Synopsis

For

FCPS (Internal Medicine)

Frequency of viral dermatological infections in cancer patients

By

Dr. Sara Batool

Supervisor

Dr. Aun Raza

Consultant infectious disease

Department of Medicine

Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore

INTRODUCTION

Dermatologic infections are among the most commonly experienced complications of cancer

and anti-cancer therapy. Alterations in host immune function secondary to the underlying

malignant process and/or its treatment have been linked to an increase in the risk of

infections.1 The skin and its appendages (i.e., hair and nails) represent the first line of defense

against infectious microorganism; its dysfunction as a physical barrier and an immunologic

organ in cancer patients leads to an increased susceptibility to infectious organisms.

Moreover, a cancer patient's vulnerable state facilitates dissemination of infections to other

sites, secondarily involving the skin. 2

Most common viral skin diseases are global, but the onset may coincide with a trip to the

tropics and pose problems in the differential diagnosis of the returning traveler. Viral

infections that are prevalent in the tropics include molluscum contagiosum in children,

plantar warts in adults, Kaposi's sarcoma in patients with HIV infection and severe blistering

forms of varicella.3

Despite all the advances in the understanding of these disorders, the viruses that lead to

common skin infections continue to evade complete destruction. 4 Saleh et al., conducted a

cross sectional survey and found that viral dermatological infections was 4.9% in patients

with cancer. 5 Later on Do et al., found that the dermatologic infection rate was detected in

17.5% cancer patients with active anti-cancer treatment. 6 But Eilers et al., conducted another

survey and found that 38% of cancer patients showed evidence of infection at sites of

dermatologic toxic effect.7

Rationale of this study is to determine the frequency of viral dermatological infections in

cancer patients. Literature has shown that frequency of viral dermatological infections is very
low in cancer patients. But there is great variability in reported frequency of viral

dermatological infections in cancer patients and there is no study conducted before in local

population. Therefore, it's important to confirm the extent of problem for the local

population. In order to lower the risk of viral dermatological infections in such critical

patients, preventive and improved treatment systems may be implemented in the future. This

will help us to improve our practice and knowledge and we will apply findings in local

setting.

OBJECTIVE: To determine the frequency of viral dermatological infections in cancer

patients

OPERATIONAL DEFINITION:

Cancer: It is defined as presence of malignancy in which some of body's cells grow

uncontrollably and spread to other parts of the body. Patients with >3 months of cancer and

receiving therapy will be enrolled in the study.

Viral dermatological infections: It will be labeled if presence of infection in skin is due to

virus, detected clinically by infectious disease team

MATERIAL AND METHODS:

Study Design:

Cross sectional study

Setting:

Department of Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Center

Lahore
Duration:

6 months after approval of synopsis

Sample Size:

By using WHO calculator, sample size of 200 cases is calculated with 95% confidence level,

3% margin of error and percentage of viral dermatological infections i.e. 4.9% in patients

with cancer. 5

Sample Technique:

Non-probability, consecutive sampling

Sample Selection

Inclusion Criteria:

Patients of age 15-65 years, either gender, diagnosed with carcinoma (as per operational

definition) and receiving treatment for >3 months.

Exclusion Criteria

 Patients with cutaneous toxic effects secondary to non–EGFR-targeted therapies (as per

medical record)

 Patients with skin cancer (on medical record)

Data Collection Procedure:

Two hundred patients who meet inclusion criteria will be included in the study from OPD

and emergency. Demographic details (age, gender, BMI, duration of cancer, family size per
room (overcrowding >3 person per room), type of cancer, stage of cancer, residence, season,

history of dry skin disease, previous history of skin infections, type of therapy receiving, and

duration of therapy) will be noted. Then patients will be evaluated by researcher and presence

of skin infection will be noted. . Reports will be assessed and confirmation of viral

dermatological infections will be done by consultant infectious diseases (as per operational

definition). Patients who will develop viral dermatological infections will be managed as per

standard protocol. All data will be recorded in Performa (attached).

Data Analysis:

Data will be entered & analyzed in SPSS 25. Normality will be checked by Shapiro-Wilk

test. For quantitative variables like age, BMI, duration of cancer, duration of receiving

treatment, mean and standard deviation will be calculated. For qualitative variable like

gender, family size per room (overcrowding), type of cancer, stage of cancer, residence,

season, history of dry skin disease, previous history of skin infections, type of therapy

receiving, and viral dermatological infections will be presented as frequency and percentage.

Data will be stratified for age, gender, BMI, duration of carcinoma, type of cancer, stage of

cancer, residence, season, history of dry skin disease, previous history of skin infections, type

of therapy receiving and duration of receiving treatment. Post-stratification, Chi-square test

will be applied to compare the viral dermatological infections in stratified groups. P-

value≤0.05 will be kept as significant.

REFERENCES

1. Do MH, Barrios DM, Phillips GS, Postow MA, Warner AB, Rosenberg JE, et al.
Dermatologic infections in cancer patients treated with checkpoint inhibitors. Journal of the
American Academy of Dermatology. 2021;85(6):1528-36.
2. Wu J, Liu D, Offin M, Lezcano C, Torrisi JM, Brownstein S, et al. Characterization
and management of ERK inhibitor associated dermatologic adverse events: analysis from a
nonrandomized trial of ulixertinib for advanced cancers. Investigational new drugs.
2021;39(3):785-95.
3. Vega-Lopez F, Ritchie S. 68 - Dermatological Problems. In: Farrar J, Hotez PJ,
Junghanss T, Kang G, Lalloo D, White NJ, editors. Manson's Tropical Infectious Diseases
(Twenty-third Edition). London: W.B. Saunders; 2014. p. 995-1026.e1.
4. Goldust M. Viral Diseases in Dermatology. Viruses. 2023;15(2).
5. Saleh R, Nada E, Hamed AF, Hussien WM. Epidemiologic Trends of Viral Skin
Infections in Egypt: A Cross-Sectional Hospital-Based Study. Dermatology Research and
Practice. 2019;2019:5469726.
6. Do MH, Barrios DM, Phillips GS, Postow MA, Warner AB, Rosenberg JE, et al.
Dermatologic infections in cancer patients treated with checkpoint inhibitors. Journal of the
American Academy of Dermatology. 2021;85(6):1528-36.
7. Eilers RE, Jr., Gandhi M, Patel JD, Mulcahy MF, Agulnik M, Hensing T, et al.
Dermatologic infections in cancer patients treated with epidermal growth factor receptor
inhibitor therapy. Journal of the National Cancer Institute. 2010;102(1):47-53.
 PROFORMA

Frequency of viral dermatological infections in cancer patients

Case: MR NO: Date:

Name: Age:

Gender: M □ F □ BMI:

Type of cancer: Duration of cancer:

Stage of cancer:

Residence: Rural □ Urban □ Urban slums □ Semi-urban □

Industrial / factory area □

Season: Winter □ Summer □ Autumn □ Spring □

Family size per room:

History of: Dry skin disease □ Previous h/o skin infection □

Type of therapy: Chemotherapy □ Radiotherapy □ Combination □

Duration of receiving treatment:

Clinical examination:

Viral skin infection: Present □ Absent □

Type of infection: