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[Sorafenib-induced multiple eruptive keratoacanthomas]
H Jantzem1, D Dupre-Goetghebeur, P Spindler
1Centre régional de pharmacovigilance de Brest, CHU La-Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France. helene.jantzem@chu-brest.fr
Background:
Sorafenib has been approved for use in the treatment of metastatic renal cell carcinoma. Cutaneous side-effects are common, including rash, hand-foot syndrome, alopecia, pruritus, dry skin and erythema. We report an original unexpected cutaneous effect: multiple keratoacanthomas. In the light of a literature review of drug-induced keratoacanthomas, we discuss the potential underlying physiopathological mechanism.
Case Report:
Three weeks after starting treatment with sorafenib for metastatic renal cell carcinoma, a 64-year-old man developed skin lesions on the face, ears, forearms and thighs having the appearance of dome-shaped nodules with central keratotic cores. Eruptive keratoacanthomas were suspected and were in fact confirmed by histology. Thanks to effective antiangiogenic treatment and the mild discomfort of the keratoacanthomas, sorafenib could be continued. Three weeks after the end of treatment, all lesions had regressed and the patient's skin returned to normal.
Discussion:
Although the precise aetiology is unknown, the development of eruptive keratoacanthomas is associated with impaired immunity, sun exposure, viral infection, genetic predisposition, radiation therapy and exposure to chemical carcinogens. A few cases of drug-induced keratoacanthomas have been described in the literature and certain immunosuppressant drugs have been implicated. This case suggests that the novel antineoplastic agent sorafenib has a complex activity that, in addition to tyrosine kinases inhibition, includes an immunosuppressant mechanism that can occasionally cause skin lesions.
Insights
Sorafenib, used for kidney cancer, can cause a rare skin reaction called eruptive keratoacanthomas. These lesions resolved after stopping the drug, suggesting a potential immunosuppressive effect.
Area of Science:
- Oncology
- Dermatology
- Pharmacology
Background:
- Sorafenib is approved for metastatic renal cell carcinoma.
- Common side effects include rash and hand-foot syndrome.
- An unexpected cutaneous effect, multiple keratoacanthomas, is presented.
Observation:
- A 64-year-old man developed dome-shaped nodules with central keratotic cores.
- Histology confirmed eruptive keratoacanthomas after three weeks of sorafenib treatment.
- Lesions regressed three weeks after discontinuing sorafenib.
Findings:
- The case suggests sorafenib may have an immunosuppressant mechanism.
- Drug-induced keratoacanthomas are rare but linked to immunosuppression.
- Sorafenib's complex activity may include effects beyond tyrosine kinase inhibition.
Implications:
- This finding broadens the understanding of sorafenib's side effect profile.
- Highlights the importance of monitoring for rare dermatological reactions.
- Suggests potential for immunosuppression-related adverse events with novel antineoplastics.
