Follicular acneiform eruption induced by imatinib

[Nodulocystic eruption induced by sorafenib]

INTRODUCTION

Sorafenib is a multikinase inhibitor used in the treatment of hepatocellular carcinoma, advanced renal cell carcinoma, and differentiated thyroid carcinoma. Cutaneous adverse events are numerous and occur frequently.

PATIENTS AND METHODS

We present two cases of nodulocystic lesions associated with comedones in patients treated with sorafenib for hepatocellular carcinoma. In the first patient, a 64-year-old man, lesions appeared on the trunk one year after beginning sorafenib. Histopathological examination revealed a non-granulomatous, perivascular and perisudoral polymorphic cellular infiltrate associated with comedones and microcysts. These lesions progressed via inflammatory episodes interrupted by long periods of spontaneous remission without any specific treatment. In the second patient, a 53-year-old woman, a rash appeared on the buttocks three months after starting sorafenib and then spread to the lumbar region and thighs. Histopathological examination was consistent with granulomatous acne lesions. The initial treatment (oral tetracycline and zinc) given for 3 months proved ineffective. Patient follow-up over 3 years showed gradual regression without the appearance of any further lesions.

DISCUSSION

In the literature, several reports discuss acneiform rashes in patients treated with targeted therapy. In most cases, these lesions were papulopustular without retentional lesions. There are few reports of nodulocystic eruptions associated with comedones following sorafenib therapy. The mechanisms of emergence of these lesions seem to involve inhibition of the RAF pathway, C-KIT, and the PDGF signaling pathway.

Cystic acne due to imatinib therapy for chronic myelocytic leukemia

Imatinib mesylate is a tyrosine kinase inhibitor used in the treatment of several malignancies. Its use, however, is associated with a number of toxic effects including adverse cutaneous reactions. Herein, we present a case of facial cystic acne in a patient receiving imatinib therapy for chronic myelocytic leukemia. This side effect resolved with cessation of therapy. To the best of our knowledge, this clinical entity has never been previously reported in the medical literature.

Drug-induced acneiform eruption

Drug-induced acne is a specific subset of acne that usually has some specific features, namely a monomorphic pattern, an unusual location of the lesions beyond the seborrheic areas, an unusual age of onset, a resistance to conventional acne therapy and, of course, the notion of a recent drug introduction. Many drugs can be responsible for such a clinical pattern. Corticosteroids, neuropsychotherapeutic drugs, antituberculosis drugs, and immunomodulating molecules are the more classical drugs associated with induced acne. Recently, new drugs, mainly targeted therapy in the field of oncology, such as epidermal growth factor receptor inhibitors, have been associated with an increased frequency of this adverse effect. Disruption of the culprit drug is rarely mandatory in cases of drug-induced acne. Close cooperation between the dermatologist and medical staff in charge of the patient is an important challenge to achieve optimal management of the initial disease.