[Dermatomyositis-like skin changes with long-term hydroxyurea (Litalir) therapy]

Area of Science:

• Dermatology
• Oncology
• Pharmacology

Background:

• Hydroxyurea is a common treatment for chronic myelogenous leukemia (CML).
• Adverse cutaneous reactions are known side effects of hydroxyurea therapy.
• Dermatomyositis-like reactions are rare but significant side effects.

Observation:

• Two CML patients on long-term hydroxyurea developed dermatomyositis-like skin conditions.
• Skin manifestations included xerosis, pruritus, hyperpigmentation, scaling, atrophy, and facial telangiectasias.
• Histopathology revealed interface dermatitis with features overlapping with lichen planus-like changes.

Findings:

• The observed skin changes mimicked dermatomyositis but lacked muscular involvement or elevated muscle enzymes.
• Skin biopsies showed interface dermatitis with lichenoid infiltrate, vacuolar changes, and necrotic keratinocytes.
• Histopathological findings were similar to previously reported lichen planus-like reactions to hydroxyurea.

Implications:

• The study questions the distinct classification of dermatomyositis-like versus lichen planus-like skin reactions to hydroxyurea.
• Recognizing these cutaneous reactions is crucial for managing patients on long-term hydroxyurea therapy.
• Further research may clarify the spectrum of hydroxyurea-induced dermatoses and their underlying mechanisms.