Silvina Pugliese, MD

All Publications

• Erythema dyschromicum perstans-like eruptions induced by epidermal growth factor receptor inhibitors in patients with lung cancer. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Bang, A. S., Said, J. T., Hirner, J., Rana, J., Pugliese, S., Wang, J. Y., Zaba, L., Zhao, L., Doan, L., Smith, J., Kwong, B. Y. 2024; 32 (6): 354

  Abstract

  Cutaneous adverse reactions to epidermal growth factor receptor inhibitors (EGFRi) are some of the most common side effects that patients experience. However, cutaneous adverse reactions that cause dyspigmentation in patients have been rarely reported. Erythema dyschromicum perstans (EDP) is a rare pigmentary condition that causes ashy-grey hyperpigmented macules and patches, with a few cases reported from EGFRi in the literature. The disfiguration caused by this condition may negatively impact patients' quality of life. Our study aimed to describe the clinical characteristics of EDP induced by EGFRi to better recognize and manage the condition.We conducted a multicenter retrospective review at three academic institutions to identify patients with EDP induced by EGFRi from 2017 to 2023 and included sixteen patients in our study.The median age of patients was 66 years old, with 63% female and 37% male (Table 1). The majority of our patients were Asian (88%). All patients had non-small cell lung cancer and most patients received osimertinib. Median time to EDP was 6 months. The most common areas of distribution were the head/neck region, lower extremities, and upper extremities. Various topical ointments were trialed; however, approximately less than half had improvement in their disease and most patients had persistent EDP with no resolution. All patients desired treatment except one with EDP on the tongue, and there was no cancer treatment discontinuation or interruption due to EDP. Table 1 Patient demographics and clinical characteristics of 16 patients with EDP induced by EGFRi Case no Demographics: age, race, and sex Fitzpatrick skin type Cancer type EGFR therapy Concomitant photosensitive drug(s) Time to EDP (months) Clinical features Distribution Symptoms Treatments and clinical course EDP status from most recent follow up 1 47 y/o Asian male III Stage IV NSCLC Erlotinib None Unknown Brown-blue-gray hyperpigmented patches Bilateral shins Left thigh Xerosis Pruritus Triamcinolone 0.1% ointment for 4 months, improvement of blue discoloration Tacrolimus 0.1% BID for 9 months, improvement but no resolution Ongoing 2 62 y/o Asian female IV Stage IV NSCLC Osimertinib None 4 Gray-brown hyperpigmented patches Bilateral arms Back Forehead Neck Right shin None Tacrolimus 0.1% ointment for 1 year with minor improvement Ongoing 3 69 y/o Asian female IV Stage IV NSCLC Osimertinib None 4 Gray-brown macules and patches Chest Face Forehead Bilateral legs None Tacrolimus 0.1% ointment for 10 months, no improvement Ongoing 4 79 y/o White male II Stage IV NSCLC Osimertinib None 15 Mottled grey-blue hyperpigmented patches and plaques with mild scaling Bilateral arms Back Forehead Neck None Photoprotection, no improvement Ongoing 5 69 y/o Asian female III Stage IV NSCLC Osimertinib Ibuprofen 4 Blue-grey hyperpigmented macules and patches Abdomen Bilateral arms None Tacrolimus 0.1% ointment for 7 months, no improvement Ongoing 6 65 y/o Asian male III Stage IV NSCLC Osimertinib None 20 Hyperpigmented blue gray macules and patches Helix Bilateral shins None Photoprotection, no improvement Ongoing 7 66 y/o Asian female IV Stage IV NSCLC Erlotinib TMP-SMX 6 Ashy grey-brown thin plaques Back Forehead None 2.5% hydrocortisone ointment for 8 months, resolved Resolved 8 82 y/o Asian male III Stage III NSCLC Erlotinib Simvastatin 20 Ash-grey hyperpigmented patches Dorsal feet Forehead Scalp None Photoprotection Ongoing 9 57 y/o Asian female III Stage II NSCLC Erlotinib None 1 Bue-grey discoloration Tongue None No intervention Ongoing 10 51 y/o Asian female III Stage IV NSCLC Osimertinib None 9 Blue-grey hyperpigmented macules and patches Bilateral arms Axillae Groin Neck Trunk None 2.5% hydrocortisone ointment, triamcinolone 0.1% ointment, photoprotection with mild improvement Ongoing 11 67 y/o Asian male III Stage IV NSCLC Osimertinib None 7 Gray-blue macules and patches with mild background erythema and scaling Bilateral arms Ears Face Bilateral shins None Triamcinolone 0.1% ointment, protection for 6 months with mild improvement Ongoing 12 75 y/o Asian female IV Stage III NSCLC Osimertinib TMP-SMX 3 Gray-blue hyperpigmented patches Bilateral arms Abdomen Back Face Bilateral shins Pruritus Triamcinolone 0.1% and betamethasone 0.01% with relief of pruritus, lesions unchanged Triluma cream 6 months, mild improvement Ongoing 13 42 y/o Asian male IV Stage IV NSCLC Afatinib TMP-SMX 24 Grey-brown hyperpigmented patches Back Face None Hydroquinone 4% cream for 2 years with mild improvement Ongoing 14 74 y/o White female III Stage II NSCLC Osimertinib Atorvastatin 4 Grey-brown hyperpigmented patches Bilateral legs Trunk None Photoprotection Ongoing 15 64 y/o Asian female IV Stage IV NSCLC Osimertinib None 3 Gray-brown hyperpigmentation Abdomen Bilateral arms Back Bilateral legs Pruritus Triamcinolone 0.1% cream; No change, minimal concern to patient Ongoing 16 52 y/o Asian female IV Stage IV NSCLC Osimertinib None 42 Gray hyperpigmented patches with digitate shape Abdomen Bilateral flanks None Triamcinolone 0.1% cream Ongoing NSCLC, non-small cell lung cancer, TMP-SMX, Trimethoprim/Sulfamethoxazole CONCLUSIONS: We highlight the largest case series describing EDP from EGFR inhibitors, which mostly affected Asian patients with lung malignancy and on EGFR tyrosine kinase inhibitors. Clinicians should be able to recognize this condition in their patients and assess how it is affecting their quality of life, and refer to dermatology to help with management.

