Neill Brett, Ryser Ted, Neill John, Aires Daniel, Rajpara Anand
Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas.
Dermatol Online J. 2017 Nov 15;23(11):13030/qt8h64503t.
Hydroxyurea is an antimetabolite primarily used to treat myeloproliferative disorders, and chronic treatment is associated with many cutaneous adverse effects ranging in severity from ichthyosis to aggressive nonmelanoma skin cancer.
We report a 67-year-oldman with a history of polycythemia vera who was referred for management of progressively worsening dorsal hand lesions. The patient presented withhyperpigmentation, ichthyosis, plantar keratoderma, dermatomyositis-like eruptions, two squamous cell carcinomas, and actinic keratoses. The adversereactions observed were acknowledged to be related to chronic hydroxyurea use. The patient underwent Mohs excision of the squamous cell carcinomas and thehydroxyurea was promptly discontinued; subsequent cutaneous improvement of the dermatomyositislike lesions ensued. Another clinically suspicious aggressive squamous cell carcinoma was suspected and the patient was referred to the plastic surgery department for complete excision because of the size of the lesion. The patient remains on periodic dermatology follow up.
We report a case that exemplifies the cutaneous adverse effects of chronic hydroxyurea therapy. Although many cases improve after drug discontinuation, strict photoprotection and ongoing surveillance are indicated given the recently proposed premalignant potential of dermatomyositis-like eruptions and the aggressive nature of hydroxyurea-induced nonmelanoma skin cancer.
羟基脲是一种抗代谢药物，主要用于治疗骨髓增殖性疾病，长期使用会引发多种皮肤不良反应，严重程度从鱼鳞病到侵袭性非黑素瘤皮肤癌不等。
我们报告一例67岁男性，有真性红细胞增多症病史，因手部背部病变逐渐加重前来就诊。患者表现为色素沉着、鱼鳞病、掌跖角化病、皮肌炎样皮疹、两处鳞状细胞癌和光化性角化病。观察到的不良反应被认为与长期使用羟基脲有关。患者接受了鳞状细胞癌的莫氏手术切除，羟基脲随即停用；随后皮肌炎样病变的皮肤状况有所改善。怀疑出现另一例临床上可疑的侵袭性鳞状细胞癌，由于病变大小，患者被转诊至整形外科进行完整切除。患者仍定期接受皮肤科随访。
我们报告了一例体现长期羟基脲治疗皮肤不良反应的病例。尽管许多病例在停药后有所改善，但鉴于最近提出的皮肌炎样皮疹的癌前潜能以及羟基脲诱导的非黑素瘤皮肤癌的侵袭性，仍需严格的光保护和持续监测。
