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Yu K, Wang T, An D, Li X, Tang Z. Investigating the disparities among drug categories in drug-induced dermatomyositis: A systematic review. Semin Arthritis Rheum 2024; 67:152478. [PMID: 38833729 DOI: 10.1016/j.semarthrit.2024.152478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/03/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
Drug-induced dermatomyositis (DIDM) is a rare and underestimated variant of dermatomyositis (DM) characterized by muscle damage and skin rash and related to certain drug exposure. The spectrum of drugs causing DIDM has evolved over time, originally implicating hydroxyurea, penicillamine, and statins as causative agents. Tumor necrosis factor α inhibitors and immune checkpoint inhibitors have also been associated with such conditions. To bridge the gap between current literature and clinical practice, and therefore guide clinicians, we conducted a comprehensive review of English literature from Pubmed, EMBASE, and MEDLINE. Our analysis included demographic data, clinical features, laboratory findings, therapeutic outcomes, and extant research pertaining to the probable pathogenesis of DIDM induced by various drugs. Furthermore, we categorized the drugs involved in DIDM cases into biologics and traditional agents for subsequent statistical analysis. Over time, there has been a gradual accumulation of reported DIDM cases. A total of 69 published DIDM cases were documented in our study, among which 33 should be attributed to biologics and the remaining 36 to traditional drugs. Interestingly, 41 of all DIDM cases had a previous history of malignancies. Additionally, DIDM cases exhibited similar cutaneous and muscular manifestations to classic DM, with the exception of cases induced by hydroxyurea, which did not entail muscle damage. Positive antinuclear antibodies and anti-TIF1-γ autoantibodies have been predominantly observed in biologics-induced cases, while positive anti-TIF1-γ antibodies were merely reported in the cases that were primarily diagnosed with malignant diseases and exposed to ICIs afterwards. Anti-TIF1-γ antibodies may potentially serve as a red flag in the identification of co-existing malignant diseases in DM patients. We also provided a comprehensive summary and exploration of potential mechanisms lying behind drug-induced dermatomyositis. In conclusion, our review consolidates the current literature on DIDM, highlighting the evolving spectrum of medications and elucidating the differences in clinical manifestations, laboratory findings, and underlying mechanisms.
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Affiliation(s)
- Kunze Yu
- Zhejiang University School of Medicine Second Affiliated Hospital, Department of Dermatology, Hangzhou, Zhejiang, PR China
| | - Tianxiang Wang
- Zhejiang University School of Medicine Second Affiliated Hospital, Department of Dermatology, Hangzhou, Zhejiang, PR China
| | - Dadao An
- Zhejiang University School of Medicine, Department of Basic Medicine, Hangzhou, Zhejiang, PR China
| | - Xiawei Li
- Zhejiang University School of Medicine Second Affiliated Hospital, Department of Gastrointestinal Surgery, Hangzhou, Zhejiang, PR China
| | - Zhuangli Tang
- Zhejiang University School of Medicine Second Affiliated Hospital, Department of Dermatology, Hangzhou, Zhejiang, PR China.
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2
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Saeidnia M, Shadfar F, Sharifi S, Babashahi M, Ghaderi A, Shokri M. Skin complications during iron chelation therapy for beta-thalassemia: overview and treatment approach. Int J Hematol 2024:10.1007/s12185-024-03825-w. [PMID: 39088188 DOI: 10.1007/s12185-024-03825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/26/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024]
Abstract
Thalassemia is an inherited genetic disorder of hemoglobin that affects a large population worldwide, and it is estimated that between 50,000 and 60,000 infants with thalassemia are born each year. The most common treatment for thalassemia is blood transfusion, which leads to iron overload. This in itself is a serious clinical condition, and is commonly managed with iron chelation therapy. However, iron chelators can cause various skin complications, including hyperpigmentation, skin rash, itching, and photosensitivity. These skin side effects can impact patients' quality of life. Therefore, this article provides a comprehensive overview of skin complications caused by iron chelators, along with a proposed comprehensive approach to their management in patients with beta-thalassemia. Key strategies include patient education, regular skin assessment, sun protection measures, symptomatic relief with topical corticosteroids and antihistamines, and consideration of treatment modification if severe complications occur. Collaboration between hematologists and dermatologists, along with psychological support and regular follow-up, is an essential component of this multidisciplinary approach. By implementing these strategies, healthcare providers can optimize skin care for patients with beta-thalassemia treated with iron chelators and improve their quality of life.
