We present a case of perforating folliculitis in a patient treated with nilotinib, a kinase inhibitor. A 48-year-old man presented with a severely pruritic follicular rash for several months that started after reaching a complete molecular response of his myeloid chronic while treated with nilotinib. Clinical examination showed predominantly follicular pinpoint papules on trunk and proximal extremities and a biopsy showed a slightly dilated hair follicle with a focal disruption of the infundibular follicular epithelium. Other diseases related with perforating folliculitis were ruled out. The temporary relationship between the treatment and the appearance of the lesions suggests some pathogenic role of nilotinib. Relationship with nilotinib is also supported by previous similar cases related with sorafenib therapy. Both drugs inhibit c-kit and PDGF-R. PDGF-R has been previously involved in murine and human in vitro models of hair follicle cycle. So, our case supports in vivo the previous evidence of the importance of PDGF-R, a kinase, in the normal hair follicle development.

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DEAR EDITOR, We read with great interest the article by Orrin et al. 1 recently published in the BJD. In that article, they described the U.K. experience with protease inhibitors, specifically the cutaneous side-effects seen with telaprevir and boceprevir combined with pegylated interferon plus ribavirin, for the treatment of patients with hepatitis C virus (HCV) genotype 1. In that study they concluded that the addition of telaprevir or boceprevir to a pegylated interferon/ribavirin regimen increased the risk of cutaneous adverse reactions, suggesting that this is a class effect with protease inhibitors.It is well known that the use of telaprevir increases the frequency and severity of skin eruptions. 2 However, we consider that this is not so clear in the case of boceprevir. Reviewing the literature, the two clinical trials that led to the approval of boceprevir, SPRINT-2 and RESPOND-2, showed contradictory results in relation to the increase of skin adverse events in patients who received triple therapy with boceprevir compared with pegylated interferon/ribavirin. 3-5 A meta-analysis published later concluded that a higher risk of skin eruptions was observed with boceprevir triple antiviral therapy than with dual therapy, both in treatment-naive patients and in treatment-experienced patients. 6 Based on our own experience, we performed a prospective study including 82 patients with HCV genotype 1, who received treatment with telaprevir (60 patients) or boceprevir (22 patients) in combination with pegylated interferon and ribavirin in daily clinical practice. The results obtained with the 60 patients in the telaprevir group are included in an article that has already been accepted for publication. 7 Regarding the 22 patients in the boceprevir group, five (23%) developed a drug-induced skin eruption. The onset time of the skin lesions ranged from 5 to 25 weeks after the introduction of boceprevir. In all cases, the clinical pattern was eczematous and the lesions were localized on the lower limbs, upper limbs and trunk. The severity of skin eruptions was mild, so they were treated with topical corticosteroids and resolved in a few days. Skin biopsy and discontinuation of triple antiviral treatment due to cutaneous side-effects were not required.Searching in the PubMed database, we found a few publications that described skin eruptions during boceprevir triple therapy in clinical practice. Recently, Kłujszo et al. 8 have published a study with 109 patients, of whom 33 received boceprevir triple therapy. Out of this cohort, 21% developed skin eruptions and the most frequent clinical pattern was eczematous dermatitis. None had to discontinue the antiviral treatment due to cutaneous side-effects.As we mentioned above, some studies 3 showed that the frequency of skin eruptions was similar when using pegylated interferon/ribavirin alone or in combination with boceprevir. Reviewing the literature, the frequency when using the dual therapy ranged from 34% 2 to 19% 9 depending on the series. Similar percentages were obser...

Since the introduction of telaprevir, administered in combination with pegylated interferon and ribavirin for the treatment of patients with chronic hepatitis C, the incidence and severity of skin eruptions have increased significantly. The aim of this prospective study is to assess the frequency of drug-induced skin eruptions and their clinical and histological characteristics in patients who received the above treatment in daily clinical practice at our hospital. A total of 60 patients were included. The frequency of telaprevir-associated skin eruptions was 48.3%, which is slightly below, but close to, previously described ranges. There was a predominance of an eczematous clinical pattern, and spongiotic dermatitis on histological examination. A slightly high frequency of severe skin eruptions (13.3%) was found in our study series, which may be explained by all our patients being assessed and closely monitored by one or more dermatologists.