Hydroxyurea-induced dermatomyositis-like eruption

Dacey, Michael J.; Callen, Jeffrey P.

doi:10.1067/mjd.2003.74

Cited by 63 publications

(63 citation statements)

References 17 publications

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“…Нежелательные явления, вызванные гидроксикарбами-дом. Ониходистрофия, меланонихия КЛИНИЧЕСКАЯ ОНКОГЕМАТОЛОГИЯ клеток эпидермиса из-за ингибирования синтеза ДНК и образования свободных радикалов [25,26]. Яз-венное поражение сохраняется до тех пор, пока не вос-становятся кератиноциты и эндотелиальные клетки.…”

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Dermatological Toxicity of Hydroxycarbamide

Суборцева¹,

Melikyan²,

Gilyazitdinova³

et al. 2018

Клиническая онкогематология

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Hydroxycarbamide is an antitumor agent mainly used for treatment of Ph-negative myeloproliferative disorders and sickle cell disease. The development of skin ulcers is a rare but serious adverse event in long-term antitumor therapy. Hydroxycarbamide-induced ulcers are often multiple and bilateral, and usually occur in the lower legs, although they can occur in other regions of the body. The ulcers are smallsized and shallow with sharp margins and yellow fibrine-covered base. They cause constant severe, difficult to treat pain which is a characteristic sign. The drug withdrawal usually leads to spontaneous healing of ulcers. Regular dermatologic screening must be obligatory for all the patients receiving hydroxycarbamide. The present paper provides a literature review on dermatological toxicity of hydroxycarbamide and a clinical case description.

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Dermatological Toxicity of Hydroxycarbamide

Суборцева¹,

Melikyan²,

Gilyazitdinova³

et al. 2018

Клиническая онкогематология

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“…dermatomyositis, dermatomyositis-like eruption, and dermatomyositis-like lesions [8,9]. The eruption on the hands is characterized by poikiloderma (i.e., atrophy, telangiectasias, and mottled pigmentation) with violaceous papules on the dorsum of the hands and on the fingers, erythematous plaques with scale mimicking mechanic hands of dermatomyositis, and, occasionally, nail fold infarcts [8,10].…”

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“…The eruption on the hands is characterized by poikiloderma (i.e., atrophy, telangiectasias, and mottled pigmentation) with violaceous papules on the dorsum of the hands and on the fingers, erythematous plaques with scale mimicking mechanic hands of dermatomyositis, and, occasionally, nail fold infarcts [8,10]. Results on physical examination lack the proximal muscle weakness, heliotrope rash, and shawl sign typically seen with dermatomyositis [9].…”

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“…A review of two larger case series showed an average age at onset of 60 years, a male-to-female ratio of 1.2:1, and an average time to onset of symptoms after initiation of hydroxycarbamide therapy of 56 months [8,11]. Hydroxycarbamide-induced dermopathy is most commonly seen in patients receiving therapy for chronic myelogenous leukemia [8].…”

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confidence: 99%

“…Hydroxycarbamide-induced dermopathy is most commonly seen in patients receiving therapy for chronic myelogenous leukemia [8]. Most patients (82%) have partial or complete improvement after discontinuation of hydroxycarbamide therapy; however, some patients have persistent cutaneous atrophy [8,11].…”

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Hydroxycarbamide‐induced dermopathy

et al. 2009

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Hydroxycarbamide (hydroxyurea) is an agent administered orally for the treatment of chronic myelogenous leukemia, myeloproliferative disorders, thalassemias, erythrocytosis, and sickle cell anemia [1][2][3]. An estimated 13% of patients with chronic myelogenous leukemia have mucocutaneous changes with long-term hydroxycarbamide therapy [4]. Myriad cutaneous adverse effects from long-term hydroxycarbamide therapy have been noted in the medical literature, including a dermatomyositis-like erythematous eruption on the hands, mucositis and oral ulceration, hair loss, nail pigmentation, and hyperpigmentation of the face [5]. The most common cutaneous adverse effect of long-term hydroxycarbamide therapy is painful lower-leg ulcers that typically appear spontaneously, involve the lateral malleoli and exhibit poor healing [6,7].A 62-year-old woman presented with an 18-month history of a painful and pruritic eruption on the dorsum of her hands. The patient's medical history showed myelodysplasia that had been treated with hydroxycarbamide for the past 5 years. Her hands showed shiny, violaceous papules over her knuckles and erythematous, reticulated, scaly plaques on her fingers and the dorsum of her hands (Image 1), mimicking Gottron papules and mechanic hands of dermatomyositis. Laboratory evaluation showed a negative result for antinuclear antibody and normal aldolase and creatine kinase values. A skin biopsy showed hyperkeratosis and epidermal atrophy. The basal layer showed vacuolar change and cytoid bodies. Direct immunofluorescence testing was negative for a lichenoid tissue reaction or lupus band.The skin eruption improved with use of a midpotency topical corticosteroid and discontinuation of hydroxycarbamide therapy. After 7 months of follow-up, only cutaneous atrophy remained. Unfortunately, the patient's myelodysplasia had progressed to acute myelogenous leukemia.Several terms have been used to describe the cutaneous changes of the hands associated with long-term hydroxycarbamide therapy, including hydroxyurea dermopathy, pseudoImage 1. Shiny, violaceous papules over the knuckles and erythematous, reticulated, scaly plaques on the fingers and the dorsum of the hands caused by reaction to long-term hydroxycarbamide therapy.

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