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Affiliation(s)
- Mohammadreza Saeidnia
- Department of Hematology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
- Clinical Research Development Unit, Imam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran.
| | - Fariba Shadfar
- Department of Dermatology, School of Medicine, Imam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Shokoufeh Sharifi
- Department of Dermatology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mashallah Babashahi
- Department of Pathobiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Abolhassan Ghaderi
- Clinical Research Development Unit, Imam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Mehdi Shokri
- Department of Pediatrics, School of Medicine, Imam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
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3
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Pruessmann W, Kirfel J, Sailer VW, Rose C. Dermatomyositis-like skin eruptions under hydroxyurea therapy conceal TP53-mutated atypical keratinocytes: A histopathologic and molecular pathologic case series. J Cutan Pathol 2024. [PMID: 39005167 DOI: 10.1111/cup.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
Hydroxyurea is an antimetabolite that inhibits DNA synthesis and is used as a treatment option in chronic myeloproliferative disorders. Rarely, "dermatomyositis (DM)-like" skin lesions are observed after long-term therapy. In this case series, five skin biopsies of four patients were evaluated by histology, immunohistochemistry, and next-generation sequencing of the TP53 gene locus. All biopsies showed focal basal pleomorphic keratinocytes and suprabasal aberrant p53 expression as well as sparse to severe vacuolar interface dermatitis. Histopathologically, "DM-like" skin lesions can be clearly distinguished from DM by marked subepidermal fibrosis, vascular proliferation, and the absence of dermal mucin deposits. In 75% of the specimens multiple, partly inactivating and/or pathogenic point mutations of TP53 were found in low frequencies. "DM-like" skin eruptions as a long-term consequence of hydroxyurea therapy are possibly not chemotherapy-associated benign toxic changes, but rather inflammatory reactions to complex keratinocyte alterations that clinically mimic the picture of DM. Synergistic mutagenic effects of hydroxyurea and sunlight might be responsible for this unique drug side effect and could provide a pathogenic link to the known increased risk of skin cancer in these patients.
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Affiliation(s)
| | - Jutta Kirfel
- Institute of Pathology, University of Lübeck, Lübeck, Germany
| | | | - Christian Rose
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Dermatopathology Lübeck, Lübeck, Germany
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4
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Ahdoot R, Rew J, Reynolds KA, Lowe L, Mervak JE. Violaceous scaly plaques of the dorsal hands. JAAD Case Rep 2024; 49:85-87. [PMID: 38938698 PMCID: PMC11208765 DOI: 10.1016/j.jdcr.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Affiliation(s)
- Rodney Ahdoot
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Joanna Rew
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Kelly A. Reynolds
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Lori Lowe
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Julie E. Mervak
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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Caravan S, Lopez CM, Yeh JE. Causes and Clinical Presentation of Drug-Induced Dermatomyositis: A Systematic Review. JAMA Dermatol 2024; 160:210-217. [PMID: 38198130 DOI: 10.1001/jamadermatol.2023.5418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Importance While several medications are known to induce dermatomyositis (DM), most existing studies are case reports or small case series from a single institution. There is also limited information on DM induced by immune checkpoint inhibitors, which are increasingly used in oncologic therapy. Objective To characterize causes and clinical presentation of drug-induced DM based on the current literature. Evidence Review A systematic review was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, from inception to August 22, 2022. Articles meeting preestablished inclusion criteria (written in English and classified as original articles, case reports, literature reviews, and observation letters) were selected and data abstracted. Articles that met the scope of the review were also added from reference lists. When possible, study results were quantitatively combined. Findings In 134 studies (114 from the literature search and 20 additional studies pulled from reference lists) describing 165 cases, 88 patients (53.3%) were female, and the median (IQR) age was 61 (49-69) years. Among the cases of drug-induced DM, the most common associated medications were hydroxyurea (50 [30.3%]), immune checkpoint inhibitors (27 [16.4%]), statins (22 [13.3%]), penicillamine (10 [6.1%]), and tumor necrosis factor inhibitors (10 [6.1%]). Histopathologic testing, when undertaken, helped establish the diagnosis. There was a median (IQR) of 60 (21-288) days between drug initiation and drug-induced DM onset. History of cancer was reported in 85 cases (51.6%). Conclusions and Relevance In this systematic review, drug-induced DM was associated with multiple types of medications, including chemotherapies and immunotherapies. It is essential that dermatologists promptly recognize and diagnose drug-induced DM so that they can guide management to minimize interruption of therapy when possible.
