The cutaneous toxicity of MEK inhibitors may limit treatment adherence. The authors present a retrospective study of 41 paediatric patients with NF‐1 undergoing therapy with selumetinib and propose a treatment algorithm.
A 2-year-old-girl presented with a 6-month history of a pruritic eruption on the lateral left upper arm. On examination, there were palpable subcutaneous nodules, with overlying excoriations, hypertrichosis, and hyperpigmentation (Figure 1). Her mother reported that she had previously undertaken an ultrasound (not available for review), that was suggestive of an "angioma." The patient was otherwise healthy, had no regular medications, no known allergies and was up to date on recommended vaccinations.
Accelerated nodulosis, the rapid progression/extension of preexisting nodules, is a recognized complication of immunomodulatory therapy, occurring mostly in patients with rheumatoid arthritis treated with methotrexate. As of today, its physiopathology remains incompletely understood, and there are no standardized guidelines regarding its management. Here, we conduct a literature review of the reported cases of drug-induced accelerated nodulosis and add our case of a 79-year-old female with an atypical clinical presentation.
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