  View details for DOI 10.1007/s00520-024-08551-x

  View details for PubMedID 38750379

  View details for PubMedCentralID 7005333

• Association of Intraoperative Antibiotic Irrigation With Systemic Contact Dermatitis. JAMA dermatology So, J. Y., Suzuki, N., Chen, J. K., Pugliese, S., Kwong, B. Y., Meng, L., Honari, G. 2022

  Abstract

  This case series describes the development of morbilliform drug eruption after breast surgery.

  View details for DOI 10.1001/jamadermatol.2022.4458

  View details for PubMedID 36383358

• Consensus on the Clinical Management of Chronic Radiation Dermatitis and Radiation Fibrosis: A Delphi Survey. The British journal of dermatology Wilson, B. N., Shah, R., Menzer, C., Aleisa, A., Sun, M. D., Kwong, B. Y., Kaffenberger, B. H., Seminario-Vidal, L., Barker, C. A., Stubblefield, M. D., Romesser, P. B., Fabbrocini, G., Alam, M., Abdulla, F., Dulmage, B., Sibaud, V., Anadkat, M., Mazer, J., Parikh, D., McLellan, B., Cartier, H., Pugliese, S., Wolkerstorfer, A., Laubach, H., LeBoeuf, N., Leventhal, J., Wan, D. C., Choi, J., Thanh Nga, T., Anderson, R. R., Markova, A., Rossi, A. 2022

  View details for DOI 10.1111/bjd.21852

  View details for PubMedID 36047980

• Partnering with a senior living community to optimize teledermatology via full body skin screening during the COVID-19 pandemic: a pilot program Skin Health and Disease Trinh, P., Yekrang, K., Phung, M., Pugliese, S., Chang, A. S., Bailey, E. E., Ko, J. M., Sarin, K. Y. 2022; 2 (3): e141

