Zimmer Lisa, Livingstone Elisabeth, Hillen Uwe, Dömkes Stephanie, Becker Arne, Schadendorf Dirk
Department of Dermatology, University Hospital Essen, Essen, Germany.
Arch Dermatol. 2012 Mar;148(3):357-61. doi: 10.1001/archdermatol.2011.2842. Epub 2012 Jan 16.
Painful lobular panniculitis appears to be a novel cutaneous adverse effect of selective BRAF inhibitors.
We report the clinical course and management in 2 women with metastatic melanomas harboring the BRAF(V600E) mutation, who developed panniculitis with arthralgia during therapy with selective oral BRAF inhibitors. Panniculitis with arthralgia was the acute presenting adverse effect in both patients. Painful, red, nodular lesions were located on the upper and lower extremities. Biopsy specimens of the nodules showed a mild, predominantly lobular neutrophilic panniculitis. Analgesic and anti-inflammatory treatment improved panniculitis and arthralgia in both cases. It was also necessary to reduce the BRAF inhibitor dose in 1 patient.
During therapy with selective BRAF inhibitors, panniculitis with arthralgia represents a new adverse effect that can require dose reduction. In case of this adverse effect, treatment with nonsteroidal anti-inflammatory drugs, such as etoricoxib, should be initiated early to keep patients on treatment and to avoid drug discontinuation and tumor progression.
疼痛性小叶性脂膜炎似乎是选择性BRAF抑制剂的一种新型皮肤不良反应。
我们报告了2例携带BRAF（V600E）突变的转移性黑色素瘤女性患者的临床病程及治疗情况，她们在接受选择性口服BRAF抑制剂治疗期间出现了伴有关节痛的脂膜炎。伴有关节痛的脂膜炎是这两名患者的急性不良反应。疼痛的红色结节性病变位于上下肢。结节的活检标本显示为轻度、以小叶为主的中性粒细胞性脂膜炎。镇痛和抗炎治疗使两例患者的脂膜炎和关节痛均得到改善。在1例患者中还需要减少BRAF抑制剂的剂量。
在选择性BRAF抑制剂治疗期间，伴有关节痛的脂膜炎是一种可能需要减少剂量的新不良反应。出现这种不良反应时，应尽早开始使用非甾体类抗炎药（如依托考昔）进行治疗，以使患者能够继续治疗，避免停药和肿瘤进展。
