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Ichthyosiform Pityriasis Rubra Pilaris-Like Eruption Secondary to Ponatinib Therapy: Case Report and Literature
Ariel E Eber1, Alyx Rosen2, Kate E Oberlin2
1Department of Dermatology and Cutaneous Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1475 NW 12th Avenue, Miami, FL, 33136, USA. a.eber@med.miami.edu.
Abstract:
Tyrosine kinase inhibitors have revolutionized the chemotherapy arena as targeted therapies for a multitude of malignancies. They are more selective than conventional chemotherapy, and often elicit fewer systemic adverse events, however toxicities still exist. Cutaneous toxicities are common and their management presents a novel challenge to physicians and patients. Ponatinib is a third-generation tyrosine kinase inhibitor increasingly reported to cause cutaneous eruption. A 50-year-old woman with a history of chronic myelogenous leukemia presented with a 4-month history of worsening atrophic and ichthyosiform pink plaques involving the axillae, thighs and abdomen; red patches were also observed on the cheeks and forehead. She was started on the third-generation, ponatinib, 5 months earlier because of disease refractory to previous therapies including interferon, imatinib, dasatinib and bosutinib. A skin biopsy revealed perifollicular fibrosis, alternating orthokeratosis and parakeratosis, and a sparse perivascular lymphocytic infiltrate consistent with a pityriasis rubra pilaris-like reaction. Topical tretinoin 0.025% cream was initiated, resulting in resolution within 3 weeks without discontinuation of ponatinib. A review of previous reports identified significant similarities among the ponatinib-induced drug reactions. Here, we highlight not only that cutaneous eruptions occur on ponatinib therapy, but that the dermatologic manifestations are characteristic and unique, and benefit from retinoid therapy, without requiring interruption of vital chemotherapy.
Insights
Ponatinib, a tyrosine kinase inhibitor, can cause unique skin reactions resembling pityriasis rubra pilaris. Topical tretinoin effectively treated these eruptions without halting chemotherapy.
Area of Science:
- Oncology
- Dermatology
- Pharmacology
Background:
- Tyrosine kinase inhibitors (TKIs) are targeted cancer therapies with improved selectivity over conventional chemotherapy.
- While TKIs offer fewer systemic side effects, cutaneous toxicities remain a significant challenge for clinicians and patients.
- Ponatinib, a third-generation TKI, has been increasingly associated with distinct cutaneous eruptions.
Purpose of the Study:
- To describe a unique pityriasis rubra pilaris-like cutaneous reaction associated with ponatinib therapy.
- To evaluate the efficacy of topical retinoid treatment for ponatinib-induced dermatologic adverse events.
- To emphasize that these unique skin reactions can be managed without interrupting essential chemotherapy.
Main Methods:
- Case presentation of a patient with chronic myelogenous leukemia experiencing a novel skin eruption after initiating ponatinib.
- Histopathological examination of skin biopsy to characterize the dermatologic reaction.
- Clinical trial evaluating the response to topical tretinoin treatment.
Main Results:
- The patient presented with atrophic, ichthyosiform plaques and facial redness, consistent with a pityriasis rubra pilaris-like reaction.
- Skin biopsy revealed perifollicular fibrosis and characteristic epidermal changes.
- Treatment with topical tretinoin 0.025% cream resulted in complete resolution of skin lesions within 3 weeks, allowing continuation of ponatinib therapy.
Conclusions:
- Ponatinib therapy can induce characteristic and unique cutaneous eruptions.
- Topical retinoids, such as tretinoin, represent an effective treatment strategy for these specific ponatinib-induced skin reactions.
- Management of these dermatologic manifestations with topical therapy allows for uninterrupted continuation of vital chemotherapy.
