Case and Research Letters
Inflammation of Actinic Keratosis During Panitumumab Therapy
Inflamación de queratosis actínicas durante el tratamiento con panitumumab
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En dermis observamos elastosis solar, melanófagos e infiltrado linfocitario sobre todo perifolicular (H&E ×10).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.M. Escudero-Góngora, L.J. del Pozo-Hernando, O. Corral-Magaña, E. Antón" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.M." "apellidos" => "Escudero-Góngora" ] 1 => array:2 [ "nombre" => "L.J." "apellidos" => "del Pozo-Hernando" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Corral-Magaña" ] 3 => array:2 [ "nombre" => "E." 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Case 2 presented with plantar lesion of PPP (a) and alopecia areata (b).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "T. Hiraiwa, T. Yamamoto" "autores" => array:2 [ 0 => array:2 [ "nombre" => "T." "apellidos" => "Hiraiwa" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Yamamoto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018300358" "doi" => "10.1016/j.ad.2017.09.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018300358?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302300?idApp=UINPBA000044" "url" => "/15782190/0000010900000008/v1_201810020631/S1578219018302300/v1_201810020631/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219018302609" "issn" => "15782190" "doi" => "10.1016/j.adengl.2017.09.003" "estado" => "S300" "fechaPublicacion" => "2018-10-01" "aid" => "1971" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2018;109:748" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4 "HTML" => 4 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>" "titulo" => "Depression of the Frontal Veins in Frontal Fibrosing Alopecia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "748" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Depresión de las venas frontales en la alopecia frontal fibrosante" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1134 "Ancho" => 850 "Tamanyo" => 135773 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. González-Guerra" "autores" => array:1 [ 0 => array:2 [ "nombre" => "E." 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Escudero-Góngora, L.J. del Pozo-Hernando, O. Corral-Magaña, E. Antón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.M." "apellidos" => "Escudero-Góngora" "email" => array:1 [ 0 => "mmarescudero88@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L.J." "apellidos" => "del Pozo-Hernando" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "O." "apellidos" => "Corral-Magaña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Antón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Inflamación de queratosis actínicas durante el tratamiento con panitumumab" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 760 "Ancho" => 1250 "Tamanyo" => 248697 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histological image showing atypical keratinocytes in the basal layer of the epidermis and hyperkeratosis in the follicular infundibulum. Solar elastosis, melanophages, and predominantly perifollicular lymphocytic infiltrate are evident in the dermis (hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Panitumumab is a monoclonal antibody that inhibits epidermal growth factor (EGF) by binding to its extracellular domain.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> It is approved for the treatment of metastatic colorectal carcinoma in patients who express EGF receptor and wild-type <span class="elsevierStyleItalic">KRAS</span>. Adverse cutaneous effects can occur in up to 90% of patients.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> We present a case of panitumumab-associated inflammation of subclinical actinic keratosis, an adverse effect not described in the literature to date.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was an 80-year-old woman who in 2007 had been diagnosed with stage IV <span class="elsevierStyleItalic">KRAS</span> wild-type adenocarcinoma with metastasis in the liver, lung, mediastinum, and peritoneum. After progression during several lines of chemotherapy she began intravenous panitumumab monotherapy every 3 weeks. Two months after beginning panitumumab treatment she attended the dermatology department with erythematous-desquamative lesions on the face that were rough to the touch and in some cases erosive (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). She had no history of skin problems and was taking no other medication. Dermatoscopy of the lesions showed an erythematous pseudoreticulum with a distinctive strawberry pattern (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Biopsy of one of the lesions revealed the presence of atypical keratinocytes, which were largely confined to the basal layer of the epidermis. Marked solar elastosis, predominantly perifollicular lymphocytic infiltrate, and scattered melanophages were evident in the dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The patient was diagnosed with grade 1 actinic keratosis with inflammation,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> for which she was treated for 2 weeks with a topical corticosteroid and antibiotics. She received a total of 8 cycles of panitumumab therapy. Five months later the lesions reappeared, leaving a residual pink macula (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Cutaneous effects of panitumumab include alterations of the hair and nails, mucositis, photosensitivity, xerosis, fissures, and papulopustular eruptions, and may necessitate dose reduction.