Cutaneous manifestations of long-term hydroxyurea therapy

Area of Science:

• Dermatology
• Oncology
• Pharmacology

Background:

• Long-term hydroxyurea therapy is associated with various cutaneous side effects, though extensive and debilitating changes are rarely reported.
• Understanding the full spectrum of hydroxyurea-induced dermatological adverse events is crucial for patient management.

Observation:

• A patient on long-term hydroxyurea therapy developed extensive and debilitating skin manifestations.
• These included previously reported effects like ichthyosis, dermatomyositis-like eruption, facial erythema, and accelerated development of premalignant/malignant skin lesions.
• New observations included an erosive eruption on the glans penis and a rapidly enlarging viral wart with concerning cytological atypia.

Findings:

• The patient exhibited an erosive penile eruption and an atypical viral wart mimicking squamous cell carcinoma.
• Hydroxyurea may contribute to accelerated photoaging, rapid wart growth, and histological atypia.
• The temporal progression suggests direct toxicity of hydroxyurea on epidermal basal cells and mucosal surfaces.

Implications:

• This case expands the known spectrum of hydroxyurea-induced skin toxicity.
• Clinicians should be vigilant for these rare but severe cutaneous adverse events in patients on long-term hydroxyurea.
• Further research into the mechanisms of hydroxyurea dermatotoxicity is warranted.