  View details for DOI 10.1002/ski2.141

• NUTRITIONAL DEFICIENCY CONTRIBUTING TO REFRACTORY ERYTHRODERMA IN HEMATOPOETIC CELL TRANSPLANT PATIENTS: DISTINCTIVE CLINICAL AND HISTOPATHOLOGICAL FINDINGS. Journal of the American Academy of Dermatology Winge, M. C., Rieger, K. E., Kim, J., Weng, W., Johnston, L. J., Miklos, D. B., Strelo, J., Zaba, L. C., Pugliese, S. B., Novoa, R. A., Kwong, B. Y. 2021

  View details for DOI 10.1016/j.jaad.2021.07.077

  View details for PubMedID 34450206

• Drug-induced hypersensitivity syndrome like reaction with angioedema and hypotension associated with BRAF inhibitor use and antecedent immune checkpoint therapy. JAAD case reports Rana, J., Maloney, N. J., Rieger, K. E., Pugliese, S. B., Strelo, J. L., Liu, A., Zaba, L. C., Kwong, B. Y. 2021; 13: 147-151

  View details for DOI 10.1016/j.jdcr.2021.04.033

  View details for PubMedID 34195327

• Disseminated Tuberculosis Presenting as Medium-Vessel Vasculitis in an Immunocompromised Host. Journal of cutaneous pathology Wang, J. Y., Brown, R. A., Pugliese, S., Kwong, B. Y., Novoa, R. A. 2020

  Abstract

  Cutaneous tuberculosis is an uncommon entity with several clinical forms recognized. Histopathologically, most cases are characterized by granulomatous inflammation and caseating necrosis, though less common findings, including vasculitis, have also been described. We report a 55-year-old male with a history of recently diagnosed dermatomyositis receiving immunosuppression with mycophenolate mofetil and prednisone, who developed multifocal soft tissue abscesses and an indurated erythematous plaque on the back. Skin biopsy of the back revealed a necrotizing medium-vessel vasculitis. M. tuberculosis was detected in the skin via acid-fast bacilli stain and confirmed by tissue culture and polymerase chain reaction. Cutaneous findings improved rapidly with anti-tuberculosis therapy. This case illustrates an uncommon clinical and histopathologic presentation of disseminated tuberculosis. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/cup.13678

  View details for PubMedID 32133689

• Pityriasis rubra pilaris-like graft-vs-host disease following allogeneic stem cell transplant in two patients. Clinical case reports Wang, J. Y., Tabata, M. M., Pugliese, S., Phillips, D., Kim, J., Weng, W. K., Kwong, B. Y. 2019; 7 (12): 2491-2494

  Abstract

  Chronic cutaneous graft-vs-host disease (GVHD) has several atypical variants. We describe two cases of GVHD with clinical and histopathologic features of pityriasis rubra pilaris (PRP), which responded to additional immunosuppression. Recognition of this newly described PRP-like clinical presentation of GVHD may prompt early consideration of additional steroid-sparing therapies.

  View details for DOI 10.1002/ccr3.2458

  View details for PubMedID 31893086

  View details for PubMedCentralID PMC6935619

• Pityriasis rubra pilaris-like graft-vs-host disease following allogeneic stem cell transplant in two patients CLINICAL CASE REPORTS Wang, J. Y., Tabata, M. M., Pugliese, S., Phillips, D., Kim, J., Weng, W., Kwong, B. Y. 2019

  View details for DOI 10.1002/ccr3.2458

  View details for Web of Science ID 000496342800001

• Association of Antibiotic Resistance With Antibiotic Use for Epidermal Growth Factor Receptor Inhibitor-Related Papulopustular Eruption JAMA DERMATOLOGY Hirotsu, K., Dang, T. M., Li, S., Neal, J. W., Pugliese, S., Subramanian, A., Kwong, B. Y. 2019; 155 (7): 848–50

  View details for DOI 10.1001/jamadermatol.2019.0063

  View details for Web of Science ID 000482127300016

• Association of Antibiotic Resistance With Antibiotic Use for Epidermal Growth Factor Receptor Inhibitor-Related Papulopustular Eruption. JAMA dermatology Hirotsu, K. n., Dang, T. M., Li, S. n., Neal, J. W., Pugliese, S. n., Subramanian, A. n., Kwong, B. Y. 2019

