Skin reactions caused by bone-anchored hearing aid(BAHA) implantation

Objective: To report a case of intractable skin reactions caused by bone-anchored hearing aid (BAHA) implantation to improve our under-standing and treatment of BAHA implantation-caused skin reactions. Methods:We reported a case of severe skin reactions caused by BAHA implantation. Related literature were also reviewed. Results:We found grade IV skin reactions, including hyperplasia around the implant, which led to the removal of the BAHA implant 10 months after implantation. The findings indicated poor skin hygiene, allergy to titanium and inadequate surgicals skills as the possible causes of the skin reaction. Conclusion: Skin adverse reactions, usually rare in BAHA implantation patients, may cause implant removal and implantation failure. We suggest to further investigate the mechanisms underlying titanium allergy. Copyright ? 2016, PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Adverse Skin Reactions to Personal Protective Equipment Among Health-Care Workers During COVID-19 Pandemic: A Multicenter Cross-sectional Study in Indonesia

Objective:Health-care workers(HCWs)in Indonesia have been participating in the war against the coronavirus disease-2019 since March 2020.Ever since HCWs were exposed to the regular use of personal protective equipment(PPE)with varying levels and maintain hand hygiene more as recommended by the World Health Organization.Adverse skin reactions to PPE in Indonesia has yet to be acknowledged.This study aimed to study the prevalence and characteristics-,possible risk factors-,and suggest possible solutions towards adverse skin reactions to PPE among HCWs in a multi-center setting of Indonesia.Methods:A cross-sectional survey was conducted online among HCWs in the Siloam Hospitals Group of Banten province.HCWs of Banten Province were surveyed from June 1 to August 31,2020.The data was obtained using avalidated online survey questionnaire including(1)demographic characteristics;(2)occupational-related characteristics;(3)adverse skin reactions.Results:A response rate of 40.2%was obtained and 200 valid respondents were yielded.The mean age of respondents was(26.94±7.23)years old.Adverse skin reactions(66.5%)were reported primarily in female(73.7%)working as doctors(82.7%)of a non-referral center for coronavirus disease-2019(60.2%)wearing level 2 and 3 PPE(43.6% and 37.6%,respectively).The cheeks and chin was the most common site involved(69.9%)with dryness/tightness(63.9%)and acne(77.4%)as the highest symptoms and signs reported.Sex,age group classification,level of PPE worn,hand hygiene frequency,and duration of PPE worn daily were factors considerably associated with adverse skin reactions to PPE(P<0.05).Conclusions:Adverse skin reactions to PPE are common among HCWs in Indonesia.Comprehensive strengthening of the skin condition and awareness on adverse skin reactions should be advocated.

Association between Skin Reactions and Efficacy of Summer Acupoint Application Treatment on Chronic Pulmonary Disease:A Prospective Study

Objective： To examine the variations in the prevalence of skin reactions and the association between skin reactions and efficacy of summer acupoint application treatment （SAAT） on chronic pulmonary disease （CPD）. Methods： A total of 2,038 patients with CPD were enrolled at 3 independent hospitals （defined as Groups A, B and C, respectively） in China. All patients were treated by SAAT, as applying a herbal paste onto the acupoints of Fengmen （BL 12） and Feishu （BL 13） on the dog days of summer, according to the lunar calendar, in 2008. Ten days after treatment, skin reaction data （no reaction, itching, stinging, blistering, and infection） were obtained via face-to-face interviews. Patients were retreated in the same hospital one year later, thereby allowing doctors to assess treatment efficacy based on the patients＇ symptoms, the severity of the spirometric abnormalities, and the concomitant medications used. Results： A large number of patients （85.3%） displayed reactive symptoms; however, the marked associations between reactive symptoms and age or gender were not observed. An increased number of patients from Group B （99.3%） and Group C （76.5%） displayed reactive symptoms due to the increased mass of crude Semen Sinapis Albae. The effective rate of SPAT was as high as 90.4% for patients of Group B, which was followed by Group A （70.9%） and Group C （42.2%）. Using stratified analyses, a convincing association between reactive symptoms and therapeutic efficacy was observed for patients with asthma [itching： odds ratio （OR）=2,17, 95% confidence interval （CI）： 1.49 to 3.14; blistering： OR=0.43, 95% Ch 0.25 to 0.73; and no reaction： OR=0.56, 95% CI： 0.35 to 0.90]. However, the same tendency was not observed for patients with chronic bronchitis and chronic obstructive pulmonary disease. Conclusions： SAAT can induce very mild skin reactions for patients with CPD, among which patients with asthma displayed a strong association between skin reactions and therapeutic efficacy. The skin reactions may be induced by the crude Semen Sinapis Albae.

Rare bullous pemphigoid during PD-1 inhibitor therapy:a case report

Immunotherapy is an important treatment modality in cancer,but it can also cause adverse reactions,with skin toxicity being the most common.The increasing number of immune checkpoint inhibitors being used in the clinic will inevitably cause an increase in the rate of adverse skin reactions that markedly affect the patient's quality of life.A 58-year-old patient with intrahepatic cholangiocareinoma developed bullous pemphigoid(BP)nearly a year after using immune checkpoint inhibitors,which is different from what has been reported inthe literature within two weeks of treatment.Pathologically,the skin biopsy diagnosis was epidermal hyperplasia and focal sub-epidermal pustule formation,consistent with drug-induced dermatitis.The patient was treated with methylprednisolone,minocyeline,colchicine,nicotinamide,triamcinolone,and traditional Chinese medicine decoction.No new blisters developed after 1 week of treatment.The medication was gradually discontinued,and BP did not recur.Clinicians should carefully consider the risk-benefit ratio when using PD-1 inhibitors,particularly concerning rash severity.Further studies are needed to investigate the relationship between adverse skin reactions and drug efficacy.

A Case Report:Severe Bullous Skin Reaction Induced by Anti-PD-1 Antibody(Toripalimab)Therapy in a Patient with Thymic Carcinoma

The development of immune checkpoint inhibitors,such as those targeting programmed cell death protein 1(PD-1),represents a major breakthrough in cancer therapy.Although immune checkpoint blockade therapy has a favorable risk/benefit ratio,it causes significant immune-related adverse events(irAEs),such as cutaneous reactions,in particular,severe bullous skin reactions and toxic epidermal necrolysis.Here,we report a case of a 51-year-old woman with malignant thymoma who developed a severe bullous skin reaction(characterized by a systemic rash,bullae,epidermal desquamation,and Stevens-Johnson syndrome)as a result of treatment with the PD-1 inhibitor toripalimab.The patient was treated with high doses of glucocorticoid,intravenous immunoglobulin,and intensive care,and eventually recovered from the severe irAEs.The intravenous injection of anti-PD-1 antibodies induces cutaneous reactions,which are associated with higher mortality rates.High doses of glucocorticoid combined with intravenous immunoglobulin are effective in alleviating such irAEs.Thus,improving the level of care and preventing skin infections can effectively reduce the risk of death.