RESUMEN
BACKGROUND: Palmoplantar keratoderma (PPK) are a heterogenous group of hereditary and acquired disorders that are characterized by excessive epidermal thickening of the palms and/or soles. PPK has been described as a rare adverse event for some medications. The aim of this systematic review was to summarize outcomes in PPK associated with various medications. This data will assist dermatologists and other healthcare providers treating patients with drug-induced PPK. METHODS: EMBASE and MEDLINE databases were searched in accordance with PRISMA guidelines using the keyword "palmoplantar keratoderma." 40 studies met the inclusion criteria. RESULTS: A total of 247 patients (mean age: 57.0 years) were included in the analysis. Among patients whose sex was reported, 60.3% (n = 35/58) were male. PPK most frequently developed after treatment with BRAF inhibitors (73.7%, n = 182/247), BRAF inhibitors combined with MEK1/2 inhibitors (15.4%, n = 38/247), tyrosine kinase inhibitors (TKIs) (3.2%, n = 8/247), or chemotherapy (2.4%, n = 6/247). The mean latency period between initiation of the drug and onset of PPK was 7.6 months (range: 0.25-90 months). Improvement of PPK was reported in 24 cases, with 50% (n = 12/24) achieving complete resolution and 50% (n = 12/24) achieving partial resolution. All patients who achieved complete resolution stopped the suspected drug, with a mean resolution period of 2.4 months (range: 2 weeks-6 months). The most common treatments for PPK were keratolytic treatments (n = 10) and topical corticosteroids (n = 4). CONCLUSIONS: PPK was most frequently associated with targeted kinase inhibitors, specifically BRAF, MEK1/2, and tyrosine kinase inhibitors.
Asunto(s)
Queratodermia Palmoplantar/inducido químicamente , Femenino , Humanos , Queratodermia Palmoplantar/diagnóstico , Queratodermia Palmoplantar/terapia , MasculinoAsunto(s)
Síndrome de Hipersensibilidad a Medicamentos , Eosinofilia , Exantema , Queratodermia Palmoplantar , Preparaciones Farmacéuticas , Síndrome de Hipersensibilidad a Medicamentos/diagnóstico , Síndrome de Hipersensibilidad a Medicamentos/etiología , Eosinofilia/inducido químicamente , Eosinofilia/diagnóstico , Humanos , Queratodermia Palmoplantar/inducido químicamente , Queratodermia Palmoplantar/diagnósticoRESUMEN
ABSTRACT: Chronic arsenism usually occurs after a long-term unawareness of arsenic exposure from environment, occupation, food, and water. We here reported 3 cases with diffused arsenic keratosis and skin cancers derived from long-term arsenic medication ingestion. In these cases, hyperkeratotic skin lesions were initially found on palms and soles, slowly progressed to every part of the skin and lasted maximally for over 30 years. Skin cancers were diagnosed and removed intermittently within decades, but with no malignancies in other organs. Oral retinoids combing with topical 5- fluorouracil and photodynamic treatment yielded a desirable outcome.