  View details for PubMedID 31017625

• Localized bullous pemphigoid in a melanoma patient with dual exposure to PD-1 checkpoint inhibition and radiation therapy. JAAD case reports Hirotsu, K. n., Chiou, A. S., Chiang, A. n., Kim, J. n., Kwong, B. Y., Pugliese, S. n. 2017; 3 (5): 404–6

  View details for PubMedID 28884139

• Cutaneous Complications of Targeted Melanoma Therapy (17, 57, 2016) CURRENT TREATMENT OPTIONS IN ONCOLOGY de Golian, E., Kwong, B. Y., Swetter, S. M., Pugliese, S. B. 2016; 17 (12): 63

  View details for PubMedID 27817056

• Cutaneous Complications of Targeted Melanoma Therapy. Current treatment options in oncology de Golian, E., Kwong, B. Y., Swetter, S. M., Pugliese, S. B. 2016; 17 (11): 57-?

  Abstract

  The landscape of advanced and metastatic melanoma therapy has shifted dramatically in recent years. Since 2011, eight drugs (ipilimumab, vemurafenib, dabrafenib, trametinib, cometinib, pembrolizumab, nivolumab, and talimogene laherparepvec) have received FDA approval for the treatment of advanced or metastatic melanoma, including combination regimens of both small molecule kinase and immune checkpoint inhibitors. These therapies have revolutionized the management of unresectable regional nodal and distant melanoma, providing hope of extended survival to patients. As the use of novel agents has increased, so have the cutaneous toxicities associated with these medications. While most skin reactions are low-grade and can be managed conservatively with topical therapies, malignant lesions and more serious or life-threatening drug reactions can arise during therapy, requiring prompt dermatologic recognition and treatment in order to improve patient outcome. Given the survival benefit attributed to these new agents, treating skin toxicity and maintaining patient quality of life is of paramount importance. Oncologists should be aware of the common cutaneous toxicities associated with these medications and should be encouraged to involve dermatologists in the collaborative care of advanced melanoma patients. Close communication between oncologists and dermatologists can help to avoid unnecessary dose reduction or treatment discontinuation and identify situations when treatment cessation is truly warranted.

  View details for DOI 10.1007/s11864-016-0434-0

  View details for PubMedID 27645330

• Management of Dermatologic Complications of Lung Cancer Therapies. Current treatment options in oncology Pugliese, S. B., Neal, J. W., Kwong, B. Y. 2015; 16 (10): 50-?

  Abstract

  In recent years, oncogene-directed targeted agents and immunotherapies have expanded the treatment armamentarium for advanced lung cancer and, in particular, non-small cell lung cancer (NSCLC). Along with extended survival, these agents are accompanied by a host of cutaneous complications that affect the skin, hair, and nails. These skin complications range from the well-characterized papulopustular (acneiform) eruption of the epidermal growth factor receptor (EGFR) inhibitors to the emerging characterization of lichenoid skin eruptions seen during treatment with antibodies targeting the programmed cell death protein 1 (PD-1) and programmed cell death protein 1 ligand (PD-L1). When promptly recognized and accurately diagnosed, most cutaneous adverse events can be managed with supportive treatments, avoiding the need to interrupt antitumor therapy. Furthermore, preemptive management of skin problems can lead to significantly decreased severity of many cutaneous complications of these therapies. We encourage close collaboration between dermatologists and oncologists to better characterize cutaneous toxicity, select appropriate management, and avoid unnecessary dose reduction or discontinuation while simultaneously improving patient quality of life.

  View details for DOI 10.1007/s11864-015-0368-y

  View details for PubMedID 26338208

• Management of Dermatologic Complications of Lung Cancer Therapies. Current treatment options in oncology Pugliese, S. B., Neal, J. W., Kwong, B. Y. 2015; 16 (10): 368-?

