Multiple Painful, Treatment-Resistant Leg Ulcers Associated With Dermatomyositis-Like Lesions Over the Interphalangeal Joints Induced by Hydroxyurea

Hydroxyurea‐induced dermatomyositis: true amyopathic dermatomyositis or dermatomyositis‐like eruption?

“…The face may be involved, with edema and heliotrope erythema in some cases 1,7,18 . The severity of clinical manifestations is mild to moderate in most of the patients and seems to correlate with the duration of the drug intake rather than with the evolution of the hematological malignancy 3,7 …”

“…Although hydroxyurea‐induced dermatomyositis usually occurs after prolonged intake (2–10 years) of continuous hydroxyurea therapy, there is no definite time after which the drug could be excluded as a cause of dermatomyositis 3 …”

“…Major adverse reactions of hydroxyurea therapy include non‐dermatological effects, such as bone marrow suppression, gastrointestinal symptoms, hepatotoxicity, and teratogenesis. On the other hand, cutaneous reactions are not infrequent and occur in 10–35% of patients who are subjected to long‐term therapy 2,3 . Skin eruptions include xerosis, acquired ichthyosis, acral erythema, hyperpigmentation, alopecia, photosensitivity, skin atrophy, fixed drug eruption, palmoplantar keratoderma, allergic vasculitis and, less commonly, dermatomyositis‐like eruptions, nail abnormalities, oral ulceration and pigmentation, leg ulcers, actinic keratoses, and squamous cell carcinoma.…”

“…These lesions have a typical clinical presentation and course, do not respond to conventional therapies, particularly leg ulcers, and characteristically resolve spontaneously when hydroxyurea is withdrawn 4,5 . These observations should raise the suspicion of the drug as the causal agent and mean that clinicians, particularly dermatologists, should be aware of the adverse drug reactions associated with the long‐term use of hydroxyurea to avoid any delay in diagnosis, unnecessary investigations, and exhaustive therapies 3,6 …”

Essential Thrombocythemia: The Dermatologic Point of View

“…The effect is typically most visible on surfaces prone to mechanical trauma, such as the malleolar areas. 51,52 Management of leg ulcers is very important, because they are often extremely painful. In 2007, an International Working Group 53 identified leg ulcers as a reason for HC therapy discontinuation.…”