Weber L, Schick E, Merkel M, Pillekamp H, Sterry W
Dermatologische Klinik, Universität, Ulm.
Hautarzt. 1995 Oct;46(10):717-21. doi: 10.1007/s001050050328.
We report on dermatomyositis-like adverse cutaneous reactions following long-term maintenance therapy with hydroxyurea in two patients suffering from chronic myelogenous leukaemia (CML). In addition to non-specific side effects, such as xerosis, pruritus and hyperpigmentation, both patients presented with more specific skin changes, i.e. erythematous lesions, scaling, and partially atrophic areas distributed in a linear fashion on the dorsal aspects of the hands and fingers. In addition, teleangiectatic erythema of the face was present in both patients, and this was associated with oedema of the eyelids in one patient. Despite these dermatomyositis-like features there were no clinical signs of muscular involvement, and muscle-specific enzymes were within normal ranges. Skin biopsy specimens revealed an interface dermatitis characterized by a lichenoid cell infiltrate, vacuolar alteration of basal cells, necrotic keratinocytes within the spinous zone, focal hypergranulosis, ortho-hyperkeratosis and telangiectases in the upper part of the dermis. Analogous histopathological findings have been documented in lichen planus-like skin changes on the hands following hydroxyurea therapy. It seems doubtful whether there are actually any major differences between those skin changes described as dermatomyositis-like and those interpreted as lichen planus-like in patients receiving long-term hydroxyurea therapy.
我们报告了两例慢性粒细胞白血病（CML）患者在接受羟基脲长期维持治疗后出现的皮肌炎样皮肤不良反应。除了干燥、瘙痒和色素沉着等非特异性副作用外，两名患者均出现了更具特异性的皮肤变化，即手部和手指背侧出现呈线状分布的红斑性病变、脱屑和部分萎缩区域。此外，两名患者均出现面部毛细血管扩张性红斑，其中一名患者还伴有眼睑水肿。尽管有这些皮肌炎样特征，但没有肌肉受累的临床体征，肌肉特异性酶也在正常范围内。皮肤活检标本显示为界面性皮炎，其特征为苔藓样细胞浸润、基底细胞空泡变性、棘层内坏死角质形成细胞、局灶性颗粒层增厚、正角化过度以及真皮上部的毛细血管扩张。在羟基脲治疗后手部出现的扁平苔藓样皮肤变化中也有类似的组织病理学发现。对于接受长期羟基脲治疗的患者，那些被描述为皮肌炎样的皮肤变化与被解释为扁平苔藓样的皮肤变化之间是否真的存在任何重大差异，这似乎值得怀疑。