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Affiliation(s)
- Sahar Caravan
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Christopher M Lopez
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Jennifer E Yeh
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
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Selva-O’Callaghan A, Trallero-Araguás E, Ros J, Gil-Vila A, Lostes J, Agustí A, Riera-Arnau J, Alvarado-Cárdenas M, Pinal-Fernandez I. Management of Cancer-Associated Myositis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2022; 8:91-104. [PMID: 36313478 PMCID: PMC9589595 DOI: 10.1007/s40674-022-00197-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 12/01/2022]
Abstract
Purpose of the Review Cancer-associated myositis (CAM) is defined as when cancer appears within 3 years of myositis onset. Dermatomyositis and seronegative immune–mediated necrotizing myopathy are the phenotypes mostly related to cancer. In general, treatment principles in myositis patients with and without CAM are similar. However, some aspects of myositis management are particular to CAM, including (a) the need for a multidisciplinary approach and a close relationship with the oncologist, (b) the presence of immunosuppressive and antineoplastic drug interactions, and (c) the role of the long-term immunosuppressive therapy as a risk factor for cancer relapse or development of a second neoplasm. In this review, we will also discuss immunotherapy in patients treated with checkpoint inhibitors as a treatment for their cancer. Recent Findings Studies on cancer risk in patients treated with long-term immunosuppressive drugs, in autoimmune diseases such as systemic lupus erythematosus or rheumatoid arthritis, and in solid organ transplant recipients have shed some light on this topic. Immunotherapy, which has been a great advance for the treatment of some types of malignancy, may be also of interest in CAM, given the special relationship between both disorders. Summary Management of CAM is a challenge. In this complex scenario, therapeutic decisions must consider both diseases simultaneously. Supplementary Information The online version contains supplementary material available at 10.1007/s40674-022-00197-2.
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Affiliation(s)
- Albert Selva-O’Callaghan
- Systemic Autoimmune Diseases Unit, Internal Medicine Dept, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Javier Ros
- Medical Oncology Department, Vall d’Hebron General Hospital, Barcelona, Spain
| | - Albert Gil-Vila
- Systemic Autoimmune Diseases Unit, Internal Medicine Dept, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julia Lostes
- Medical Oncology Department, Vall d’Hebron General Hospital, Barcelona, Spain
| | - Antonia Agustí
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Judit Riera-Arnau
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | | | - Iago Pinal-Fernandez
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
- Faculty of Health Sciences and Faculty of Computer Science, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
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Tolu SS, Crouch A, Choi J, Gao Q, Reyes-Gil M, Ogu UO, Vinces G, Minniti CP. Hydroxyurea and fetal hemoglobin effect on leg ulcers in patients with sickle cell disease. Ann Hematol 2022; 101:541-548. [PMID: 35039901 DOI: 10.1007/s00277-021-04635-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/14/2021] [Indexed: 11/01/2022]
Abstract
The presence of leg ulcers in individuals with sickle cell disease often represents an early sign of vasculopathy and future end organ damage. Pathophysiological mechanisms of formation and evolution of leg ulcers are poorly understood; nevertheless, HbF has been associated with lower incidence of leg ulcers, while hydroxyurea has been correlated with high risk of leg ulcers. As a result, there is hesitation regarding hydroxyurea use in patients with SCD and leg ulcers. In this study, we aim to define (1) a target of HbF that offers protection against leg ulcer development and (2) the impact of hydroxyurea therapy on leg ulcer prevalence. Our study demonstrated that in order to reduce leg ulcer incidence by one-third, a HbF > 25% is needed, a threshold not commonly reached and maintained in the adult SCD population. Importantly, leg ulcer incidence appears to be independent of HU use (p = 0.50). Our interpretation of this data is that the use of HU in a patient with SCD and leg ulcers should be guided by a careful assessment of risks and benefits of this therapeutic modality.
