with more clinical studies, prospective in design, focused on relevant clinical outcomes of this dupilumab‐treated subset of patients.