Dermatomyositis-like eruption after long-term hydroxyurea therapy for polycythemia vera

Area of Science:

• Dermatology
• Hematology
• Pharmacology

Background:

• Hydroxyurea (HU) is an established antitumor agent for myeloproliferative neoplasms.
• While generally well-tolerated, long-term HU therapy is associated with various cutaneous side effects.
• Dermatomyositis-like changes are known but infrequently reported in polycythemia vera patients on HU.

Observation:

• A 69-year-old male with polycythemia vera developed a facial and hand eruption resembling dermatomyositis.
• The patient had been undergoing long-term hydroxyurea treatment.
• No muscular involvement or elevated muscle enzymes were detected.

Findings:

• The patient's cutaneous eruption resolved within two months after HU treatment cessation.
• This clinical course strongly suggests hydroxyurea as the etiological factor for the observed dermatomyositis-like presentation.
• The case highlights a rare but notable cutaneous adverse effect of hydroxyurea in polycythemia vera.

Implications:

• This case underscores the importance of monitoring for dermatological side effects during long-term hydroxyurea therapy.
• It suggests hydroxyurea may induce dermatomyositis-like reactions, even without systemic muscle involvement.
• Discontinuation of hydroxyurea should be considered in patients developing such cutaneous manifestations.