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Are topical beta-blockers really effective "in real life" for targeted therapy-induced paronychia
Vincent Sibaud1, Eline Casassa2, Mirella D'Andrea3
1Oncodermatology, Institut Claudius REGAUD and Institut Universitaire du Cancer Toulouse Oncopole, 1 avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France. sibaud.vincent@iuct-oncopole.fr.
Abstract:
Paronychia and periungual pyogenic granuloma represent one of the most common and bothersome dermatologic toxicities observed with ErbB inhibitors. There is no standardized treatment, and management remains challenging. Moreover, conservative management with noninvasive treatment should be promoted for fragile patients in a metastatic setting. Over the last few years, the efficacy of topical blocking agents has been considered for managing cutaneous or mucosal pyogenic granulomas. Very recently, the use of topical propranolol or of timolol has been reported in several patients undergoing treatment with EGFR inhibitors and developing pyogenic granulomas of the nail. We performed a retrospective single-center review of patients with targeted therapy-related paronychia/periungual pyogenic granulomas who had been treated with topical timolol, either alone or in combination with other topical treatments. Nearly two thirds of patients showed at least a partial response after 1 month of therapy, and the use of a topical beta-blocker in our population was associated with a favorable safety profile. Finally, topical timolol may represent a promising treatment option for the management of cancer patients suffering from painful periungual lesions. Comparative clinical trials, however, are still needed.
Insights
Topical timolol shows promise for treating painful nail and skin inflammation caused by cancer therapies. This beta-blocker offers a safe and effective option for patients experiencing paronychia and pyogenic granulomas.
Area of Science:
- Dermatology
- Oncology
- Pharmacology
Background:
- Paronychia and periungual pyogenic granuloma are common side effects of ErbB inhibitor cancer therapies.
- Current management strategies are not standardized and present challenges, especially for fragile patients.
- Noninvasive treatments are preferred for patients in a metastatic setting.
Purpose of the Study:
- To evaluate the efficacy and safety of topical timolol for treating paronychia and periungual pyogenic granulomas in cancer patients.
- To assess the response rate and safety profile of topical timolol monotherapy or combination therapy.
Main Methods:
- Retrospective single-center review of patients with targeted therapy-related paronychia/periungual pyogenic granulomas.
- Patients were treated with topical timolol, alone or in combination with other topical treatments.
- Data on treatment response and safety were collected and analyzed.
Main Results:
- Nearly two-thirds of patients demonstrated at least a partial response after one month of topical timolol therapy.
- The use of topical beta-blockers was associated with a favorable safety profile in this patient population.
- Topical timolol was effective in managing painful periungual lesions.
Conclusions:
- Topical timolol may be a promising treatment option for cancer patients with paronychia and periungual pyogenic granulomas.
- The treatment demonstrated a favorable safety profile.
- Further comparative clinical trials are necessary to confirm these findings.