Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo, Japan.
The Second Department of Internal Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan.
J Dermatol. 2020 Apr;47(4):363-368. doi: 10.1111/1346-8138.15264. Epub 2020 Feb 13.
Subcutaneous injection of azacitidine (AZA) is an important treatment option for myelodysplastic syndrome (MDS), which improves overall survival. In hematology, the incidence of AZA-induced cutaneous adverse events (AE) has been known to be relatively high, which has not been well recognized by dermatologists. Discontinuation of AZA can result in the deterioration of MDS disease activity. Therefore, on dermatological consultation, precise evaluation of AE severity and careful consideration is required for post-AE medication management. To enhance our understanding of AZA-induced cutaneous AE, we report four cases with two representative cutaneous AE subtypes and summarize the clinicopathological phenotypes and courses of the cases in the published work. Case 1, a 71-year-old man, developed neutrophilic dermatosis involving the dermis and subcutaneous tissue. The other three cases, a 75-year-old man, a 78-year-old woman and a 68-year-old man, presented injection-site erythema associated with flare-up reaction. Discontinuation of AZA was necessary for case 1 alone. The published work review delineated three major subtypes of AZA-induced cutaneous AE: systemic cutaneous reaction, neutrophilic dermatosis type and erythematous type injection-site reaction. Histologically, the first two subtypes are mostly characterized by neutrophil infiltration, while the third subtype presents lymphocytic cell infiltration. Neither AZA discontinuation nor intensive interventions were required for the erythematous type injection-site reaction, while AZA termination or systemic treatments, represented by corticosteroid administration, were preferentially conducted for the systemic cutaneous reaction or the neutrophilic dermatosis type injection-site reaction subgroup. These observations support the necessity of subtype-dependent treatment strategies for the management of AZA-induced cutaneous AE.
皮下注射阿扎胞苷（AZA）是治疗骨髓增生异常综合征（MDS）的重要选择，可改善总生存期。在血液学中，AZA 诱导的皮肤不良事件（AE）的发生率相对较高，但皮肤科医生对此认识不足。AZA 的停药可能导致 MDS 疾病活动的恶化。因此，在皮肤科咨询时，需要对 AE 的严重程度进行精确评估，并仔细考虑 AE 后药物管理。为了增强我们对 AZA 诱导的皮肤 AE 的理解，我们报告了 4 例具有两种代表性皮肤 AE 亚型的病例，并总结了已发表文献中病例的临床病理表型和病程。病例 1，一名 71 岁男性，发生累及真皮和皮下组织的中性粒细胞皮肤病。其他 3 例为 75 岁男性、78 岁女性和 68 岁男性，表现为与爆发反应相关的注射部位红斑。仅病例 1 需要停用 AZA。文献综述描述了 AZA 诱导的皮肤 AE 的 3 种主要亚型：全身性皮肤反应、中性粒细胞皮肤病型和红斑型注射部位反应。组织学上，前两种亚型主要表现为中性粒细胞浸润，而第三种亚型表现为淋巴细胞浸润。红斑型注射部位反应既不需要停用 AZA，也不需要强化干预，而全身性皮肤反应或中性粒细胞皮肤病型注射部位反应亚组则需要停用 AZA 或进行全身性治疗，如皮质类固醇给药。这些观察结果支持针对 AZA 诱导的皮肤 AE 进行基于亚型的治疗策略的必要性。
