Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
Allergol Int. 2022 Apr;71(2):163-168. doi: 10.1016/j.alit.2021.08.005. Epub 2021 Aug 28.
Drug-induced scleroderma-like lesion is a condition in which administration of a drug induces skin sclerotic lesions similar to systemic sclerosis or morphea. The clinical manifestations of drug-induced scleroderma-like lesion can be divided into two types: scleroderma-like lesions and morphea-like plaques. A wide variety of drugs can cause drug-induced scleroderma-like lesion. Bleomycin, -tryptophan, vinyl chloride, and phytonadione (vitamin K) have been reported, but in recent years, cases due to chemotherapeutic agents, such as taxane-based agents, gemcitabine, and tegafur-uracil, and immune checkpoint inhibitors have increased. Drug-induced scleroderma-like lesion differs from systemic sclerosis in that it does not include Raynaud's phenomenon, nail-fold capillary abnormality, organ involvement, such as reflux esophagitis, interstitial pneumonia, renal crisis, or anti-nuclear Abs. On the other hand, there are reports of cases in which Raynaud's phenomenon, positive conversion of anti-nuclear Abs, and development of skin sclerosis from the fingers developed after initiation of the drug. Whether the skin sclerosis improves after discontinuation of the drug depends on the patient. In patients with severe skin sclerosis, functional impairment, such as flexion contracture of the fingers, may occur, and systemic therapy, such as steroids, may be necessary. When treating patients with skin sclerosis, it is important to keep in mind the possibility that the sclerotic lesion may be induced by a drug.
药物诱导的硬皮病样病变是一种药物引起的皮肤硬化性病变类似于系统性硬皮病或硬斑病的情况。药物诱导的硬皮病样病变的临床表现可分为两种类型：硬皮病样病变和硬斑病样斑块。多种药物可引起药物诱导的硬皮病样病变。已报道博来霉素、色氨酸、氯乙烯和叶绿醌（维生素 K），但近年来，由于化疗药物，如紫杉烷类药物、吉西他滨和替加氟-尿嘧啶，以及免疫检查点抑制剂，导致的病例有所增加。药物诱导的硬皮病样病变与系统性硬皮病不同，它不包括雷诺现象、甲襞毛细血管异常、反流性食管炎、间质性肺炎、肾危象或抗核抗体等器官受累。另一方面，有报道称，在开始使用药物后，出现雷诺现象、抗核抗体阳性转换和手指皮肤硬化的病例。皮肤硬化是否在停药后改善取决于患者。在皮肤严重硬化的患者中，可能会出现手指弯曲挛缩等功能障碍，可能需要全身性治疗，如皮质类固醇。在治疗皮肤硬化症患者时，重要的是要记住皮肤病变可能是由药物引起的可能性。