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Affiliation(s)
- Seda S Tolu
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210th street, Bronx, NY, 10467, USA.
| | - Andrew Crouch
- Department of Medicine, Division of Hematology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jaeun Choi
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Qi Gao
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Moramaya Reyes-Gil
- Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Ugochi Olivia Ogu
- Department of Medicine, Division of Hematology/Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Giacomo Vinces
- Department of Family and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Caterina P Minniti
- Department of Medicine, Division of Hematology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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8
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Bax CE, Maddukuri S, Ravishankar A, Pappas-Taffer L, Werth VP. Environmental triggers of dermatomyositis: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:434. [PMID: 33842655 PMCID: PMC8033368 DOI: 10.21037/atm-20-3719] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Dermatomyositis (DM) is an autoimmune disease that affects the skin, lungs, and muscle. Although the pathogenesis of DM is not completely understood, several environmental triggers have been linked to DM onset or flare. This article specifically examines the effects of herbal supplements, drugs, infections, ultraviolet (UV) radiation, and environmental pollutants on the onset or exacerbation of DM. Herbal supplements such as Spirulina platensis, Aphanizomenon flos-aquae, Chlorella, Echinacea, and Alfalfa have been implicated and are frequently used in health foods. Medications such as hydroxyurea, TNF-α inhibitors, immune checkpoint inhibitors (ICI), and penicillamine, as well as certain viral infections, such as parvovirus B19, coxsackie virus, polyomavirus, Epstein-Barr virus (EBV), hepatitis, influenza, and human immunodeficiency viruses (HIV) have been associated with DM onset. Bacterial infections and vaccinations have also been linked to the development of DM. Additional environmental factors, including UV radiation and air pollutants, such as silica, biological/mineral dust, and particulate air matter from vehicle and industrial emissions, may also play a role in DM pathogenesis. Overall, there is general agreement that an autoimmune attack of the skin, muscle, and lungs in DM can be triggered by various environmental factors and warrants further investigation.
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Affiliation(s)
- Christina E Bax
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Spandana Maddukuri
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Adarsh Ravishankar
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Pappas-Taffer
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria P Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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9
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Kaul S, Kaffenberger BH, Choi JN, Kwatra SG. Cutaneous Adverse Reactions of Anticancer Agents. Dermatol Clin 2019; 37:555-568. [DOI: 10.1016/j.det.2019.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Abstract
Dermatomyositis (DM) is an idiopathic, inflammatory connective tissue disorder characterized by symmetrical proximal myopathy and characteristic skin involvement. The pathogenesis of DM is widely debated; however, it is postulated to be an end result of immune-mediated cascade, triggered by multiple environmental factors in a genetically predisposed individual. In addition to underlying malignancies, many drugs have been reported to be associated with DM. Capecitabine is a chemotherapeutic agent, approved by the United States-Food and Drug Administration for the management of colonic, metastatic colonic, and metastatic breast carcinoma. It is converted into 5-fluorouracil after oral intake. Common dose-limiting toxicities associated with the usage of the capecitabine include increased bilirubin levels, diarrhea, and hand-foot syndrome. DM-induced by capecitabine has rarely been reported. Herein, we describe a patient of metastatic carcinoma breast, who developed DM after capecitabine intake. The patient had accidental re-challenge with capecitabine resulting in the reappearance of the cutaneous and musculoskeletal system, thereby confirming our diagnosis of drug-induced DM in the setting of underlying malignancy.
