Neil Shear

Neil Shear
University of Toronto | U of T · Sunnybrook Health Sciences Centre

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599
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Publications

Publications (599)
Article
Full-text available
Reactive infectious mucocutaneous eruption is a recently distinguished mucosal-predominant blistering eruption triggered by respiratory infections. We describe a previously healthy 11-year-old Black female with rapidly progressive mucocutaneous blistering after prodromal respiratory infection symptoms. Reactive infectious mucocutaneous eruption was...
Article
Pediatric Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threating blistering diseases triggered by medications that affect the skin and mucosae. Drug-induced epidermal necrolysis is a better term for medication-triggered cases because there is a spectrum of disease severity that otherwise is divided into the...
Article
Drug reaction with eosinophilia and systemic symptoms (DReSS), also known as drug-induced hypersensitivity syndrome (DiHS), is a severe, systemic, T cell mediated drug reaction with combinations of cutaneous, hematologic, and internal organ involvement. Pathogenesis of DReSS is multi-factorial, involving drug-exposure, genetic predisposition throug...
Article
Infophobia, a term not being introduced in the medical literature, is one of many factors that may hamper a Patient-Health Care Provider (HCP) encounter. This phobia creates resistance to accepting medical knowledge, potentially becoming a significant barrier in medical practice, explained by patients' fear of information that may negatively impact...
Article
Full-text available
IntroductionDupilumab is approved to treat moderate-to-severe atopic dermatitis (AD) in several countries in patients as young as 6 years of age. Since its approval, practical issues related to the use of dupilumab for AD have arisen, with particular interest in transitioning from current therapies and managing medication overlap, considerations fo...
Article
Full-text available
There is an increase in the incidence of onychomycosis, especially in at-risk populations. Onychomycosis is difficult to treat, as the efficacy of most antifungal agents is relatively low. Nondermatophyte molds (NDMs) and mixed infection (dermatophyte plus NDM) onychomycosis are contributing to growing antifungal resistance, as they are often under...
Article
Objective: We determined the relative efficacy of non-surgical monotherapies for hidradenitis suppurativa (HS). Methods: Network meta-analyses were conducted to determine treatments' surface under the cumulative ranking curve (SUCRA) value (i.e., an estimate that ranks efficacy); pairwise comparisons were conducted. Results and conclusions: Te...
Article
Background Ultra high-frequency ultrasound (uHFUS) is a recently developed diagnostic technology. Despite its potential usefulness, no study has assessed its advantage in diagnosis and evaluation of hair disorders in comparison with other diagnostic methods. Objectives To assess the practicability of uHFUS in diagnosing hair disorders and propose...
Article
Antimicrobial stewardship (AMS) programs have been widely recognized among the public health community. These programs focus majorly on bacterial infections, efficient antibiotic use, and measures to curb increasing antibacterial resistance. AMS programs are successfully established around the globe; however, very few include antifungal stewardship...
Article
Full-text available
Background Although several therapeutic options have been suggested for alopecia areata (AA), none of them are consistently effective, thus making the management of severe or refractory cases challenging. Several studies have recently reported the usage of methotrexate (MTX) in AA; however, the pure effect of MTX monotherapy remains elusive. Objec...
Article
Importance: Prospective data are limited on pregnancy outcomes among women with psoriasis who may be receiving biologic or conventional systemic therapy. Objective: To report pregnancy outcomes observed in the Psoriasis Longitudinal Assessment and Registry (PSOLAR). Design, setting, and participants: This cohort study used data from PSOLAR, a...
Article
Full-text available
Background The comparative safety and benefit-risk profiles of moderate-to-severe psoriasis treatments have not been well studied. Objective To compare the short-term (12-16 weeks) and long-term (48-56 weeks) safety and benefit-risk profiles of moderate-to-severe psoriasis treatments. Methods A systematic literature review of Phase II-IV randomiz...
Article
Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse drug reactions. Objectives To learn about the clinical characteristics of patients with SJS/TEN including treatments provided, outcomes, and mortality. Methods We conducted a retrospective chart review of patients who were hospitalized with the diagnosis of...
Chapter
It is important to remember that adverse drug interactions are overall predictable and therefore generally preventable. Drug interactions follow the 80/20 rule, that is, 20% of drugs cause 80% of drug interactions. It is important to be aware of situations in which the patient is truly at significant risk. Adverse drug interactions may lead to incr...
