Mazaud C, Breban M, Mahé E
Service de dermatologie, hôpital Victo-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France.
Service de rhumatologie, université Paris-Ile de France-Ouest, centre hospitalier universitaire Ambroise-Paré, Assistance publique-Hôpitaux de Paris, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
Ann Dermatol Venereol. 2019 Oct;146(10):640-645. doi: 10.1016/j.annder.2019.04.024. Epub 2019 May 28.
Eruptive melanocytic nevi (EMN) are a rare phenomenon characterized by simultaneous rapid onset of multiple nevi. The condition has been described in different contexts: immunosuppression, immunosuppressive drugs, targeted therapies, bullous diseases, and chemical melanocytic stimulation. We report 3 cases of EMN following anti-TNF alpha treatment.
Case 1 - A 51-year-old female patient was receiving adalimumab for spondyloarthritis (the first treatment for this patient). A few months after the start of treatment, multiple nevi were noted on the 4 limbs, and in particular on the right palm. The patient confirmed the absence of these lesions before initiation of treatment. A diagnosis was made of adalimumab-induced EMN. Case 2 - A 49-year-old male patient was receiving etanercept for spondyloarthritis (the first biologic in this patient). Multiple small nevi developed on the trunk in the months after the start of treatment. The patient indicated that these lesions had appeared after the start of treatment. A diagnosis was made of etanercept-induced EMN. Case 3 - A 20-year-old woman with hidradenitis suppurativa was treated with infliximab. After 1.5 months, she reported the outbreak of various pigmented lesions 2-3mm in diameter on the trunk and one lesion on her right palm. The clinical diagnosis was EMN. After follow-up of 4 months to 5 years, no transformation to melanoma was noted in any of these 3 patients.
EMN remains a rare phenomenon in patients on anti-TNF alpha. These cases, associated with the description of a moderate increased risk of developing cutaneous carcinoma under anti-TNF alpha, underscore the need for dermatological follow-up and increased sun protection in patients receiving this treatment.
发疹性黑素细胞痣（EMN）是一种罕见现象，其特征为多个痣同时迅速出现。这种情况已在不同背景下被描述：免疫抑制、免疫抑制药物、靶向治疗、大疱性疾病以及化学性黑素细胞刺激。我们报告3例抗TNF-α治疗后发生的EMN病例。
病例1 - 一名51岁女性患者因脊柱关节炎接受阿达木单抗治疗（该患者首次接受此类治疗）。治疗开始数月后，四肢尤其是右手掌出现多个痣。患者确认治疗开始前不存在这些皮损。诊断为阿达木单抗诱发的EMN。病例2 - 一名49岁男性患者因脊柱关节炎接受依那西普治疗（该患者首次使用生物制剂）。治疗开始数月后，躯干出现多个小痣。患者表示这些皮损在治疗开始后出现。诊断为依那西普诱发的EMN。病例3 - 一名20岁患有化脓性汗腺炎的女性接受英夫利昔单抗治疗。1.5个月后，她报告躯干出现直径2 - 3毫米的各种色素沉着皮损，右手掌有一处皮损。临床诊断为EMN。经过4个月至5年的随访，这3例患者均未出现向黑色素瘤的转变。
EMN在接受抗TNF-α治疗的患者中仍然是一种罕见现象。这些病例，结合抗TNF-α治疗下皮肤癌发生风险适度增加的描述，强调了接受该治疗的患者需要皮肤科随访并加强防晒。