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Affiliation(s)
- Neerja Saraswat
- Department of Dermatology, Base Hospital Delhi Cantt, New Delhi, India
| | - Rajesh Verma
- Department of Dermatology, Army College of Medical Sciences, New Delhi, India
| | - Shekha Neema
- Department of Dermatology, Command Hospital, Kolkata, West Bengal, India
| | - Sushil Kumar
- Department of Dermatology, MLN Medical College, Allahabad, Uttar Pradesh, India
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12
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Complications dermatologiques de l’hydroxyurée au long cours. Therapie 2017; 72:391-394. [DOI: 10.1016/j.therap.2016.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/19/2016] [Indexed: 11/22/2022]
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Dermatomyositis-Like Eruption Associated With Hydroxyurea Therapy: A Premalignant Condition? ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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de Unamuno-Bustos B, Ballester-Sánchez R, Sabater Marco V, Vilata-Corell JJ. Dermatomyositis-like eruption associated with hydroxyurea therapy: a premalignant condition? ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:876-8. [PMID: 24666578 DOI: 10.1016/j.ad.2014.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/29/2014] [Accepted: 02/02/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
- B de Unamuno-Bustos
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - R Ballester-Sánchez
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - V Sabater Marco
- Servicio de Anatomía Patológica, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J J Vilata-Corell
- Servicio de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
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15
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Quattrone F, Dini V, Barbanera S, Zerbinati N, Romanelli M. Cutaneous ulcers associated with hydroxyurea therapy. J Tissue Viability 2013; 22:112-21. [DOI: 10.1016/j.jtv.2013.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/25/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
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16
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Nofal A, Salah E. Acquired poikiloderma: Proposed classification and diagnostic approach. J Am Acad Dermatol 2013; 69:e129-40. [DOI: 10.1016/j.jaad.2012.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 05/25/2012] [Accepted: 06/11/2012] [Indexed: 02/08/2023]
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Nofal A, El-Din ES. Hydroxyurea-induced dermatomyositis: true amyopathic dermatomyositis or dermatomyositis-like eruption? Int J Dermatol 2012; 51:535-41. [PMID: 22515579 DOI: 10.1111/j.1365-4632.2011.05105.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hydroxyurea-induced dermatomyositis is a rare adverse reaction of long-term hydroxyurea therapy. It has been reported under different names; however, the exact classification and nomenclature of this eruption have been the subject of much debate, and a more precise term is still awaiting. Herein, we review the different aspects of this reaction and suggest a new term that might help to minimize the confusion about its nomenclature. MATERIALS AND METHODS We describe a 68-year-old woman who had been on long-term hydroxyurea therapy for the treatment of chronic myeloid leukemia for nine years. She presented with typical dermatomyositis-like lesions and many of the other mucocutaneous adverse effects of hydroxyurea. RESULTS Skin examination revealed typical Gottron's papules on the dorsa of the hands, atrophy, xerosis, acquired ichthyosis, photosensitivity, cutaneous, oral and nail hyperpigmentation, acral erythema, palmoplantar keratoderma, actinic keratoses, and leg ulcers. There was no clinical or laboratory evidence of proximal muscle weakness. Cessation of hydroxyurea was associated with remarkable improvement of the skin lesions. CONCLUSION Hydroxyurea-induced dermatomyositis is a rare drug-induced dermatomyositis characterized by skin lesions identical to classic dermatomyositis without clinical or laboratory evidence of myositis. We propose that the term hydroxyurea-induced amyopathic dermatomyositis that adequately describes the findings reported in this subset of patients would be more precise and specific.
