Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.
Department of Dermatology, University of Duisburg-Essen, Essen, Germany.
J Eur Acad Dermatol Venereol. 2015 Sep;29(9):1797-806. doi: 10.1111/jdv.13039. Epub 2015 Mar 6.
BRAF inhibitors have been licensed for the therapy of BRAF-mutated melanoma. Recently, inflammatory skin lesions clinically resembling erythema nodosum have been reported as therapy side-effects that may lead to treatment discontinuation.
To identify and characterize cases with BRAF inhibitor-associated erythema nodosum-like inflammatory skin lesions and development of an algorithm for their management.
Retrospective chart review of melanoma patients treated with BRAF inhibitors in 14 departments of Dermatology in Germany and Austria and PubMed search for cases in the literature.
Sixteen patients were identified who developed erythema nodosum-like lesions under BRAF inhibitor therapy; 14 had received vemurafenib and two dabrafenib plus trametinib. The most frequently involved body sites were the legs. Histopathology was performed in five cases and revealed panniculitis in three and vasculitis in two patients respectively. Arthralgia and fever were associated symptoms in 44% and 31% of patients respectively. Inflammatory symptoms led to discontinuation of treatment in three patients, while in the majority of cases symptomatic management was sufficient. Skin lesions finally resolved despite continued BRAF inhibitor therapy in seven patients. In the literature, 19 additional patients with similar cutaneous appearance under BRAF inhibitors could be identified. An algorithm for the management of such lesions is proposed.
Erythema nodosum-like skin lesions histologically correspond to panniculitis and/or vasculitis. Symptomatic treatment may be sufficient. However, additional work-up and interruption of BRAF inhibitor therapy may be necessary in severe cases which are commonly associated with systemic symptoms.
BRAF 抑制剂已获许可用于治疗 BRAF 突变型黑色素瘤。最近，临床上类似于结节性红斑的炎症性皮肤病变被报道为治疗的副作用，可能导致治疗中断。
识别和描述 BRAF 抑制剂相关的结节性红斑样炎症性皮肤病变病例，并制定其管理算法。
回顾性分析德国和奥地利 14 个皮肤科部门接受 BRAF 抑制剂治疗的黑色素瘤患者的病历，并在 PubMed 上搜索文献中的病例。
共确定了 16 例患者在接受 BRAF 抑制剂治疗时出现结节性红斑样病变；其中 14 例接受了 vemurafenib，2 例接受了 dabrafenib 加 trametinib。最常受累的身体部位是腿部。5 例患者进行了组织病理学检查，其中 3 例为脂膜炎，2 例为血管炎。分别有 44%和 31%的患者出现关节痛和发热。3 例患者因炎症症状而停止治疗，而大多数情况下对症治疗即可。尽管继续使用 BRAF 抑制剂治疗，7 例患者的皮肤病变最终仍得到缓解。在文献中，还确定了 19 例接受 BRAF 抑制剂治疗后出现类似皮肤表现的患者。提出了一种用于管理此类病变的算法。
结节性红斑样皮肤病变的组织学表现为脂膜炎和/或血管炎。对症治疗可能就足够了。然而，在常见伴有全身症状的严重病例中，可能需要进一步检查和中断 BRAF 抑制剂治疗。
