JOURNAL READING

“SYSTEMIC DRUG-INDUCED
CHRONIC PARONYCHIA AND
PERIUNGUAL PYOGENIC
GRANULOMA”
DERMATOVENEREOLOGY Consulent:
HUSADA HOSPITAL dr. Juliana,MH.Kes, Sp.KK
FACULTY OF MEDICINE
TARUMANAGARA UNIVERSITY
INTAN SARI
406181035
REVIEW ARTICLE
“SYSTEMIC DRUG-INDUCED CHRONIC PARONYCHIA AND
PERIUNGUAL PYOGENIC GRANULOMA”
 INTRODUCTION

Chronic
Paronychia
SYSTEMIC DRUG
- ANTICANCER
AGENTS Periungual
Pyogenic
Granuloma
ANTI TAXANE
CANCER
AGENTS EGFRI
EGFRI
EGFR-TKI EGFR-TKI
TKI
MEK-REKI
TKIs

MEK-REK Inhibitors
Anti- CD20
Monoclonal
BRAF Inhibitors VEGF
Antibody
Inhibitor

Anti-CD20 monoclonal antibody

VEGF Inhibitor

Retinoids TAXANE
ANTICANCER AGENTS
TAXANE
Docetaxel, Paclitaxel
EGFRI
Cetuximab, Panitumumab
EGFR-TKI
Gefitinib, Erlotinib, Icotinib, Afatinib, Osimetrinib
TKIs
Imatinib
MEK-REK Inhibitors
Cometinib, Trametinib, Selumetinib
BRAF Inhibitors
Vemurafenib, Dabrafenib, Sorafenib
Anti-CD20
monoclonal antibody Rituximab
VEGF Inhibitor
Bevacizumab, Ranibizumab
Retinoids
Isotretinoin
 TAXANE EGFRI EGFR-TKI
• 40–89% during • 10% Paronychia is • 13% to 22% of patients
treatments with cutaneousadverse as adverse
Docetaxol ,onycholysis event during event of Gefitinib.
and discoloration as treatment with • 30 – 35% Paronychia
the most common cetuximab seen in has been observed in
findings. most common patients
• Paronychia is an patients.[2] treated with
uncommon adverse Osimertinib.[3]
event. [1]

[1] Winther D, Saunte DM, et al. Nail changes due to docetaxel - a neglected side effect and nuisance for the patient. Support Care Cancer 2007;15:1191-7.
[2]Soda H, Maeda H, et al. Multicenter Phase II study of FOLFOX or biweekly XELOX and Erbitux (cetuximab) as first-line therapy in patients with wild-type KRAS/BRAF
metastatic colorectal
cancer: The FLEET study. BMC Cancer 2015;15:695.
[3] Takimoto T, Hirashima T,et al. Gefitinib for previously untreated patients with non-small cell lung cancer (NSCLC)--a retrospective study of 12 patients treated in one
institution. Gan To Kagaku Ryoh 2005;32:1985-8.
 MEK-REK BRAF
TKIs
Inhibitors Inhibitors
• Imatinib-induced • Trametinib : non spesific • Vemurafenib is known
periungual PG has paronychia to induce paronychia
been observed • Selumetinib : 9% spesific but trials suggest that
paronychia (delayed this adverse effect is
occasionally. [4]
onset, erythema, uncommon.[6]
swelling, ingrown nail,
and resolution upon
treatment
interruption).[5]

[4] Dika E, Barisani A, et al. Periungual pyogenic granuloma following imatinib therapy in a patient with chronic myelogenous leukemia. J Drugs Dermatol 2013;12:512-3.
[5] Balagula Y, Barth Huston K,et al. Dermatologic side effects associated with the MEK 1/2 inhibitor selumetinib (AZD6244,ARRY-142886). Invest New Drugs 2011;29:1114-21.
[6]Chapman PB, Hauschild A, Robert C, et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med 2011;364:2507-16.
 Anti-CD20
monoclonal VEGF Antibody RETINOIDS
antibody
• Multiple periungual PG’s • chronic paronychia in a • Isotretinoin ,In a large series of acne
have been observed in patient with colorectal patients, chronic paronychia
and hypergranulation of the lateral
a 73-year-old female cancer treated with nail folds have been described in four
patient suffering from Bevacizumab-FOLFIRI patients [9]Such adverse
• Etretinate and less with acitretin for
rheumatoid arthritis (5-fluorouracil,folinic induced paronychia. [10]
treated by Rituximab acid, irinotecan).[8] • In rare cases, PG formation has been
[Figure 3].[7] observed in patients
treated with acitretin [11]

[7]Wollina: Paronychia and pyogenic granuloma 298 Indian Dermatology Online Journal | Volume 9 | Issue 5 | September-October 2018 during anti-CD20 monoclonal
antibody therapy for rheumatoid arthritis. J Dermatol Case Rep 2010;4:44-6
[8] ung JJ, Della Torre KE, Fell MR, Teng CC,et al.Presumed pyogenic granuloma associated with intravitreal anti-vascular endothelial growth factor therapy. Open
Ophthalmol J 2011;5:59-62.
[9]Bigby M, Stern RS. Adverse reactions to isotretinoin. A report from the Adverse Drug Reaction Reporting System. J Am Acad Dermatol 1988;18:543-52.
[10]Baran R. Etretinate and the nails (study of 130 cases)possible mechanisms of some side-effects. Clin Exp Dermatol1986;11:148-52.
[11] Figueiras Dde A, Ramos TB, Marinho AK, Bezerra MS, Cauas RC. Paronychia and granulation tissue formation during treatment with isotretinoin. An Bras Dermatol
2016;91:223-5.
 DISCUSSION

Prevention and Treatment

• For mild cases :

• topical solution
• 2% povidone-iodine in a dimethylsulfoxide vehicle has
6 weeks of treatment. (76% effective)
• The combination = corticosteroid + topical fusidinic
acid.
• Chronic / Severe cases :
• Surgery or laser-surgery is a treatment option to
reduce the time to complete healing.

Conflict of Interest

• There are no conflict of interest

Journal Resources:
Wollina U. Systemic drug-induced chronic
paronychia and periungual pyogenic
granuloma. Indian Dermatol Online J
2018;9:293-8. [Downloaded free from
http://www.idoj.in on Tuesday, September 18,
2018, IP: 120.188.81.44].