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Inflammation of actinic keratosis is common in patients treated with imiquimod, ingenol mebutate, or topical 5-fluorouracil, and its intensity appears to be related to the degree of clinical response.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Subclinical actinic keratosis in the field of cancerization is also frequently observed following treatment with these agents,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and following systemic monotherapy with a variety of chemotherapeutic agents including fluorouracil, capecitabine, doxorubicin, deoxycoformycin, cisplatin, docetaxel, and fludarabine. Inflammation of actinic keratosis has also been reported in patients treated with combination therapies (dactinomycin, dacarbazine, and vincristine, and doxorubicin, cytarabine, and 6-thioguanine),<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and with new target therapies, including sorafenib, sunitinib, and erlotinib.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–9</span></a> However, we have found no reports linking panitumumab therapy to inflammation of actinic keratosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The pathogenesis of this reaction remains unclear. Inflammation of actinic keratosis in patients treated with classical chemotherapeutic agents may reflect a direct cytotoxic effect on atypical keratinocytes or radiation recall in the field of cancerization.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In the case of sunitinib, an antiangiogenic effect on atypical keratinocytes is suspected.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">EGF receptor function is dysregulated in actinic keratosis and squamous cell carcinoma.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> It is therefore possible that panitumumab-induced inhibition of this receptor triggered the inflammation of actinic keratosis in our patient. The preferential accumulation of the drug in the follicular infundibulum could favor hyperkeratinization and secondary inflammation of subclinical actinic keratosis, as previously proposed for erlotinib.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> It remains unknown whether this cutaneous reaction is associated with a better treatment response, as described for erlotinib.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In summary, we present the first described case of panitumumab-associated inflammation of subclinical actinic keratosis. While this adverse effect has been previously described for some classic chemotherapeutic drugs and new target therapies, the underlying mechanism remains unknown.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Escudero-Góngora MM, del Pozo-Hernando LJ, Corral-Magaña O, Antón E. Inflamación de queratosis actínicas durante el tratamiento con panitumumab. Actas Dermosifiliogr. 2018;109:749–751.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 501 "Ancho" => 1250 "Tamanyo" => 98321 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous desquamative lesions on the patient's forehead (A) that resolved after 8 cycles of panitumumab therapy (B).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 502 "Ancho" => 750 "Tamanyo" => 61551 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermatoscopic image of one of the lesions showing erythema, desquamation, and an erythematous pseudoreticulum with a strawberry pattern.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 760 "Ancho" => 1250 "Tamanyo" => 248697 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histological image showing atypical keratinocytes in the basal layer of the epidermis and hyperkeratosis in the follicular infundibulum. Solar elastosis, melanophages, and predominantly perifollicular lymphocytic infiltrate are evident in the dermis (hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 7 | 13 |
| 2024 October | 60 | 49 | 109 |
| 2024 September | 77 | 27 | 104 |
| 2024 August | 101 | 58 | 159 |
| 2024 July | 89 | 36 | 125 |
| 2024 June | 109 | 47 | 156 |
| 2024 May | 81 | 49 | 130 |
| 2024 April | 70 | 17 | 87 |
| 2024 March | 84 | 26 | 110 |
| 2024 February | 64 | 33 | 97 |
| 2024 January | 62 | 33 | 95 |
| 2023 December | 63 | 18 | 81 |
| 2023 November | 83 | 27 | 110 |
| 2023 October | 93 | 27 | 120 |
| 2023 September | 87 | 29 | 116 |
| 2023 August | 51 | 21 | 72 |
| 2023 July | 99 | 43 | 142 |
| 2023 June | 84 | 29 | 113 |
| 2023 May | 53 | 31 | 84 |
| 2023 April | 38 | 23 | 61 |
| 2023 March | 46 | 33 | 79 |
| 2023 February | 54 | 27 | 81 |
| 2023 January | 52 | 33 | 85 |
| 2022 December | 47 | 45 | 92 |
| 2022 November | 36 | 25 | 61 |
| 2022 October | 67 | 23 | 90 |
| 2022 September | 58 | 51 | 109 |
| 2022 August | 65 | 34 | 99 |
| 2022 July | 55 | 43 | 98 |
| 2022 June | 20 | 24 | 44 |
| 2022 May | 35 | 62 | 97 |
| 2022 April | 52 | 27 | 79 |
| 2022 March | 46 | 49 | 95 |
| 2022 February | 43 | 31 | 74 |
| 2022 January | 65 | 39 | 104 |
| 2021 December | 56 | 35 | 91 |
| 2021 November | 73 | 51 | 124 |
| 2021 October | 54 | 56 | 110 |
| 2021 September | 43 | 45 | 88 |
| 2021 August | 54 | 35 | 89 |
| 2021 July | 47 | 41 | 88 |
| 2021 June | 36 | 30 | 66 |
| 2021 May | 42 | 41 | 83 |
| 2021 April | 88 | 72 | 160 |
| 2021 March | 71 | 36 | 107 |
| 2021 February | 64 | 38 | 102 |
| 2021 January | 44 | 36 | 80 |
| 2020 December | 49 | 43 | 92 |
| 2020 November | 34 | 42 | 76 |
| 2020 October | 17 | 29 | 46 |
| 2020 September | 31 | 24 | 55 |
| 2020 August | 22 | 32 | 54 |
| 2020 July | 21 | 26 | 47 |
| 2020 June | 31 | 40 | 71 |
| 2020 May | 18 | 12 | 30 |
| 2020 April | 13 | 11 | 24 |
| 2020 March | 20 | 11 | 31 |
| 2020 February | 1 | 0 | 1 |
| 2020 January | 1 | 0 | 1 |
| 2018 December | 1 | 2 | 3 |
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