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Mazzetto R, Miceli P, Sernicola A, Tartaglia J, Alaibac M. Skin Hypopigmentation in Hematology Disorders. Hematol Rep 2024; 16:354-366. [PMID: 38921184 PMCID: PMC11204138 DOI: 10.3390/hematolrep16020036] [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: 04/10/2024] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Hypopigmentation disorders pose significant diagnostic challenges in dermatology, sometimes reflecting underlying hematological conditions. This review explores the clinical presentations related to hypopigmentation in hematological disorders, focusing on vitiligo, morphea, and syndromic albinism. Vitiligo, an autoimmune disorder targeting melanocytes, involves interactions between genetic polymorphisms and immune responses, particularly regarding CD8+ T cells and IFN-γ. Drug-induced vitiligo, notably by immune checkpoint inhibitors and small-molecule targeted anticancer therapies, underscores the importance of immune dysregulation. Morphea, an inflammatory skin disorder, may signal hematological involvement, as seen in deep morphea and post-radiotherapy lesions. Syndromic albinism, linked to various genetic mutations affecting melanin production, often presents with hematologic abnormalities. Treatment approaches focus on targeting the immune pathways specific to the condition, and when that is not possible, managing symptoms. Understanding these dermatological manifestations is crucial for the timely diagnosis and management of hematological disorders.
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Affiliation(s)
| | | | - Alvise Sernicola
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padova, Italy; (R.M.); (J.T.); (M.A.)
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Bang AS, Fay CJ, LeBoeuf NR, Etaee F, Leventhal JS, Sibaud V, Arbesman J, Wang JY, Kwong BY. Multi-center retrospective review of vitiligo-like lesions in breast cancer patients treated with cyclin-dependent kinase 4 and 6 inhibitors. Breast Cancer Res Treat 2024; 204:643-647. [PMID: 38224427 DOI: 10.1007/s10549-023-07217-2] [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: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Cutaneous adverse effects from cyclin-dependent 4 and 6 kinase inhibitors (CDK4/6i) used in metastatic breast cancer are prevalent and well described. Vitiligo-like lesions have been reported and are rare. They can negatively impact patients' quality of life and may be associated with survival benefits. We describe the clinical characteristics of vitiligo-like lesions in an international cohort of patients treated with CDK4/6i to help improve recognition and management. METHODS Retrospective review of patients diagnosed with vitiligo-like lesions from CDK4/6i from five academic institutions in the USA and Europe was performed. Ten patients were included in the study. RESULTS Median age of our patients was 55 (range 37-86). Median progression-free survival was 24 months in 5 patients. The median time to rash was 10 months. Sun-exposed areas such as the arms and face were the most affected areas. Multiple skin-directed therapies such as topicals, laser, and phototherapy were trialed with minor success. Mild repigmentation was seen in one patient treated with ruxolitinib cream. CDK4/6 treatment was discontinued due to the vitiligo-like lesions in one patient. CONCLUSION Clinical characteristics are similar to previously reported findings in case reports and series. We add topical ruxolitinib as a potential treatment option for these patients and include data regarding progression-free survival that should continue to be collected. No definitive conclusions can be made regarding survival benefits from our cohort. Clinicians should refer these patients to dermatologists to aid with management.
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Affiliation(s)
- Alexander S Bang
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Dermatology, Stanford University, Palo Alto, CA, USA
| | - Christopher J Fay
- Dermatology of Dermatology, Harvard Medical School, Center for Cutaneous Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nicole R LeBoeuf
- Dermatology of Dermatology, Harvard Medical School, Center for Cutaneous Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Farshid Etaee
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | | | - Vincent Sibaud
- Oncodermatology Department, Institut Universitaire du Cancer, Toulouse Oncopole, Toulouse, France
| | - Joshua Arbesman
- Department of Dermatology, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Y Wang
- Department of Dermatology, Stanford University, Palo Alto, CA, USA
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University, Palo Alto, CA, USA.
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Pérez NB, Millán PI, Menéndez AD, Domínguez Auñón JD. Vitiligo-like depigmentation affecting sun-exposed areas caused by palbociclib. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12923. [PMID: 37929877 DOI: 10.1111/phpp.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 10/14/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Nuria Barrientos Pérez
- Departamento de Dermatología, Hospital Universitario del Henares, Madrid, Spain
- Facultad de Medicina Universidad Francisco de Vitoria, Madrid, Spain
| | - Patricia Ibeas Millán
- Facultad de Medicina Universidad Francisco de Vitoria, Madrid, Spain
- Servicio de Oncología, Hospital Universitario del Henares, Madrid, Spain
| | - Ariel Díaz Menéndez
- Facultad de Medicina Universidad Francisco de Vitoria, Madrid, Spain
- Servicio De Anatomía Patológica, Hospital Universitario del Henares, Madrid, Spain
| | - José D Domínguez Auñón
- Departamento de Dermatología, Hospital Universitario del Henares, Madrid, Spain
- Facultad de Medicina Universidad Francisco de Vitoria, Madrid, Spain
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Jhan JY, Wang WE, Chu SC, Cheng CH, Chang CH. Case Report: Ribociclib-induced phototoxicity presented as dyschromia with subsequent bullae formation. Front Oncol 2023; 13:1184738. [PMID: 37692847 PMCID: PMC10484504 DOI: 10.3389/fonc.2023.1184738] [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: 03/12/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Ribociclib, a cyclin-dependent kinase 4/6 inhibitor, is a novel targeted therapy for advanced-stage breast cancer. Although ribociclib-induced cutaneous side effects have been previously noted, they have not been well documented. Herein, we present a case of ribociclib-induced phototoxicity, which manifested as dyschromia over sun-exposed forearms and neck initially and as bullae formation subsequently. A 71-year-old woman with metastatic breast cancer developed dyschromia after daily treatment with ribociclib (600 mg) for 7 months. Skin biopsy of the pigmented lesion revealed interface dermatitis with melanin incontinence and dyskeratotic cells and ballooning keratinocytes with loss of melanocytes in the basal layer. Further, clefting at the basal layer of epidermis was noted in a more hyperpigmented field. Fontana-Masson staining revealed melanophages in the dermis. Human Melanoma Black-45 staining revealed decreased melanocyte numbers in the epidermis above the cleft. Immunohistochemical analyses revealed activated CD1a+ epidermal Langerhans cells and infiltrating CD4+ and CD8+ T cells in the epidermis and dermis, thereby indicating type IV hypersensitivity that was associated with damage to keratinocytes and melanocytes. To prevent progression of bullous dermatitis, we advised the patient to discontinue ribociclib and prescribed oral and topical prednisolone. Due to the risk of phototoxicity, we educated the patient on sun-protection strategies. The patient's skin lesions subsided during the 2 months of treatment. Phototoxicity with dyschromia is a rare but significant ribociclib-induced cutaneous side effect. Early diagnosis, rapid ribociclib withdrawal, protection from sunlight, and prompt treatment are critical for preventing subsequent severe bullous dermatosis.
