Management of chronic paronychia

Patients with advanced stage non-small cell lung cancer with sensitizing epidermal growth factor receptor (EGFR) mutations using EGFR tyrosine kinase inhibitors (TKIs) such as erlotinib, gefitinib and afatinib as first-line treatment had better progression-free survival, overall response rate and quality of life than those on chemotherapy. Although EGFR TKIs are commonly associated with skin-related (rash, xerosis and paronychia) and gastrointestinal-related (diarrhea and stomatitis) adverse events (AEs), these effects are usually mild. But severe cases can occur, significantly affecting patient's well-being, treatment compliance and quality of life. Therefore, patient education, early diagnosis, and prophylactic treatment are important strategies to optimally manage EGFR TKI-related adverse effects. In this review, we summarize the commonly encountered EGFR TKI-related AEs and provide a current overview of AE management in local practice with a focus on Asian patients. K E Y W O R D Sadverse drug events, gastrointestinal tract, mutations, non-small cell lung cancer, skin BACKGROUNDEighty percent of lung cancers are advanced-stage non-small cell lung cancer (NSCLC). (1) Epidermal growth factor receptor (EGFR) gene mutation, which is a major and potent oncogenic driver in NSCLC is a therapeutic target, with EGFR tyrosine kinase inhibitors (EGFR TKIs), altering the pattern of care in patients with advanced stage NSCLC.With EGFR TKIs (erlotinib, gefitinib and afatinib) as first-line treatment for patients with advanced stage NSCLC with sensitizing EGFR mutations, higher progression-free survival, overall response rate and quality of life than chemotherapy can be achieved. 1 These drugs are generally well tolerated as they have a predictable toxicity profile and less serious toxicities than traditional cytotoxic chemotherapy. 2 Nevertheless, EGFR TKIs can still produce severe adverse events (AEs) and impair quality of life.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. wileyonlinelibrary.com/journal/ajco 23

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“…43,45,46 Prolonged exposure to water should also be avoided. If the patient has to wear vinyl gloves, they should use cotton gloves underneath.…”

Section: Management Of Paronychiamentioning

confidence: 99%

Management of epidermal growth factor receptor tyrosine kinase inhibitor‐related cutaneous and gastrointestinal toxicities

Tan

Chin

et al. 2017

Asia-Pac J Clncl Oncology

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“…Topical/systemic antifungal agents, topical corticosteroids, topical/systemic antibiotics, tacrolimus ointment, and surgery can be used to treat CP. A response to therapy may take several weeks or months because clinical improvements develop slowly [3]. Following up to assess improvements achieved through the treatments and staging the CP are important in clinical practice and especially in clinical studies.…”

Section: Discussionmentioning

confidence: 99%

A Proposal for a New Severity Index for the Evaluation of Chronic Paronychia

Atış

Göktay

Ferhatoğlu

et al. 2018

Skin Appendage Disord

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Introduction: Chronic paronychia (CP) is an inflammatory disease of the nail folds. Staging of CP is important for clinicians. We developed an objective scale that evaluates each finding of CP separately in addition to evaluating the treatment process and follow-up. Methods: A new “chronic paronychia severity index scale” was developed to enable dermatologists to examine all features of CP. A previous categorical severity scale and this new scale were used for the evaluation of CP by 6 different dermatologists. The dermatologists evaluated the nails with both scales again 20 days later using randomly ordered photographs. Results: Using the previous scale, the intra-observer intraclass correlation coefficient (ICC) values between the first and second evaluations were 0.767, 0.860, 0.734, 0.609, 0.900, and 0.840 for the 6 dermatologists. Using the new proposed scale, the intra-observer ICC values between the first and second evaluations were 0.930, 0.931, 0.942, 0.934, 0.938, and 0.920 for the 6 dermatologists. All intra-observer ICC values were higher for the results of the proposed scale than for those of the previous scale. The inter-observer ICC values were also higher for the proposed scale than for the previous scale for the 6 dermatologists. Conclusion: The new scale is a standardized, more suitable, objective, and valuable method to use in clinical practice and studies on CP.

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“…It is a form of contact dermatitis [16,25], the aetiology of which is often complex. In the hand, patients affected include cleaners, laundry workers, food handlers, dishwashers, bartenders, swimmers and nurses [26]. Dermatological conditions such as Reiter's syndrome and pemphigus vulgaris can mimic paronychia and medications such as retinoids, antiretrovirals, and chemotherapeutics can cause paronychial inflammation [22,27].…”

Section: Chronic Paronychiamentioning

confidence: 99%

“…Referral to a dermatologist is essential and management should be led by their expertise. This may consist of irritant avoidance regimes, topical or systemic steroids, tacrolimus ointment, and surgical en bloc excision being reserved for recalcitrant cases [26].…”

Section: Chronic Paronychiamentioning

confidence: 99%

Toenail paronychia

Lomax

Thornton

Singh

2016

Foot and Ankle Surgery

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Paronychia is an inflammation of the tissues alongside the nail. It may be acute or chronic and can be seen in isolation or in association with an ingrowing toenail. Acute paronychial infections develop when a disruption occurs between the seal of the nail fold and the nail plate, providing a portal of entry for invading organisms. The treatment of paronychia associated with an ingrowing toenail is aimed at treating the causal toenail. In paronychia not associated with an ingrowing toenail, antibiotics may cure an early infection but surgical drainage of an abscess is often required. In this case, an intra-sulcal approach is preferable to a nail fold incision. Chronic paronychia is less common in the feet than in the hands. It is a form of contact dermatitis and is frequently non-infective, however the chronically irritated tissue may become secondarily colonised by fungi. A dermatology consultation should be obtained for suspected chronic paronychia. Patients with chronic paronychia that is unresponsive to standard treatment should be investigated for unusual causes, such as malignancy. An algorithm for the treatment of paronychia is presented in this review.

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Management of chronic paronychia

Cited by 34 publications

References 19 publications

Management of epidermal growth factor receptor tyrosine kinase inhibitor‐related cutaneous and gastrointestinal toxicities

Management of epidermal growth factor receptor tyrosine kinase inhibitor‐related cutaneous and gastrointestinal toxicities

A Proposal for a New Severity Index for the Evaluation of Chronic Paronychia

Toenail paronychia

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