Chapter
Cutaneous drug reactions with systemic symptoms are generally severe, albeit rare, adverse reactions and include Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS, TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), drug-induced lupus (DIL) and serum sickness-like reacti...
Article
Superficial mycoses are becoming increasingly resistant to current antifungal medications. As alternative therapeutic options are limited, the increasing frequency of reports of antifungal resistance is alarming. This epidemic parallels the rise of antibiotic resistance; however, the significance of this problem has yet to gain global attention. He...
Article
Full-text available
Background: β-lactam antibiotics are associated with a variety of immune-mediated or hypersensitivity reactions, including immediate (Type I) reactions mediated by antigen-specific IgE. Objective: To identify genetic predisposing factors for immediate reactions to β-lactam antibiotics. Methods: Patients with a clinical history of immediate hypers...
Article
Background: Granulomatous drug eruptions are rare entities, where granuloma formation occurs as an attempt to contain an exogenous or endogenous inciting agent. Granulomatous drug eruptions may be localized to the skin or may include major systemic involvement, and their characteristics depend both on the properties of the causative irritant and h...
Article
Various monotherapies exist for tinea capitis; however, their relative efficacies have never been determined using a statistical approach which compares treatments' efficacy simultaneously. The goal of this study was to determine the relative efficacy (mycologic and complete cure rates) of monotherapies for the treatment of tinea capitis. On Octobe...
Article
Background: Onychomycosis is an uncommon condition in children with increasing global prevalence. Health practitioners should confirm the diagnosis through mycology examination and examine family members of affected individuals for onychomycosis and tinea pedis. Objective: To comprehensively summarize the treatment and management strategies for ped...
Article
Full-text available
Background: Until recently, there was no FDA‐approved antifungal treatment for onychomycosis in children. There is evidence regarding the safety and efficacy of topical antifungal agents for pediatric onychomycosis. Objective: To summarize the results of a recent study using efinaconazole 10% solution to treat onychomycosis in children and discuss...
Article
Onychomycosis is a fungal infection of the nail, causing discoloration and thickening of the affected nail plate, and is the most common nail infection worldwide. Onychomycosis was initially thought to be predominantly caused by dermatophytes; however, new research has revealed that mixed infections and those caused by non‐dermatophyte molds (NDMs)...
Article
Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are potentially life-threatening, immune-mediated adverse reactions characterized by widespread erythema, epidermal necrosis, and detachment of skin and mucosa. Efforts to grow and develop functional international collaborations and a multidisciplinary interactive network focusing on...
Article
Onychomycosis is a fungal infection of the nail and is more likely to occur in toenails. In Europe and North America, approximately 4.3% of people have this infection. The infection accounts for approximately 50% of all nail‐related disease. To treat toenail infection, oral (taken by mouth) and topical (applied to the skin) medications are availabl...
Article
甲癣是指/趾甲的真菌感染,更有可能发生在脚趾甲上。在欧洲和北美,约 4.3% 的人发生这种感染。感染约占所有指/趾甲相关疾病的 50%。 现有口服(经口服用)和局部用药(涂抹于皮肤)的药物可用于治疗脚趾甲感染。局部治疗的成功率比口服治疗更低,但口服治疗可能产生副作用或影响其他药物的作用方式。 已发表的临床试验研究并没有直接比较口服和局部治疗。加拿大研究人员开展的这项研究旨在使用称为网络荟萃分析的统计分析来估计口服和局部治疗在真菌治愈(根除真菌感染)和不良事件(副作用)方面的可比性。 作者发现 26 项已发表的研究并包括在分析中。作者希望包括基于器械的治疗(如激光)和联合治疗,但关于这些治疗没有足够数量的随机对照试验。 结果表明,每日使用特比萘芬 250 mg 和伊曲康唑 200 mg 口服治...
Article
Background: Onychomycosis is a chronic, fungal infection of the nails. Complete cure remains challenging, but oral antifungal medications have been successful in managing the fungus for a significant proportion of patients. Treatment with these drugs can be continuous or intermittent, albeit the evidence on their relative efficacies remain unclear...
Chapter
Cutaneous adverse drug reactions are common. Many drugs can cause cutaneous eruptions in children but antibiotics, antiepileptics and nonsteroidal anti‐inflammatory drugs are the most frequently implicated. Most cutaneous drug reactions in children are mild and self‐limited upon discontinuation of the drug, but can sometimes be severe and life‐thre...
