Dermatomyositis-like Eruption Induced by Hydroxyurea-Case Report and Literature Review

Area of Science:

• Dermatology
• Oncology
• Rheumatology

Background:

• Hydroxyurea (HU) is a chemotherapeutic agent for myeloproliferative disorders.
• Long-term HU use can rarely induce a dermatomyositis-like (DM-like) eruption.
• This eruption presents with skin manifestations only, lacking muscle involvement or specific serologic markers.

Purpose of the Study:

• To present a case of hydroxyurea-induced DM-like eruption.
• To review the existing literature on this rare adverse effect.
• To highlight diagnostic and management strategies.

Main Methods:

• A case report of a 77-year-old woman with polycythemia vera on HU therapy.
• Clinical evaluation, laboratory tests, and skin biopsies were performed.
• A systematic literature review of 23 cases published before January 2025.

Main Results:

• The patient displayed DM-like cutaneous features (interface dermatitis, basal vacuolar degeneration, dermal mucin) without muscle or serologic abnormalities.
• Literature review showed a median latency of 5 years from HU initiation to eruption, with dorsal hands being the most common site.
• Over 90% of cases resolved with HU discontinuation and corticosteroid therapy, with a median healing time of 3 months.

Conclusions:

• Hydroxyurea-induced DM-like eruption is a distinct clinical entity.
• Prompt recognition and management, primarily HU discontinuation and corticosteroid use, are crucial.
• Dermatologic surveillance is recommended for patients on long-term HU due to potential premalignant skin changes.