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Affiliation(s)
- Ahmad Nofal
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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19
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Changes of immunological profiles in patients with chronic myeloid leukemia in the course of treatment. Clin Dev Immunol 2010; 2010:137320. [PMID: 21197073 PMCID: PMC3004381 DOI: 10.1155/2010/137320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/15/2010] [Accepted: 10/20/2010] [Indexed: 11/30/2022]
Abstract
In the previous paper of ours we compared, prior to start any treatment, a number of immunological parameters in 24 chronic myeloid leukemia patients with the same number of healthy subjects matched by age and sex. We found significant differences in the levels of immunoglobulins, the C4 component of complement, the C-reactive protein, interleukin 6, the composition of lymphocyte population and the production of some cytokines by stimulated CD3+ cells. Eleven of these patients were followed longitudinally. After treatment with hydroxyurea, interferon alpha, imatinib mesylate and dasatinib, or various combinations thereof, hematological remission was achieved in all patients and complete cytogenetic remission in nine of them. There was a nearly general tendency towards normalization of the abnormalities observed in the patients at their enrollment.
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20
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Cook-Norris RH, Mansfield AS, Michaels JD, Davis MDP. Hydroxycarbamide-induced dermopathy. Am J Hematol 2010; 85:75-6. [PMID: 19425065 DOI: 10.1002/ajh.21421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robert H Cook-Norris
- Department of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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22
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Dem A, Diallo M, Gaye Fall M, Dieng M, Gaye M, Touré P. Complications cutanées induites par l’hydroxyurée au long cours. Ann Dermatol Venereol 2008; 135:800-1. [DOI: 10.1016/j.annder.2008.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 02/15/2008] [Indexed: 10/21/2022]
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Seidler AM, Wasserman DI, González-Serva A, Konnikov N. Amyopathic dermatomyositis resembling stasis dermatitis. J Am Acad Dermatol 2008; 59:515-8. [DOI: 10.1016/j.jaad.2008.02.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 01/19/2008] [Accepted: 02/12/2008] [Indexed: 11/16/2022]
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Seidler AM, Gottlieb AB. Dermatomyositis induced by drug therapy: a review of case reports. J Am Acad Dermatol 2008; 59:872-80. [PMID: 18625537 DOI: 10.1016/j.jaad.2008.05.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 04/01/2008] [Accepted: 05/27/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Drugs have occasionally been implicated in dermatomyositis (DM) onset. OBJECTIVE We sought to review case reports of drug-induced DM. METHODS Articles were gathered from MEDLINE and bibliographies of acquired reports. Causality was assessed using World Health Organization criteria. Clinical characteristics, management, and resolution were examined. RESULTS In 70 reported cases, 50% of patients were female and the median age was 57 years. Hydroxyurea was implicated in 51% of cases. All cases had pathognomonic (76%) or compatible (24%) cutaneous findings. Hydroxyurea cases lacked myositis, but myositis was described in 79.4% of nonhydroxyurea cases. Drug causality was probable (25.7%) or possible (74.3%), but not certain in any case. Most patients had underlying pathology associated with DM (44% had malignancy; 16% had rheumatoid arthritis). Of the sample, 84.3% had improvement of DM after discontinuation of the drug. LIMITATIONS Case reports may emphasize unusual findings. CONCLUSIONS Further work is needed to differentiate drug effects from underlying, predisposing factors.
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Affiliation(s)
- Anne M Seidler
- Department of Dermatology, Tufts University School of Medicine and Tufts Medical Center, Boston, Massachusetts 02111-1533, USA.
