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[Longitudinal melanonychia induced by hydroxyurea therapy].
Sven Neynaber1, Hans Wolff, Gerd Plewig
1Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München.
Summary
Hydroxycarbamide therapy can cause nail pigmentation in patients with myeloproliferative syndrome. This streaky longitudinal pigmentation may resolve after discontinuing the medication, but melanoma must be ruled out.
Area of Science:
- Dermatology
- Hematology
- Oncology
Background:
- Nail pigmentation has diverse causes including infections, metabolic disorders, and exogenous factors.
- Differentiating the cause of nail pigmentation is critical in clinical practice.
Observation:
- Four patients with myeloproliferative syndrome developed streaky longitudinal nail pigmentation after starting hydroxycarbamide (hydroxyurea) therapy.
- The patients were treated for 5-12 years and had Fitzpatrick skin type II.
Findings:
- Longitudinal melanonychia appeared several months into hydroxycarbamide treatment.
- Pigmentation resolved in two patients after medication cessation, persisted in one, and one was lost to follow-up.
- Two cases were incidental findings, while two patients sought dermatological consultation for nail changes.
Implications:
- Hydroxycarbamide is a potential cause of nail pigmentation in patients undergoing treatment for myeloproliferative neoplasms.
- Medical history, including medication review, is essential for diagnosing nail pigmentation.
- Acral lentiginous melanoma must be excluded in patients presenting with nail pigmentation.