Hydroxyurea Associated Cutaneous Lesions: A Case Report

Abstract

BACKGROUND:Hydroxyurea (HU) is an antimetabolite agent that interferes with the S-phase of cellular replication and inhibits DNA synthesis, with little or no effect on RNA or protein synthesis. It is used in the treatment of many myeloproliferative disorders (MD) and is particularly a first line treatment drug for intermediate to high-risk essential thrombocythemia. Although safe and very well tolerated by the patients suffering from MD, there have been numerous reports of a broad palette of cutaneous side effects associated with prolonged intake of the medication. These may include classical symptoms such as xerosis, diffuse hyperpigmentation, brown-nail discolouration, stomatitis and scaling of the face, hands, and feet or more serious side effects such as actinic keratosis lesions, leg ulcers and multiple skin carcinomas.CASE REPORT:We report a case of a 52-year-old man, on long-term therapy with HU for essential thrombocytosis, with several concurrent skin lesions. Despite the perennial use of HU, the cutaneous changes were neglected. The local dermatological examination revealed oval perimalleolar ulcer on the right leg, with dimensions 6 x 4 cm, clearly demarcated from the surroundings with regular margins, periulcerous erythema, with very deep and highly fibrinous bed of the ulcer, positive for bacterial infection. The ulcer was treated with topical wound therapy with alginate and parenteral antibiotics. The extended dermatological screening also showed two nummular lesions in the right brachial region, presenting as erythematous papules with sharp margins from the surrounding skin, gritty desquamation and dotted hyperpigmentations inside the lesion. Further dermoscopy and biopsy investigations confirmed a diagnosis of basal cell carcinoma. Nasal actinic keratosis was also noted. The patient was advised for discontinuing or substituting the HU therapy.CONCLUSION:We present this case to draw attention to the various cutaneous side effects that occur with perennial HU use and suggest an obligatory reference to a dermatological consult.

Non-melanoma Skin Cancers in Patients on Hydroxyurea for Philadelphia Chromosome-Negative Myeloproliferative Neoplasms: A Systematic Review

“…HU is considered to be well-tolerated, but a quick literature search highlights the varied presentation of cutaneous side effects of this drug [ 4 ]. The adverse cutaneous reactions range from alopecia, hyperpigmentation, melanonychia, xerosis, keratoderma, ulcers, dermatomyositis-like eruptions, actinic keratosis to various types of malignancies [ 7 - 8 ]. Chronic nonhealing ulcers, dermatomyositis-like eruptions, and actinic keratosis are pre-malignant, and if not recognized, can progress to full-blown malignancy.…”

Squamous cell carcinoma during long term hydroxyurea treatment: A case report

“…The cutaneous side effects of hydroxyurea treatment are diverse and frequent. Squamous cell carcinoma is one of the most dreaded effects [5] , [6] , [7] , [8] . The authors report the case of a patient with skin carcinomas after treatment with hydroxyurea.…”

Hydroxyurea: a reappraisal of its cutaneous side effects and their management

“…1 Since then, its use has been expanded to treat essential thrombocythemia, polycythemia vera, sickle cell disease (SCD), head and neck cancer, ovarian cancer, and psoriasis. 1,2 While this drug is generally well-tolerated and considered safe, 3 it is known to cause a broad spectrum of cutaneous side effects from xerosis and hyperpigmentation to leg ulceration and cutaneous malignancy. 2 Although dermatologists are often consulted for the treatment of these side effects, a comprehensive resource discussing the different types and their management is lacking.…”

“…1,2 While this drug is generally well-tolerated and considered safe, 3 it is known to cause a broad spectrum of cutaneous side effects from xerosis and hyperpigmentation to leg ulceration and cutaneous malignancy. 2 Although dermatologists are often consulted for the treatment of these side effects, a comprehensive resource discussing the different types and their management is lacking. In this study, we conducted a literature search within PubMed, Google Scholar, Embase, and Cochrane for case reports and larger studies under the term "hydroxyurea" in conjunction with "cutaneous adverse/side effects," "mucocutaneous adverse/side effects," "skin changes," "dermatologic uses," and "psoriasis" in order to critically evaluate the reported types and management of hydroxyurea's cutaneous side effects, as well as review its mechanism of action, dermatologic uses, and common systemic side effects.…”