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Dourmishev LA, Dourmishev AL. Activity of certain drugs in inducing of inflammatory myopathies with cutaneous manifestations. Expert Opin Drug Saf 2008; 7:421-33. [DOI: 10.1517/14740338.7.4.421] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Alvarez F, Pagot C, Vabre-Latre CM, Uro-Coste E, Paul C, Chaix Y, Mazereeuw-Hautier J. Carbimazole-induced juvenile dermatomyositis. Br J Dermatol 2007; 158:196-7. [PMID: 17986297 DOI: 10.1111/j.1365-2133.2007.08289.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hanchi I, Zeglaoui F, Ezzine N, Daoud L, Karoui M, Fazaa B, Ridha Kamoun M. [Leg ulcer in a patient treated with hydroxyurea for polycythemia vera]. Presse Med 2006; 35:1174-6. [PMID: 16840894 DOI: 10.1016/s0755-4982(06)74775-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Causes of leg ulcers vary widely, although venous insufficiency and peripheral arteriopathy are most common. Ulcers are much rarer in patients treated by hydroxyurea. CASE A 66-year-old woman who had been treated with hydroxyurea for polycythemia vera for four years came to our consultation a month after ulceration of the left lateral malleolus had begun. Symmetric peripheral pulses were present and there was no patent venous insufficiency. After two months of local symptomatic treatment, the size of the ulcer had increased. The possible involvement of hydroxyurea in the genesis and maintenance of this leg ulcer was then considered. Hydroxyurea was stopped, and the ulcer progressively grew smaller, finally healing completely two months later. DISCUSSION We conclude that hydroxyurea was the primary cause of the malleolar ulcer, for it healed rapidly when this treatment stopped. Hydroxyurea causes cutaneous atrophy; when followed by microtrauma, associated with deterioration in DNA repair mechanisms, it may lead to the formation of persistent cutaneous ulcers. Hydroxyurea can also affect the microcirculation and induce tissular anoxia, which may also explain both the occurrence of cutaneous ulcers after microtrauma and their often painful character.
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Abstract
Dermatomyositis is one of the idiopathic inflammatory myopathies. It is characterized clinically by progressive symmetrical proximal muscle weakness and a characteristic rash. There are patients with rash who have little or no muscle disease. Although the process primarily attacks the skin and the muscles, it is a systemic disease with frequent manifestations in the gastrointestinal tract and pulmonary system. Dermatomyositis has been linked to internal malignancy in somewhere between 15% and 25%. Therapy for the muscle disease includes systemic corticosteroids with or without an immunosuppressive agent. Therapy of the skin disease begins with photoprotection and topical corticosteroids, but also includes the use of antimalarial agents and immunomodulatory therapies.
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Affiliation(s)
- Jeffrey P Callen
- Division of Dermatology, University of Louisville School of Medicine, KY 40202, USA.
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Slobodin G, Lurie M, Munichor M, Kovalev J, Rosner I. Gottron's papules-like eruption developing under hydroxyurea therapy. Rheumatol Int 2006; 26:768-70. [PMID: 16583187 DOI: 10.1007/s00296-006-0123-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Accepted: 03/01/2006] [Indexed: 11/29/2022]
Abstract
A 57-year-old white female developed a Gottron's papules (GP)-like eruption, without any of the other clinical or laboratory signs of dermatomyositis (DM). She was under hydroxyurea treatment for chronic myeloid leukemia at the time. Skin biopsy was compatible with seborrheic keratosis. Conditions presenting with GP but unrelated to DM are reviewed, with emphasis on hydroxyurea-induced skin lesions.
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Affiliation(s)
- Gleb Slobodin
- Department of Internal Medicine A, Bnai Zion Medical Center, Haifa, 31048, PO Box 4940, Israel.
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Abstract
Dermatomyositis is characterized by marked clinical heterogeneity. Many classification schemes are available, based on internal organ involvement, presence of circulating autoantibodies and additional symptoms characteristic for other connective tissue diseases. Viral infections and underlying malignancies are possible mechanisms to trigger this autoimmune disease. Intensive clinical investigations to detect such malignancies are therefore required. The prognosis of the individual patient depends on the involvement of internal organs and the characterization of circulating autoantibodies. There are patients with rapidly developing subsets of dermatomyositis and those with slowly progressive disease. Therefore treatment has to be adjusted for the disease severity. Sometimes high dosages of corticosteroids in combination with immunosuppressive agents or immunoglobulins are required.
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Affiliation(s)
- Julia Kaufmann
- Klinik und Poliklinik für Dermatologie und Venerologie der Universität zu Köln.