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Affiliation(s)
- Jyun-Yan Jhan
- Skin Institute, Department of Dermatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wei-En Wang
- Skin Institute, Department of Dermatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Sung-Chao Chu
- Department of Hematology-Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chiu-Hsuan Cheng
- Department of Pathology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chung-Hsing Chang
- Skin Institute, Department of Dermatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Doctoral Degree Program in Translational Medicine, Tzu Chi University and Academia Sinica, Taipei, Taiwan
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
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Gao S, Wei G, Hao Y. Vitiligo-like lesions induced by cyclin-dependent kinase 4/6 inhibitor Palbociclib: a case report and literature review. Pathol Oncol Res 2023; 29:1611115. [PMID: 37483648 PMCID: PMC10358287 DOI: 10.3389/pore.2023.1611115] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/18/2023] [Indexed: 07/25/2023]
Abstract
Endocrine therapy has played an essential role in hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer. With the continuous development of endocrine targeting drugs, especially the emergence of selective cyclin-dependent kinase (CDK4/6) inhibitors, the overall survival time in patients with HR+HER2- advanced breast cancer has been greatly improved. Their adverse reactions also need more attention in response to the climbing number of CDK4/6 inhibitors. The common side effects of CDK4/6 inhibitors were hematological toxicity, diarrhea, and liver function damage. Skin toxicity related to CDK4/6 inhibitors was rare. We describe herein our preliminary observation of one HR+HER2- advanced metastatic breast cancer patient diagnosed with vitiligo-like lesions after 10 months of taking Palbociclib. Hoping to share our experience to increase the clinician awareness of this unusual adverse and contribute to the information in the literature.
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Affiliation(s)
- Shan Gao
- Medical Oncology Division 1, Clinical Oncology Center, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Guanjing Wei
- Department of Dermatology and Venereology, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yanrong Hao
- Medical Oncology Division 1, Clinical Oncology Center, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Romagnuolo M, Alberti Violetti S, Riva D, Barberi F, Moltrasio C. Vitiligo-like lesions induced by cyclin-dependent kinase 4/6 inhibitor palbociclib. Int J Dermatol 2023; 62:e98-e100. [PMID: 35781265 DOI: 10.1111/ijd.16356] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/09/2022] [Accepted: 06/24/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Maurizio Romagnuolo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Alberti Violetti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Riva
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Barberi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Sharaf B, AlMasri R, Abdel-Razeq N, Salama O, Hamad I, Abunasser M, Abdel-Razeq H. Vitiligo-Like Lesions in a Patient with Metastatic Breast Cancer Treated with Cyclin-Dependent Kinase (CDK) 4/6 Inhibitor: A Case Report and Literature Review. Clin Cosmet Investig Dermatol 2022; 15:5-10. [PMID: 35023941 PMCID: PMC8743357 DOI: 10.2147/ccid.s344867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022]
Abstract
Background Cyclin-dependent kinase (CDK) 4/6 inhibitors have revolutionized the treatment landscape of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer, with an impressive efficacy and safety profile. Cytopenia is the main adverse event, which is both predictable and manageable. Here, we report a case of CDK4/6 inhibitor-induced vitiligo-like lesions. Vitiligo or vitiligo-like lesions are a rare adverse event; only a few cases are reported in the literature. Case Presentation A 71-year-old female patient was diagnosed initially with early-stage right breast cancer (HR+/HER2−) and was treated with breast-conserving surgery followed by chemotherapy, radiotherapy, and hormonal therapy. A few years later, she developed metastatic disease to the hilar lymph nodes, and to multiple skeletal sites, including the left scapula, left shoulder, left iliac bone, and dorsal vertebrae, for which she was treated with ribociclib and letrozole. While on treatment, she developed hypopigmented lesions involving both hands, feet, and face, which were described as vitiligo-like lesions. Conclusion CDK4/6 inhibitor-induced vitiligo is a rare and unpredictable adverse event. This case report highlights the rarity of this adverse event, the dilemma related to the optimal treatment, and decisions related to continuation, holding, or switching CDK4/6 inhibitors.
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Affiliation(s)
- Baha' Sharaf
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Rama AlMasri
- Department of Internal Medicine, Istishari Hospital, Amman, Jordan
| | - Nayef Abdel-Razeq
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Osama Salama
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Ibrahim Hamad
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mahmoud Abunasser
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.,School of Medicine, University of Jordan, Amman, Jordan
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