Mucocutaneous Hyperpigmentation Associated with Hydroxyurea Therapy in a Patient with Essential Thrombocythemia: Case Report
DOI:
https://doi.org/10.32635/2176-9745.RBC.2023v69n1.2995Keywords:
hyperpigmentation, hydroxyurea, thrombocythemia, essentialAbstract
Introduction: Mucocutaneous hyperpigmentation is a dermatological condition that may be related to chemotherapy treatments, such as therapies using hydroxyurea (HU). HU is a cytostatic drug widely used in myeloproliferative diseases and is the main line of treatment for essential thrombocythemia (ET). The present study aims to report a rare case of mucocutaneous hyperpigmentation in a patient with ET. Case report: Male patient, 68 years old, 89 kg, diagnosed with ET using HU 2 g/day. After three months of therapy, he presented hyperpigmented brownish-colored lesions on the hands and oral cavity (tongue). In a decision shared with the assistant physician, the patient chose to continue using the drug. After six years of follow-up, the lesions remain stable. Conclusion: Mucocutaneous hyperpigmentation associated with HU therapy is a benign event secondary to the use of the drug and does not require discontinuation of use, however, its withdrawal or dose reduction usually leads to the reduction or disappearance of the lesions.
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Neculiseanu E, Harewood J, Sidhu G. Hydroxyurea-induced tongue hypermelanosis and transverse melanonychia. Cureus. 2019;11(12):e6311. doi: https://doi.org/10.7759/cureus.6311 DOI: https://doi.org/10.7759/cureus.6311
Simeonovski V, Breshkovska H, Duma S, et al. Hydroxyurea associated cutaneous lesions: a case report. Open Access Maced J Med Sci. 2018;6(8):1458-61. doi: https://doi.org/10.3889/oamjms.2018.320 DOI: https://doi.org/10.3889/oamjms.2018.320
Veillet-Lemay G, Haber RM. Hydroxyurea-induced oral hyperpigmentation: a case report and review of the literature. J Cutan Med Surg. 2018;23(1):111-3. doi: https://doi.org/10.1177/1203475418803074 DOI: https://doi.org/10.1177/1203475418803074
Tefferi A, Vannucchi AM, Barbui T. Essential thrombocythemia treatment algorithm 2018. Blood Cancer J. 2018;8(2). doi: https://doi.org/10.1038/s41408-017-0041-8 DOI: https://doi.org/10.1038/s41408-017-0041-8
Cortelazzo S, Finazzi G, Ruggeri M, et al. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. N Engl J Med. 1995;332(17):1132-7. doi: https://doi.org/10.1056/NEJM199504273321704 DOI: https://doi.org/10.1056/NEJM199504273321704
Lee KP, Vangipuram RK, Klimas NK, et al. Hydroxyurea-induced hyperpigmentation with iron deposition. Dermatol Online J. 2019;25(10):9. doi: https://doi.org/10.5070/D32510045820 DOI: https://doi.org/10.5070/D32510045820
Bulte CA, Hoegler KM, Kutlu Ö, et al. Hydroxyurea: a reappraisal of its cutaneous side effects and their management. Int J Dermatol. 2021;60(7):810-7. doi: https://doi.org/10.1111/ijd.15302 DOI: https://doi.org/10.1111/ijd.15302
Kumar B, Saraswat A, Kaur I. Mucocutaneous adverse effects of hydroxyurea: a prospective study of 30 psoriasis patients. Clin Exp Dermatol. 2002;27(1):8-13. doi: https://doi.org/10.1046/j.0307-6938.2001.00947.x DOI: https://doi.org/10.1046/j.0307-6938.2001.00947.x
Kennedy BJ, Smith LR, Goltz RW. Skin changes secondary to hydroxyurea therapy. Arch Dermatol. 1975;111(2):183-187. doi: https://doi.org/10.1001/archderm.1975.01630140041002 DOI: https://doi.org/10.1001/archderm.111.2.183
Serrano-Falcón C, Pugnaire MAF, Del Mar Serrano-Falcón M, et al. Toxicoderma caused by hydroxyurea. Int J Dermatol. 2011;50(11):1435-7. doi: https://doi.org/10.1111/j.1365-4632.2010.04517.x DOI: https://doi.org/10.1111/j.1365-4632.2010.04517.x