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Abstract
International data from 2002 report 10.9 million new cases of cancer and 6.7 million cancer deaths. Chemotherapy is an essential component in the multidisciplinary management of most cancers. Cutaneous reactions to chemotherapeutics are common and may contribute significantly to the morbidity, and rarely to the mortality, of patients undergoing such treatments. Recognition and management of these reactions is important to provide optimal care. This article aims to present the most common cutaneous reactions to frequently used chemotherapies and provides management guidelines. A MEDLINE search from 1966 through June 2005 was conducted to identify reports of common cutaneous toxicities with systemic chemotherapy and their appropriate management. An analysis of our literature search is presented in review form outlining common chemotherapy-related cutaneous reactions and their management, as well as the chemotherapeutics responsible for the cutaneous toxicity. Chemotherapy-related cutaneous toxicity includes generalized rashes such as the spectrum between erythema multiforme and toxic epidermal necrolysis, and site-specific toxicity such as mucositis, alopecia, nail changes, extravasation reactions, or hand-foot syndrome. Most of the toxicity is reversible with chemotherapy dose reductions or delays. Certain toxicities can be effectively treated or prevented, allowing optimal delivery of chemotherapy (e.g. premedications to prevent hypersensitivity, prophylactic mouthwashes to prevent mucositis). Newer non-chemotherapeutic targeted therapies such as epidermal growth factor receptor inhibitors (e.g. gefitinib, cetuximab) may also be associated with cutaneous toxicity and can be distressing for patients. Recent data suggest that skin toxicity associated with these agents may correlate with efficacy. Cutaneous toxicity occurs frequently with chemotherapy and non-chemotherapeutic biologic therapies. Early recognition and treatment of the toxicity facilitates good symptom control, prevents treatment-related morbidity, and allows continuation of anti-cancer therapy.
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Affiliation(s)
- Angela J Wyatt
- Department of Dermatology, New York Presbyterian Hospital, Weill Medical College, Cornell University, New York, New York, USA.
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Abstract
We report 2 cases of squamous dysplasia associated with long-term hydroxyurea therapy. The association between hydroxyurea and multiple aggressive squamous cell carcinomas, Bowen's disease, and multiple actinic keratoses in sun-exposed areas after a variable latency period has been increasingly reported. On reviewing the literature, 17 cases were identified and are reviewed, with emphasis on possible pathogenetic mechanisms of carcinogenicity. Squamous dysplasia, a precursor state to a more aggressive condition of multiple squamous cell carcinomas in photoexposed areas, should be added to the well-known cutaneous toxicities of hydroxyurea therapy.
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Affiliation(s)
- Carla Sanchez-Palacios
- Department of Dermatology, The Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Abstract
PURPOSE OF REVIEW Dermatomyositis (DM) is a rare multisystem autoimmune disorder of adults and children that primarily affects skin and skeletal muscle. Classification systems of dermatomyositis, polymyositis, and the other idiopathic inflammatory myopathies focus primarily on features of muscle involvement. However, cutaneous disease does not always parallel muscle disease in its onset, activity, or response to therapy. This review will describe the distinct cutaneous clinical and histopathologic presentation of DM and the relation between these cutaneous findings, pathogenesis of DM, and serological subsets of DM. RECENT FINDINGS This review discusses recent findings that have begun to elucidate the pathogenesis of DM, including polymorphism of tumor necrosis factor-alpha 308A allele and maternal fetal microchimerism. The recent description of other systemic diseases and drugs causing DM-like eruptions and the recognition that DM can resemble other common dermatoses highlights the need for a cutaneous biopsy to diagnose and distinguish the cutaneous features of DM. Once diagnosed, a number of noninvasive imaging modalities and new cutaneous assessment instruments can be used to follow and evaluate patients with DM. SUMMARY Recognition of cutaneous and histopathologic findings in DM is essential for prompt and accurate diagnosis and treatment of DM.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2003; 12:523-38. [PMID: 14513666 DOI: 10.1002/pds.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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