Asunto(s)
Intoxicación por Arsénico/patología , Enfermedad Iatrogénica , Queratodermia Palmoplantar/inducido químicamente , Neoplasias Cutáneas/inducido químicamente , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Intoxicación por Arsénico/diagnóstico , Queratodermia Palmoplantar/inducido químicamente , Trastornos de la Pigmentación/inducido químicamente , Adulto , Intoxicación por Arsénico/patología , Enfermedad Crónica , Agua Potable/química , Cabello/química , Humanos , Queratodermia Palmoplantar/patología , Masculino , Uñas/química , Trastornos de la Pigmentación/patologíaAsunto(s)
Intoxicación por Arsénico/etiología , Queratodermia Palmoplantar/inducido químicamente , Medicina Tradicional Mongoliana/efectos adversos , Melanosis/inducido químicamente , Sulfuros/envenenamiento , Intoxicación por Arsénico/diagnóstico , Intoxicación por Arsénico/tratamiento farmacológico , Arsenicales/administración & dosificación , Quelantes/administración & dosificación , Niño , Dimercaprol/administración & dosificación , Epilepsia/tratamiento farmacológico , Humanos , Queratodermia Palmoplantar/diagnóstico , Queratodermia Palmoplantar/tratamiento farmacológico , Masculino , Medicina Tradicional Mongoliana/métodos , Melanosis/diagnóstico , Melanosis/tratamiento farmacológico , Sulfuros/administración & dosificaciónAsunto(s)
Antineoplásicos/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Erupciones por Medicamentos/etiología , Queratodermia Palmoplantar/inducido químicamente , Neoplasias Pulmonares/tratamiento farmacológico , Piperazinas/efectos adversos , Pirimidinas/efectos adversos , Anciano , Receptores ErbB/antagonistas & inhibidores , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Queratoacantoma/inducido químicamente , Queratodermia Palmoplantar/inducido químicamente , Melanoma/tratamiento farmacológico , Quinasas de Proteína Quinasa Activadas por Mitógenos/antagonistas & inhibidores , Inhibidores de Proteínas Quinasas/efectos adversos , Neoplasias Cutáneas/tratamiento farmacológico , Vemurafenib/efectos adversos , Femenino , Humanos , Persona de Mediana EdadRESUMEN
A 48-year-old woman developed palmoplantar hyperkeratosis during treatment with imatinib (400mg/day) for treatment of chronic myeloid leukemia. After 5months of treatment, she developed plantar lesions with yellow-brownish plaques and palmar desquamations. The skin biopsy has eliminated psoriasis. Imatinib was discontinued, and treatment with an emollient balm and a soothing repair cream with an improvement of symptoms. A French imputability assessment score of I3 was obtained, indicating a probable relationship between the side effect and imatinib. In our case, the skin adverse events require definitive drug discontinuation and change of treatment.
Asunto(s)
Antineoplásicos/efectos adversos , Mesilato de Imatinib/efectos adversos , Queratodermia Palmoplantar/inducido químicamente , Enfermedades de la Uña/inducido químicamente , Femenino , Pie/patología , Mano/patología , Humanos , Queratodermia Palmoplantar/patología , Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Persona de Mediana Edad , Enfermedades de la Uña/patología , Piel/patologíaRESUMEN
BACKGROUND: Dabrafenib, a novel selective small-molecule inhibitor of BRAF, has been shown to increase overall survival in patients with unresectable metastatic melanoma harboring the BRAF V600E mutation. The development of resistance has led to combination therapy with selective MEK inhibitor trametinib. Compared with vemurafenib, dabrafenib is a more recent BRAF inhibitor approved by the Food and Drug Administration in May 2013 for metastatic melanoma; fewer data are available in the current literature regarding cutaneous toxicity. OBJECTIVES: We sought to present additional cutaneous side effects of dabrafenib and trametinib and follow their evolution and management. METHODS: We carried out a prospective study of 14 patients treated with dabrafenib alone or with trametinib. Patients were followed every 4 weeks, and we collected detailed cutaneous symptoms, photos, and biopsy specimens. RESULTS: All patients presented with at least 1 adverse skin reaction. The mean duration of treatment was 24 weeks. The most common adverse effect was papillomas (7/14), followed by palmoplantar hyperkeratosis (5/14), alopecia (5/14), and seborrheic dermatitis-like eruption (2/14). Three patients who received trametinib developed an acneiform eruption (3/5). One patient developed a keratoacanthoma-like squamous cell carcinoma. Side effects presented as early as 2 weeks after starting therapy, with a mean time of onset of 9 weeks. CONCLUSION: Selective BRAF inhibitor dabrafenib and MEK inhibitor trametinib are associated with multiple skin adverse effects. Given their recent approval and the potential for malignant lesions to develop on treatment, awareness of potential adverse effects and their management is necessary.