Topical Timolol for Paronychia and Pseudopyogenic Granuloma in Patients Treated With Epidermal Growth Factor Receptor Inhibitors and Capecitabine

Cubiró, Xavier; Planas-Ciudad, Sergi; Garcia-Muret, Ma Pilar; Puig, Lluís

doi:10.1001/jamadermatol.2017.4120

Cited by 29 publications

(18 citation statements)

References 6 publications

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“…Some previous studies used topical nonselective β‐AR blockers such as propranolol or timolol to treat EGFR inhibitor‐induced paronychia with pyogenic granuloma‐like lesions and found significant improvement . However, using topical nonselective β‐AR blockers to treat ulcerated infantile hemangiomas or pyogenic granuloma may induce asthma or bronchial spasm that might cause respiratory distress and much higher systemic absorption, especially under occlusion .…”

Section: Discussionmentioning

confidence: 99%

Treatment of epidermal growth factor receptor inhibitor‐induced severe paronychia with pyogenic granuloma‐like lesions with topical betaxolol: an open‐label observation study

et al. 2019

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Background Paronychia is a common adverse event caused by epidermal growth factor receptor (EGFR) inhibitors. However, high rates of post-treatment discomfort, infection, recurrence, and increased time to return to work have been noted after nail plate avulsion for EGFR inhibitor-induced paronychia. Furthermore, poor wound healing and malnutrition were common conditions found in cancer patients. The aim of this study is to find an effective, pain-relieving, and noninvasive treatment for patients with severe paronychia induced by EGFR inhibitors. Methods Data from a series of 35 non-small cell lung cancer cases suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions of digits treated with betaxolol 0.25% ophthalmic solution once daily were collected and analyzed. ResultsOf the 35 patients suffering from grade 2 or 3 paronychia with pyogenic granuloma-like lesions induced by EGFR inhibitors, 34 (97.1%) demonstrated complete resolution and only one (2.9%) had partial resolution after 12 weeks of topical betaxolol treatment. The grading of paronychia according to the Common Terminology Criteria for Adverse Events decreased from an average of 2.29 to 0.63 after 4 weeks of treatment (P = 5.55 9 10 À16 ). All the patients had significant improvement (50% pain reduction), as their pain visual analogue scale scores decreased from an average of 7.06 to 2.26 after one week of treatment (P = 6.11 9 10 À25 ).Conclusion Betaxolol 0.25% ophthalmic solution is an effective, safe, and pain-relieving treatment for patients suffering from EGFR inhibitor-induced paronychia with pyogenic granuloma-like lesions and deep fissures.

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Section: Discussionmentioning

confidence: 99%

Treatment of epidermal growth factor receptor inhibitor‐induced severe paronychia with pyogenic granuloma‐like lesions with topical betaxolol: an open‐label observation study

et al. 2019

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“…Furthermore, topical timolol can also be helpful in the case of periungual pyogenic granuloma. 33 In addition, to prevent nail adverse effects of targeted therapies, it is necessary patients to be advised and properly educated with de-…”

Section: Paronychiamentioning

confidence: 99%

Targeted therapy in oncology patients and skin: Pharmaceutical and dermocosmetic management

Varvaresou

Iakovou

Mellou

et al. 2019

J of Cosmetic Dermatology

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Background Numerous oncology patients who receive targeted therapy suffer from the skin adverse effects induced. Novel agents, that is tyrosine kinase inhibitors and RAS‐RAF‐MEK‐ERK pathway, have given good results in patient survival while decreasing the systemic toxicities in comparison to conventional cytotoxic chemotherapy, but are also related to skin adverse effects. Aims In this article, we highlighted the importance of specific pharmaceutical and dermocosmetic management of the untoward events of targeted therapy. Conclusion The combination of Oncodermatology, Psychodermatology, Cosmetic Dermatology, Cosmetic Science, Dermatopharmacology and Aesthetic Science can offer a lot for the prevention or early relief of the cutaneous adverse effects in oncology patients receiving targeted therapy.

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“…Chemotherapy‐induced paronychia has also been described in patients undergoing MEK inhibitors treatments (Dika et al, ). Recently Cubiró et al reported the successful treatment of chemotherapy‐induced paronychia and pseudopyogenic granuloma with topical timolol 0.5%, gel in 10 patients (Cubiró et al, ). To our knowledge, we report the first case of a MEK inhibitor‐induced paronychia treated successfully in a pediatric patient.…”

mentioning

confidence: 99%

“…Based on the multifocal distribution, the non‐effective prior surgery and the few publications showing very good responses with topical beta blocker treatment (Cubiró et al, ; Piraccini et al, ) for drug‐induced paronychia, we decided to initiate timolol gel 0.5% twice daily while trametinib continued being necessary. His parents referred clinical response after 10 days with residual erythema and scaling but without pain or edema.…”

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confidence: 99%

“…Piraccini et al (Piraccini et al, ) were the first to describe effectiveness of beta blocker topical treatment in antineoplastic‐induced pyogenic granulomas. After that, Cubiró et al (Cubiró et al, ) described the use of topical timolol 0.5% gel in 10 patients with paronychia and all achieved clinical response. Recently Sibaud et al reported 13 “real life” cases showing improvement in two thirds of patients (Sibaud et al, ).…”

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confidence: 99%

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Recalcitrant trametinib‐induced paronychia treated successfully with topical timolol in a pediatric patient

Martinez-de-Espronceda

Bernabéu‐Wittel

Azcona

et al. 2019

Dermatologic Therapy

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Paronychia has been described as a side effect in patients undergoing treatment with MEK (mitogen activated protein kinase enzyme) inhibitors. It is usually a recurrent condition that can have a significant impact in the quality of life. Topical beta blocker treatment has been described as an effective therapy in antineoplastic-induced pyogenic granulomas and in antineoplastic-induced paronychia. We describe the first case treated with topical timolol for a trametinib-induced paronychia in a pediatric patient that allowed to continue the third line antineoplastic therapy for his glioma.

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Topical Timolol for Paronychia and Pseudopyogenic Granuloma in Patients Treated With Epidermal Growth Factor Receptor Inhibitors and Capecitabine

Cited by 29 publications

References 6 publications

Treatment of epidermal growth factor receptor inhibitor‐induced severe paronychia with pyogenic granuloma‐like lesions with topical betaxolol: an open‐label observation study

Treatment of epidermal growth factor receptor inhibitor‐induced severe paronychia with pyogenic granuloma‐like lesions with topical betaxolol: an open‐label observation study

Targeted therapy in oncology patients and skin: Pharmaceutical and dermocosmetic management

Recalcitrant trametinib‐induced paronychia treated successfully with topical timolol in a pediatric patient

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