Eccrine squamous syringometaplasia associated with vemurafenib therapy

Story, Scott G.; Beschloss, Jonathan K.; Dolan, Christopher; Thomas, Brian C.

doi:10.1016/j.jaad.2012.02.038

Cited by 21 publications

(12 citation statements)

References 5 publications

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“…Recently, other therapeutic agents (Table ), including tyrosine kinase inhibitors (imatinib, sunitinib), vemurafenib (a selective BRAF inhibitor used to treat patients with metastatic melanoma with V600E mutation), and tamoxifen, have also been associated with the first type of SSM in manifestations that show generally similar clinicopathological features (Fig. ) …”

Section: Eccrine Squamous Syringometaplasiamentioning

confidence: 91%

“…However, direct or immune‐mediated toxic effects are thought to be involved in SSM that occurs in cases unassociated with chemotherapy, such as with the use of anti‐inflammatory drugs and toxic agents (benoxaprofen, amineptine). As vemurafenib is known to cause squamoproliferative eruptions such as keratoacanthomas and squamous cell carcinoma (SCC), SSM may represent another squamoproliferative adverse effect of vemurafenib …”

Section: Eccrine Squamous Syringometaplasiamentioning

confidence: 99%

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Syringometaplasia: variants and underlying mechanisms

Abbas

Bhawan

2015

Int J Dermatology

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Syringometaplasia is an adaptive, benign, metaplastic cellular process that affects the eccrine ducts and glands in response to a variety of physiological or pathological stimuli. Different subtypes of syringometaplasia have been described, including the squamous, mucinous, and adenomatous types. These metaplastic changes have been reported in association with chemotherapeutic agents, as well as with a variety of skin disorders including multiple infectious, neoplastic, and inflammatory skin diseases. In this review, we attempt to shed light on the different patterns of syringometaplasia, its pathogenesis, the plethora of skin conditions in which it may be observed, and the differential diagnoses that should be considered.

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Section: Eccrine Squamous Syringometaplasiamentioning

confidence: 91%

Section: Eccrine Squamous Syringometaplasiamentioning

confidence: 99%

Syringometaplasia: variants and underlying mechanisms

Abbas

Bhawan

2015

Int J Dermatology

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“…In these cases, there was a very predominant eccrine squamous syringometaplasia (ESS) associated with the histological features of NEH resulting from damage to the sweat glands. ESS has been reported in the context of BRAFi‐treated patients with melanoma . These cases raise the possibility that it might represent a later stage of NEH more than direct drug toxicity.…”

Section: Discussionmentioning

confidence: 97%

Neutrophilic eccrine hidradenitis in two patients treated withBRAFinhibitors: a new cutaneous adverse event

et al. 2017

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Neutrophilic eccrine hidradenitis (NEH) is a rare neutrophilic dermatosis, first described in patients undergoing chemotherapy for a malignant haemopathy. It has polymorphous clinical features and the association of both clinical and histological features is necessary to make a diagnosis. We report the first two cases of NEH in patients treated with a BRAF inhibitor (BRAFi), either dabrafenib or vemurafenib, for a stage IV metastatic melanoma. Disseminated erythematous plaques associated with fever and polyarthralgia occurred early after the initiation of treatment and were badly tolerated. Histological analyses confirmed the diagnosis of NEH. Symptoms disappeared a few days after the cessation of treatment and introduction of topical steroids. The replacement of one BRAFi with another is a therapeutic alternative as it is not necessarily associated with a relapse of NEH. NEH can be added to the spectrum of neutrophilic dermatoses induced by BRAFis. It occurs earlier (3-4 days) than previously described drug-induced NEH (9-12 days) and may be an earlier stage of eccrine squamous syringometaplasia, which has already been reported in the context of BRAFi-treated patients.

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“…The diagnosis relies on demonstrating characteristic squamous metaplasia of eccrine ductal epithelium on a skin biopsy specimen. In a recent reported case of ESS attributed to vemurafenib, the decrease in drug dosage led to significant clinical improvement, suggesting that this eruption might have been dose-dependent [6]. In the BRIM-3 trial and in a recent review studying vemurafenib-induced toxic-erythema-like eruptions, vemurafenib could be introduced again at a reduced dose after a treatment break without recurrence of the adverse events [2,3].…”

Section: Review and Discussionmentioning

confidence: 99%

Vemurafenib-Induced Eccrine Squamous Syringometaplasia

Lescoat

Droitcourt²,

Stock³

et al. 2013

Dermatology

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We report herein a patient treated with vemurafenib for a stage IV melanoma who developed an eruption related to eccrine squamous syringometaplasia (ESS). This entity is a well-described side effect of cytostatic therapies used for malignant neoplasia and is clinically characterized by a symmetric cutaneous eruption composed of papules and vesicles preferentially located on fold and intertriginous areas. It is histologically defined by a squamous metaplasia of eccrine ductal epithelium. ESS represents another skin eruption to be added to the list of cutaneous adverse events associated with vemurafenib, a selective BRAF inhibitor used to treat patients with metastatic melanoma harboring the V600E mutation. The discussion focuses on the pathogenesis of ESS secondary to vemurafenib and on alternative diagnoses.

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Eccrine squamous syringometaplasia associated with vemurafenib therapy

Cited by 21 publications

References 5 publications

Syringometaplasia: variants and underlying mechanisms

Syringometaplasia: variants and underlying mechanisms

Neutrophilic eccrine hidradenitis in two patients treated withBRAFinhibitors: a new cutaneous adverse event

Vemurafenib-Induced Eccrine Squamous Syringometaplasia

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