Article
Full-text available
Background: There are many treatments available for alopecia areata; however, none are approved by the US Food and Drug Administration. Thus, there is clinician benefit in efficacy comparison. Methods: A network meta-analysis was used to create direct and indirect comparisons of alopecia areata studies in addition to an inconsistency analysis, r...
Article
The topical calcineurin inhibitors (TCIs), tacrolimus (Protopic) and pimecrolimus (Elidel), were approved in the early 2000s and were widely used as a nonsteroid treatment for atopic dermatitis (AD) in adult and pediatric populations. In 2005, the addition of a boxed warning was mandated for TCIs based on a potential risk of malignancy, and there w...
Article
Full-text available
Lymphomatoid papulosis is a benign chronic often relapsing skin condition that belongs to the CD30‐positive cutaneous lymphoproliferative disorders. LyP typically presents as crops of lesions with a tendency to self‐resolve and morphology can range from solitary to agminated or diffuse papules and plaques to nodules or tumors. The clinical‐histolog...
Article
Onychomycosis is a chronic fungal infection of the nail that is recalcitrant to treatment. It is unclear why normally effective antifungal therapy results in low cure rates. Evidence suggests that there may be a plethora of reasons that include the limited immune presence in the nail, reduced circulation, presence of commensal microbes, and fungal...
Article
Full-text available
Purpose Establishment of causality between drug exposure and adverse drug reactions (ADR) is challenging even for serious ADRs such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Several causality assessment tools (CAT) exist, but the reliability and validity of such tools is variable. The objective of this study was to compare t...
Article
In today's medical practice, the approach towards quantitative analysis of the skin is considered to be challenging and subjective. The current accepted measures and indexes do not exhibit a universal measurement, carry subjective opinions, and vary from one assessor to another. We propose a novel promising technique that provides a universal measu...
Article
Background Onychomycosis is a fungal infection of the nail caused by dermatophytes, yeasts and non‐dermatophyte moulds that accounts for approximately 50% of all nail related disease. Objectives This study aims to assess the effectiveness and safety of monotherapy and combination treatments for toenail onychomycosis using a network meta‐analysis (...
Article
Scalp dysesthesia may be underrecognized but is an important condition which requires special management strategies. Through our case series of four patients, we have noted that patients were frequently misdiagnosed with seborrheic dermatitis and failed standard treatment. However, patients did benefit from low doses of oral pregabalin and a topica...
Article
Full-text available
First described in 1996, the drug reaction, eosinophilia, and systemic symptoms syndrome (DReSS) is considered, along with Stevens-Johnson syndrome and toxic epidermal necrolysis, a severe cutaneous drug reaction. It is characterized by the presence of a maculopapular erythematous skin eruption, fever, lymphadenopathy, influenza-like symptoms, eosi...
Article
Background: Despite the complexity of psoriasis treatment using biologic therapy, there does not exist a standardized synoptic reporting form for the initiation of this population. The purpose of this study was to use a modified Delphi approach to develop a standard checklist for the standardized documentation of patients receiving systemic biolog...
Article
Background Mycosis fungoides (MF) typically has a CD4⁺CD8⁻ T‐cell phenotype. Rare cases of CD4⁻CD8⁺, CD4⁻CD8⁻, or CD4⁺CD8⁺ immunophenotypes have been described. Little is known about the impact of MF immunophenotypes on disease behavior. Methods We conducted a retrospective cohort study to review all cases of MF from 2007 to 2017 from Sunnybrook H...
Article
Full-text available
Androgenetic alopecia (AGA) is characterized by non-scarring follicle miniaturization. Despite the success of approved therapies, commonly reported side effects and the need for continual use has led to the investigation of alternative therapies. The aim of this paper is to critically review the success of off-label, topical monotherapies for treat...
Article
Drug reaction with eosinophilia and systemic symptoms (DReSS), also known as drug-induced hypersensitivity syndrome (DiHS), is an uncommon severe adverse reaction to medications. It is important to recognize it as it is potentially fatal and can cause significant morbidity. From the first reports of drug reactions related to certain anticonvulsants...
Article
As a promising alternative to traditional treatment, platelet-rich plasma (PRP) is being used to encourage hair growth through the release of growth factors and cytokines. In addition to hair restoration, PRP’s multifactorial capabilities can also be used to treat aging skin, facial scarring, and acne. The purpose of this review is to critically ex...
Chapter
Drug eruptions have a wide spectrum of clinical manifestations, are caused by various drugs, and result from varied pathophysiological mechanisms. Hence, their diagnosis and management is challenging. Drug eruptions can range from a mild, simple eruption involving only the skin to severe complex eruptions with systemic involvement, such as toxic ep...
