Imatinib
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Imatinib Palmoplantar hyperkeratosis and nail dystrophy: 3 case reports Three patients developed palmoplantar hyperkeratosis and nail dystrophy during treatment with imatinib for chronic myeloid leukaemia. A 52-year-old man began receiving imatinib 300 mg/day. After 10 weeks, he developed a disseminated skin eruption on his trunk. His skin showed slightly pruritic, mostly macular erythema with pityriatic scale. His skin eruption subsequently spread over his whole body and his imatinib was interrupted. After 10 days, his skin eruption subsided and imatinib 300 mg/day was resumed. His skin eruption worsened but was controlled with concomitant topical corticosteroids. About 2 months after restarting his imatinib with gradual dose escalation, he developed periorbital oedema, hyperkeratotic lesion on his soles and palms, and onychoclasis of several toenails and fingernails. His WBC count was 8.6 x 109/L (71% eosinophils) compared with 4.7 x 109/L (4% eosinophils) before imatinib therapy. A 68-year-old man began receiving imatinib 400 mg/day. After 3 weeks, periorbital oedema and scaly erythema over his whole integument were noted. Imatinib was continued at a dosage of 300 mg/day. His skin eruption then subsided and was controlled with topical corticosteroids. About 1 month after his dose reduction, he developed hyperkeratosis around his palms and soles and onychoclasis of several fingernails. A plantar keratosis biopsy showed psoriasiform acanthosis of his epidermis with parakeratosis and focal absence of the granular layer and lymphocyte exocytosis. His WBC count was 6 x 109/L (15% eosinophils) compared with 4.4 x 109/L (1% eosinophils) before imatinib treatment. A 47-year-old woman began receiving imatinib 400 mg/day. After 2 months, she had periorbital oedema, slight hyperkeratosis around her soles and palms, and sporadic scaly erythema on her trunk. Her skin eruption was controlled with topical corticosteroids. About 3 months after starting this treatment, she suddenly developed pitting of several of her fingernails. Her WBC count was 3.8 x 109/L (20% eosinophils) compared with 5.2 x 109/L (4% eosinophils) before imatinib treatment. Patch-testing and the drug-induced lymphocyte stimulation test for imatinib were negative in all patients. Following reduction or discontinuation of imatinib, their affected nails began to revert to normal. Author comment: "The dose dependency of adverse events supports the hypothesis that [imatinib]-related cutaneous reactions are mediated by its pharmacological effect, which changes tyrosine kinase signalling rather than immunological mechanisms including hypersensitivity to this drug. . . The mechanism of the psoriasiform reaction with [imatinib] is unclear." Deguchi N, et al. Imatinib mesylate causes palmoplantar hyperkeratosis and nail dystrophy in three patients with chronic myeloid leukaemia. British Journal of 801042896 Dermatology 154: 1216-1218, No. 6, Jun 2006 - Japan
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