Muco-cutaneous changes during long-term therapy with hydroxyurea in chronic myeloid leukaemia

Metastatic squamous cell carcinoma of the skin in chronic myeloid leukaemia: complication of hydroxyurea therapy

Hydroxyurea is a ribonucleotide diphosphate reductase inhibitor used in the treatment of patients with myeloproliferative disorders. Hydroxyurea has some dermatological side-effects. It has recently been recognized that hydroxyurea can induce squamous cell and basal cell carcinomas of skin. We present the case of an elderly man with chronic myeloid leukaemia who was treated with hydroxyurea for 4 years, with good control of his disease. However, in addition to the appearance of various skin lesions and cutaneous squamous cell carcinoma after 3 years of therapy, he was found to have a metastatic squamous cell carcinoma after 4 years. Hydroxyurea was discontinued, and he underwent surgery and radiotherapy. The patient subsequently died of ventricular fibrillation. We present this case to draw attention to the association between hydroxyurea and secondary skin cancers and to emphasize the need for dermatological examination before and during the course of hydroxyurea therapy.

Squamous cutaneous epithelial cell carcinoma in two CML patients with progressive disease under imatinib treatment

Imatinib (glivec), formerly known as STI571) effectively blocks the ATP-binding site of the bcr/abl fusion protein thereby inactivating selectively the tyrosine kinase activity of bcr/abl. Therefore, it is a promising drug in Philadelphia chromosome positive chronic myeloid leukemia showing high hematologic and cytogenetic response rates combined with a mild toxicity profile. Here we report two cases of squamous cell carcinoma of the skin, which appeared in the photo-exposed areas in two elderly patients treated for advanced chronic myeloid leukemia with imatinib. The role of chemotherapy, chronic sun exposure and of possible additional risk factors such as human papillomavirus infection is discussed.

Hydroxyurea-induced dermatomyositis-like eruption

Hydroxyurea is a cytotoxic chemotherapeutic agent used for myelodysplasia. The adverse cutaneous effects due to hydroxyurea include leg ulcers, hyperpigmentation of the skin and nails, a lichen planus-like eruption, lupus erythematosus, and a dermatomyositis-like eruption. We present a case of hydroxyurea-induced dermatomyositis-like eruption and review the features of this entity as previously reported.

Genetic and environmental risk factors for idiopathic inflammatory myopathies

Although the studies discussed are beginning to reveal a number of genetic and possible environmental risk factors for myositis, further investigations are needed to fully understand and classify these syndromes. The difficulties in this process include small numbers of subjects with varying disease phenotypes available for study, polygenic risk factors for which it remains unclear which are primary and which are secondary or linked genes, and the lack of validated environmental exposure assessment tools. New technologies and international collaborative approaches, however, may overcome some of these difficulties and allow us to identify genetic and environmental risk factors, as well as the critical gene-environment interactions in the IIM and its subgroups. Nonetheless, our understanding of these diseases is still in the early stages. Although we have learned a great deal about these disorders through detailed investigations over the last several decades, we have even further to go to understand the environmental triggers and genetic susceptibilities for the myositis syndromes.