RESUMO
Vemurafenib, a BRAF inhibitor, is FDA-approved for the treatment of metastatic melanoma in patients who harbor the BRAF V600E mutation. By inhibiting BRAF, vemurafenib prevents the mitogen-activated protein kinase (MAPK) pathway from driving melanoma growth. Here we present a patient with paradoxical activation of the MAPK pathway by vemurafenib, ultimately resulting in deleterious cutaneous manifestations. An emphasis on close follow-up is warranted for new or changing lesions for patients on this medication and other BRAF inhibitors.
Assuntos
Indóis/uso terapêutico , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Sulfonamidas/uso terapêutico , Antineoplásicos/efeitos adversos , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Feminino , Humanos , Indóis/efeitos adversos , Indóis/farmacologia , Melanoma/genética , Melanoma/patologia , Pessoa de Meia-Idade , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Metástase Neoplásica , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/farmacologia , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Proteínas Proto-Oncogênicas B-raf/genética , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Sulfonamidas/efeitos adversos , Sulfonamidas/farmacologia , VemurafenibRESUMO
BACKGROUND: There are no validated outcome measures for postinflammatory hyperpigmentation (PIH). OBJECTIVE: We sought to determine the reliability and validity of an outcome measure for PIH after acne in patients with skin of color. METHODS: A postacne hyperpigmentation index (PAHPI) was developed. Six raters scored 21 patients with PIH twice. Reliability was determined within and between raters, whereas validity was evaluated by comparing scores with severity ranking by an independent dermatologist. The pigment intensity scores were compared with the melanin index of each patient using a narrowband reflectance spectrophotometer. A quality-of-life score (Skindex-29) was also compared with PAHPI scores. RESULTS: Total PAHPI scores showed good reliability within and between raters and were valid when compared with clinical severity and melanin indices. Good correlation was achieved between the total PAHPI score and the emotion subscale of the Skindex-29. LIMITATIONS: Generalizability of results is limited to African American females. CONCLUSION: The PAHPI shows good reliability and validity when scored on patients with PIH from acne vulgaris. The PAHPI also correlates well with the emotional impact of PIH as measured by the Skindex-29. Future studies should assess the ability of the PAHPI to change with improvement of PIH from acne after treatment.
Assuntos
Acne Vulgar/complicações , Hiperpigmentação/etiologia , Hiperpigmentação/patologia , Índice de Gravidade de Doença , Acne Vulgar/patologia , Adolescente , Adulto , Negro ou Afro-Americano , Povo Asiático , Dermatite/patologia , Feminino , Hispânico ou Latino , Humanos , Hiperpigmentação/psicologia , Masculino , Melaninas/análise , Variações Dependentes do Observador , Qualidade de Vida , Reprodutibilidade dos Testes , Espectrofotometria , Adulto JovemRESUMO
Yellow plaques and papules on the skin are hallmarks of xanthomas. These are not always associated with abnormalities in lipid profiles or their associated proteins. In cases of diffuse normolipemic plane xanthomas these cutaneous findings are often associated with myelodyscrasias including monoclonal gammopathy of unknown significance and multiple myeloma. Such clinical presentations may indicate that an evaluation for myelodyscrasias is warranted.