RESUMO
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.
Assuntos
Ceratodermia Palmar e Plantar/induzido quimicamente , Feminino , Humanos , Ceratodermia Palmar e Plantar/diagnóstico , Ceratodermia Palmar e Plantar/terapia , MasculinoAssuntos
Síndrome de Hipersensibilidade a Medicamentos , Eosinofilia , Exantema , Ceratodermia Palmar e Plantar , Preparações Farmacêuticas , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Eosinofilia/induzido quimicamente , Eosinofilia/diagnóstico , Humanos , Ceratodermia Palmar e Plantar/induzido quimicamente , Ceratodermia Palmar e Plantar/diagnósticoRESUMO
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.
Assuntos
Intoxicação por Arsênico/patologia , Doença Iatrogênica , Ceratodermia Palmar e Plantar/induzido quimicamente , Neoplasias Cutâneas/induzido quimicamente , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Intoxicação por Arsênico/diagnóstico , Ceratodermia Palmar e Plantar/induzido quimicamente , Transtornos da Pigmentação/induzido quimicamente , Adulto , Intoxicação por Arsênico/patologia , Doença Crônica , Água Potável/química , Cabelo/química , Humanos , Ceratodermia Palmar e Plantar/patologia , Masculino , Unhas/química , Transtornos da Pigmentação/patologiaAssuntos
Intoxicação por Arsênico/etiologia , Ceratodermia Palmar e Plantar/induzido quimicamente , Medicina Tradicional da Mongólia/efeitos adversos , Melanose/induzido quimicamente , Sulfetos/envenenamento , Intoxicação por Arsênico/diagnóstico , Intoxicação por Arsênico/tratamento farmacológico , Arsenicais/administração & dosagem , Quelantes/administração & dosagem , Criança , Dimercaprol/administração & dosagem , Epilepsia/tratamento farmacológico , Humanos , Ceratodermia Palmar e Plantar/diagnóstico , Ceratodermia Palmar e Plantar/tratamento farmacológico , Masculino , Medicina Tradicional da Mongólia/métodos , Melanose/diagnóstico , Melanose/tratamento farmacológico , Sulfetos/administração & dosagemAssuntos
Antineoplásicos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Erupção por Droga/etiologia , Ceratodermia Palmar e Plantar/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Piperazinas/efeitos adversos , Pirimidinas/efeitos adversos , Idoso , Receptores ErbB/antagonistas & inibidores , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Ceratoacantoma/induzido quimicamente , Ceratodermia Palmar e Plantar/induzido quimicamente , Melanoma/tratamento farmacológico , Quinases de Proteína Quinase Ativadas por Mitógeno/antagonistas & inibidores , Inibidores de Proteínas Quinases/efeitos adversos , Neoplasias Cutâneas/tratamento farmacológico , Vemurafenib/efeitos adversos , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Antineoplásicos/efeitos adversos , Mesilato de Imatinib/efeitos adversos , Ceratodermia Palmar e Plantar/induzido quimicamente , Doenças da Unha/induzido quimicamente , Feminino , Pé/patologia , Mãos/patologia , Humanos , Ceratodermia Palmar e Plantar/patologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Pessoa de Meia-Idade , Doenças da Unha/patologia , Pele/patologiaRESUMO
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.