Mucocutaneous adverse effects of hydroxyurea: a prospective study of 30 psoriasis patients

Abstract

Hydroxyurea is an anti-tumour agent most commonly used to treat chronic myeloproliferative disorders in doses up to 4 g per day. Dermatological adverse effects reported so far have been observed predominantly in these patients. As we are treating selected psoriasis patients with low dose hydroxyurea we attempted to define the spectrum and chronology of dermatological adverse effects in this group of patients prospectively. Of the 29 evaluable patients, 19 (65.5%) developed a mucocutaneous adverse reaction after a mean duration of 6.4 weeks of treatment. Pigmentation of nails, skin or mucosa was the most common observation and was seen in 17 (58.6%) patients. Other less common findings were xerosis, diffuse alopecia, oedema of the legs, oral ulcers and actinic psoriasis. Adverse effects subsided in 11 (57.9%) patients during a mean follow up of 18 weeks. Three hitherto unreported side-effects - scleral pigmentation, acquired ichthyosis and pigmentation of lunula of the nails - were noted. This first study of dermatological adverse effects of hydroxyurea therapy on Asian psoriatic patients reveals several new findings. Pigmentation of skin, nails and mucosa appears to be very common and occurs early. Serious dermatological side-effects probably do not occur with low dose (up to 1.5 g per day) hydroxyurea in patients with psoriasis.

Mucosal Pigmentation Caused by Imatinib: Report of Three Cases

“…Patients with CML are sometimes treated initially with hydroxyurea, which has been reported to cause mucocutaneous hyperpigmentation and melanonychia [18][19][20]. According to one study involving 29 patients using hydroxyurea, 17 cases (58.6%) showed hyperpigmentation of any site with the most common site being the fingernail; only one case (3.4%) developed pigmentation on the tongue [18].…”

“…According to one study involving 29 patients using hydroxyurea, 17 cases (58.6%) showed hyperpigmentation of any site with the most common site being the fingernail; only one case (3.4%) developed pigmentation on the tongue [18]. In addition, hydroxyurea causes mucocutaneous ulceration in approximately 2-3% of patients [18,20].…”

“…According to one study involving 29 patients using hydroxyurea, 17 cases (58.6%) showed hyperpigmentation of any site with the most common site being the fingernail; only one case (3.4%) developed pigmentation on the tongue [18]. In addition, hydroxyurea causes mucocutaneous ulceration in approximately 2-3% of patients [18,20]. The most probable cause appears to be due to an increase in melanin production secondary to direct local activation of melanocytes [19,21,22], which is different from Mattsson et al [7] Dark-brown pigmentation on the hard palatale mucosa medication-associated pigmentation as discussed above.…”

Blue Lunula Related with Hydroxyurea

“…While the most common side effect is myelosuppression, gastrointestinal symptoms such as nausea, vomiting, stomatitis, and anorexia and rash, skin ulcers, hyperpigmentation in nails, and dermatologic toxicities like facial erythema may also be observed. At higher dosages, neurologic symptoms may be rarely seen (1,2). …”

“…However, blue lunula related with hydroxyurea is rarely observed (2,3). In our study the blue color change (lunular pigmentation) occurred in both hand and foot lunula regions 3 weeks after the start of the treatment, and 4 weeks after the cessation of hydroxyurea, the color returned to normal.…”