  Abstract

  In recent years, oncogene-directed targeted agents and immunotherapies have expanded the treatment armamentarium for advanced lung cancer and, in particular, non-small cell lung cancer (NSCLC). Along with extended survival, these agents are accompanied by a host of cutaneous complications that affect the skin, hair, and nails. These skin complications range from the well-characterized papulopustular (acneiform) eruption of the epidermal growth factor receptor (EGFR) inhibitors to the emerging characterization of lichenoid skin eruptions seen during treatment with antibodies targeting the programmed cell death protein 1 (PD-1) and programmed cell death protein 1 ligand (PD-L1). When promptly recognized and accurately diagnosed, most cutaneous adverse events can be managed with supportive treatments, avoiding the need to interrupt antitumor therapy. Furthermore, preemptive management of skin problems can lead to significantly decreased severity of many cutaneous complications of these therapies. We encourage close collaboration between dermatologists and oncologists to better characterize cutaneous toxicity, select appropriate management, and avoid unnecessary dose reduction or discontinuation while simultaneously improving patient quality of life.

  View details for DOI 10.1007/s11864-015-0368-y

  View details for PubMedID 26338208

• Cosmetic benefits of natural ingredients. Journal of drugs in dermatology : JDD Bowe, W. P., Pugliese, S. 2014; 13 (9): 1021-5

  Abstract

  Photoaging is a leading concern for patients and many of these patients will express a desire to utilize natural ingredients as treatment. Mushrooms, feverfew, green tea, licorice, olive oil, soy, and coffee berry have been shown to have antioxidant properties and may play a role in the treatment and prevention of photoaging. In this manuscript, the most recent select basic science and clinical studies examining the mechanisms and efficacy of these ingredients will be discussed.
  
  J Drugs Dermatol. 2014;13(9):1021-1025.

  View details for PubMedID 25226001

• Favre-Racouchot Syndrome Acneiform Eruptions in Dermatology Zeichner, J. A., Pugliese , S., Smith, A., Epstein, R., Torres, A. Springer Publishing. 2013: 253–257
• Multicenter Photopheresis Intervention Trial in Early-Stage Mycosis Fungoides CLINICAL LYMPHOMA MYELOMA & LEUKEMIA Talpur, R., Demierre, M. F., Geskin, L., Baron, E., Pugliese, S., Eubank, K., Zic, J. A., Miller, D. R., Tharp, M., Bohjanen, K., Duvic, M. 2011; 11 (2): 219-227

  Abstract

  To demonstrate the efficacy of the UVAR XTS Photopheresis System and evaluate health-related quality of life in patients with early-stage mycosis fungoides (MF).Extracorporeal photopheresis was administered 2 days every 4 weeks for 6 months. Patients with partial responses by skin weighted assessment continued for 6 months; nonresponders added oral bexarotene and/or interferon α. Health-related quality of life was assessed at baseline and every 3 months with 3 validated tools.Nineteen patients with early-stage MF (7 men, 12 women; 16 white, 3 African Americans) with median age of 63.5 years (range, 46-85 years) participated. Their stages were IA (n = 3), IB (n = 14), and IIA (n = 2). The overall response rate for extracorporeal photopheresis (ECP) alone, was 42% (8/19; including 7 partial response, 1 complete response), with a median of 12 ECP sessions (range, 3-32) given over a median of 12 months (3-32 months) and with an overall duration of response of 6.5 months (range, 1-48 months). Seven patients with stable disease at 3 months received additional bexarotene (3/5; 1 complete response) or bexarotene plus interferon α (1/2), and 4 (57%) of 7 responded. Treatment-related adverse effects were limited to those expected with interferon (fatigue, nausea, vomiting, and diarrhea), or with hypertriglyceridemia and bexarotene. Trends in health-related quality of life indicated an improvement in emotional scores over time.ECP is effective for patients with early-stage MF alone or in combination with biologic response modifiers with low toxicity and improved quality of life.

  View details for DOI 10.1016/j.dml.2011.03.003

  View details for Web of Science ID 000291235900006

  View details for PubMedID 21575927

• DermHub: A comprehensive dermatology-focused patient education resource and social community Hagele, T., Cheng, C., Kvedar, J., Konda, S., Pugliese, S. MOSBY-ELSEVIER. 2011: AB78

  View details for Web of Science ID 000286780500305

• Adverse Reaction to Cutaneous Injection of Contents From a Vitamin E Liquid-Containing Capsule ARCHIVES OF DERMATOLOGY Pugliese, S., Yaar, R., Al-Dawsari, N., Goldberg, L. J., Garg, A. 2010; 146 (4): 454-455

  View details for Web of Science ID 000276813500028

  View details for PubMedID 20404248