Atopic dermatitis (AD) patients with predominantly head and neck involvement react to patch tests of the yeast Malassezia sympodialis (Ms). Protein patch testing methods and interpretation are controversial, but subgroups of AD patients may have unique triggers for disease activity. The aim of the study was to identify clinical characteristics of patients who are patch test-positive to Dermatophagoides farinae/pteronyssinus (Df) and Ms and characterize cutaneous cytokine profiles of the atopy patch tests (APTs). 25 AD patients and 27 control dermatitis patients were patch tested with Ms and Df. Qualitative analysis of Th-1 and Th-2 cytokines by RT-PCR mRNA was obtained from positive APTs. Atopic dermatitis patients with a textile pattern or head and neck involvement demonstrated more positive APTs to Ms than control patients. Early positive APTs (<6 hr) did not exhibit a Th-1 type cytokine profile. The subgroup of adult AD patients with head, neck and upper torso pattern of dermatitis seems most likely to react to Ms (and Df). The immune mechanism of protein patch tests includes a Th-1 cell-mediated component after 6 hr or more.

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Prostate cancer is the second most common cancer globally diagnosed in men1, with more than 160,000 new cases each year in the United States.2 Even with relatively high rates of survival, many deaths occur due to metastases. It most often metastasizes to bone, to other sites including lymph nodes, lungs, and liver as well.1,3 A wide range of treatment options are currently available — active surveillance, surgery, radiation, chemotherapy, and hormonal therapeutics.2 Although most patients experience remission with standard therapy, approximately 10-20% of prostate cancer cases are castration-resistant.4 Up to 16% of these patients show no evidence that the cancer has spread at the time of the castration-resistant diagnosis.4 Castration-resistance refers to continued tumor growth despite appropriate hormonal treatment. In February 2018, apalutamide, a nonsteroidal antiandrogen (NSAA), was approved by the Food and Drug Administration (FDA) as the first drug for non-metastatic castration-resistant prostate cancer.4   Recently, there have been cases reporting generalized eruptive keratoacanthomas (EKA) in association with use of the program cell death (PD-1) targeting drugs like nivolumab, pembrolizumab, and leflunomide when treating malignancy. 5,6,7 However, based on our literature review, we were unable to find documented cases involving apalutamide.    We present the case of an 86-year-old Caucasian male with castration-resistant prostate cancer following radical prostatectomy diagnosed with biopsy-confirmed EKA with squamous cell carcinoma (SCC) two and a half months after the initiation of apalutamide.

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