Book
This resource guides prescribers, pharmacists, and regulators with an update on the recent expansion of basic and clinical knowledge that forms a framework for understanding cutaneous reactions. This understanding will lead, in turn, to better outcomes and decisions in treatment and management, both in the clinic and in the life cycle of drug devel...
Article
Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular,...
Article
Introduction:: Many international guidelines for management of psoriasis exist and most have variations in grading evidence quality, strength of recommendations, and dosing. The objective of our review is to compare international guidelines published in the United Kingdom, Canada, Europe, and the United States for the management of moderate-to-sev...
Article
Onychomycosis is a fungal nail infection caused by dermatophytes, non-dermatophyte molds, and yeasts. Treatment of this infection can be difficult, with relapse likely to occur within 2.5 years of cure. The objective of this article is to review factors that can impact cure and to suggest practical techniques that physicians can use to maximize cur...
Article
Introduction: Onychomycosis is a chronic fungal infection of the nail bed, matrix or plate. It accounts for roughly 50% of all nail disease. As the prevalence of onychomycosis is increasing, a critical review of diagnostic techniques and treatment options is required. Area covered: This review discusses the current diagnostic techniques associated...
Article
Full-text available
Objective Our objective was to compare therapeutic response among patients with early-onset psoriasis (EOP) and late-onset psoriasis (LOP) receiving adalimumab, etanercept, infliximab, ustekinumab, or methotrexate in the Psoriasis Longitudinal Assessment and Registry (PSOLAR). Methods Patients were grouped by age of onset: EOP (age ≤ 40 years) or...
Article
Apremilast has demonstrated a favourable safety profile for the treatment of psoriasis based on its pivotal randomized controlled trials (RCTs), ESTEEM 1 and 2.1,2 One‐year safety data suggested that apremilast did not increase exposure‐adjusted incidence of adverse events (AEs) during long‐term treatment.1,2 Furthermore, approximately half of the...
Article
An adverse drug reaction is defined as any noxious, unintended, and undesired effect of a drug that occurs at doses used in humans for prophylaxis, diagnosis, or therapy. A cutaneous eruption is one of the most common manifestations of an adverse drug reaction. This chapter reviews the epidemiology, etiology, diagnosis, clinical manifestations, and...
Article
Full-text available
Onychomycosis is a difficult-to-treat chronic fungal infection of the nail. The chronic nature of onychomycosis, with relevance to current treatment practices, could be attributed to host anergy, development of increased virulence in causal agents (multidrug resistance efflux pump), and biofilms. Biofilms must be disrupted prior to antifungal treat...
Article
Due to the high relapse rates and the rise of predisposing factors, the need for curing onychomycosis is paramount. To effectively address onychomycosis, the definition of cure used in a clinical setting should be agreed upon and applied homogenously across therapies (e.g., oral, topical and laser treatments). In order to determine what is or what...
Article
Onychomycosis is an uncommon condition in childhood, but prevalence in children is increasing worldwide.The objective was to review the efficacy and safety of systemic and topical antifungal agents to treat onychomycosis in children. Databases (Pubmed, OVID, Scopus, clinicaltrials.gov, Cochrane Library) were searched. Seven studies were selected fo...
Article
Background: Atopic dermatitis is a common inflammatory condition of the skin. Moderate to severe cases not responding to topical treatments and lifestyle changes may need second-line therapy. Methotrexate has been suggested as an effective treatment in such cases. Objective: This study was done to determine the efficacy, adverse effects, and saf...
Article
Full-text available
Eosinophilia, both peripheral and in cutaneous tissue, is not a typical finding in mycosis fungoides; in fact, when faced with a lymphoeosinophilic infiltrate, mycosis fungoides is often not part of initial differential considerations. However, eosinophilia has been described in certain subtypes of mycosis fungoides, namely, in folliculotropic myco...
Article
Androgenetic alopecia, or male/female pattern baldness, is the most common type of progressive hair loss disorder. The aim of this paper is to review recent advances in non‐surgical treatments for androgenetic alopecia and identify the most effective treatments. A network meta‐analysis (NMA) was conducted of the available literature of the six most...
Article
Background Tinea capitis is the most common cutaneous fungal infection in children. Objectives This review aims to evaluate the differences that exist between medications for the treatment of tinea capitis, to determine if there are any significant adverse effects associated and to define the usefulness of sample collection methods. Methods We co...