Salmon-Ehr V, Leborgne G, Vilque JP, et al. Effets secondaires cutanés de l’hydroxyurée: étude prospective de 26 patients consultant dans un service de dermatologie. Rev Med Interne. 2000;21(1):30-4. doi: https://doi.org/10.1016/S0248-8663(00)87226-4 DOI: https://doi.org/10.1016/S0248-8663(00)87226-4
Alshammasi B, Albasry Z, Meshikhes F. Oral hyperpigmentation associated with hydroxyurea in a patient with polycythemia vera: a case report. Clin Case Rep. 2020;8(10):1904-9. doi: https://doi.org/10.1002/ccr3.3012 DOI: https://doi.org/10.1002/ccr3.3012
Barbui T, Thiele J, Gisslinger H, et al. The 2016 revision of WHO classification of myeloproliferative neoplasms: clinical and molecular advances. Blood Rev. 2016;30(6):453-9. doi: https://doi.org/10.1016/j.blre.2016.06.001 DOI: https://doi.org/10.1016/j.blre.2016.06.001
Godfrey AL, Campbell PJ, MacLean C, et al. Hydroxycarbamide plus aspirin versus aspirin alone in patients with essential thrombocythemia age 40 to 59 years without high-risk features. J Clin Oncol. 2018;36(34):3361-9. doi: https://doi.org/10.1200/JCO.2018.78.8414 DOI: https://doi.org/10.1200/JCO.2018.78.8414
Majumdar G, Heard SE, Slater NG. Reversible hyperpigmentation associated with high dose hydroxyurea. BMJ. 1990;300(6737):1468. doi: https://doi.org/10.1136/bmj.300.6737.1468-c DOI: https://doi.org/10.1136/bmj.300.6737.1468-c
Gropper CA, Don PC, Sadjadi MM. Nail and skin hyperpigmentation associated with hydroxyurea therapy for polycythemia vera. Int J Dermatol. 1993(10):731-3. doi: https://doi.org/10.1111/j.1365-4362.1993.tb02745.x DOI: https://doi.org/10.1111/j.1365-4362.1993.tb02745.x
Laughon SK, Shinn LL, Nunley JR. Melanonychia and mucocutaneous hyperpigmentation due to hydroxyurea use in an HIV-infected patient. Int J Dermatol. 2000;39(12):928-31. doi: https://doi.org/10.1046/j.1365-4362.2000.00988-2.x DOI: https://doi.org/10.1046/j.1365-4362.2000.00988-2.x
Issaivanan M, Mitu PS, Manisha C, et al. Cutaneous manifestations of hydroxyurea therapy in childhood: case report and review. Pediatr Dermatol. 2004;21(2):124-7. doi: https://doi.org/10.1111/j.0736-8046.2004.21207.x DOI: https://doi.org/10.1111/j.0736-8046.2004.21207.x
Nofal A, El-Din ES. Hydroxyurea-induced dermatomyositis: true amyopathic dermatomyositis or dermatomyositis-like eruption? Int J Dermatol. 2012;51(5):535-41. doi: https://doi.org/10.1111/j.1365-4632.2011.05105.x DOI: https://doi.org/10.1111/j.1365-4632.2011.05105.x
Murray NP, Echavarría M, Reculé F, et al. Acquired hyperpigmentation of the tongue associated with hydroxyurea: case report of a very rare location of a rare adverse effect. Glob J Dermatol Venereol. 2016;4(1):12-3. doi: https://doi.org/10.12970/2310-998X.2016.04.01.3 DOI: https://doi.org/10.12970/2310-998X.2016.04.01.3
Algarra AC, Miguel RA, Romero FT, et al. Mucocutaneous lesions and nail pigmentation in a patient with essential thrombocytosis. Aust Fam Physician [Internet]. 2017 [cited 2022 June 30];46(4):222-4. Available from: https://www.racgp.org.au/afp/2017/april/mucocutaneous-lesions-and-nail-pigmentation-in-a-p
Latagliata R, Spadea A, Cedrone M, et al. Symptomatic mucocutaneous toxicity of hydroxyurea in Philadelphia chromosome-negative myeloproliferative neoplasms: the Mister Hyde Face of a safe drug. Cancer. 2012;118(2):404-9. doi: https://doi.org/10.1002/cncr.26194 DOI: https://doi.org/10.1002/cncr.26194
Cozzani E, Iurlo A, Merlo G, et al. Essential thrombocythemia: the dermatologic point of view. Clin Lymphoma Myeloma Leuk. 2015;15(12):739-47. doi: https://doi.org/10.1016/j.clml.2015.08.086 DOI: https://doi.org/10.1016/j.clml.2015.08.086
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