Generalized lichenoid drug eruption associated with imatinib mesylate therapy

Abstract

Imatinib mesylate (IM), an anticancer drug, has been widely used to treat chronic myeloid leukemia (CML), gastrointestinal stromal tumors (GIST), and dermato-fibrosarcoma protuberans. Cutaneous reactions to IM have been reported to occur in varying number of patients in different case series. Non-lichenoid cutaneous reactions secondary to IM have been well-documented in the literature and are the commonest non-hematologic adverse reactions associated with its use. Lichenoid drug eruption (LDE) associated with IM therapy has rarely been reported in the literature. A case of a generalized LDE associated with IM therapy has been described here for its rarity and interesting clinical presentation. As the clinical usage of IM is increasing, one might expect an increasing number of similar patients in the future. It is thus important to realize the potential of IM to produce LDE and to differentiate this entity from idiopathic lichen planus. In the present article, the reports of IM-associated LDE, described in the PubMed and Medline database (in English language literature), have also been reviewed.

Imatinib mesylate induced lichenoid drug eruption masquerading as small plaque parapsoriasis

“…These may commonly include, angiotensin converting enzyme inhibitors, thiazide diuretics, gold, antimalarials, penicillamine, nonsteroidal antinflammatory agents, dental amalgams, sulfasalazine, β blockers, and proton pump inhibitors. 5 Similar to present case, lichenoid drug eruption commonly manifests as skin lesions comprising papules or plaques, usually on the photo exposed parts of the skin and often spares the oral mucosa, genitalia and typically lack Wickham's striae. 5 Patients with LDE are often taking more than one drug hence making the diagnosis challenging.…”

“…5 Similar to present case, lichenoid drug eruption commonly manifests as skin lesions comprising papules or plaques, usually on the photo exposed parts of the skin and often spares the oral mucosa, genitalia and typically lack Wickham's striae. 5 Patients with LDE are often taking more than one drug hence making the diagnosis challenging. Resolution of lesions on discontinuation of the offending drug favours the diagnosis of LDE as seen in the present case where in which regression of the lesions were seen after the withdrawal of imatinib mesylate.…”

“…The time interval ranges from one month to fifteen months for the appearance of cutaneous adverse effects after initiation of IM therapy which was consistent in the present case. 5 Imatinib mesylate was identified as the offending drug and was withdrawn for one month after which the eruption subsided with persistent hyperpigmentation. This was similar to an isolated case report of imatinib induced extensive hyperpigmentation in chronic myeloid leukemia.…”

“…6 Till date very few cases of IM-associated lichenoid drug eruption have been described over the last decade. 5 Lichenoid drug eruption (LDE) is an interface dermatitis caused by ingestion, contact or inhalation of a variety of drugs and has a latent period ranging from several weeks to months after onset of drug intake. LDE have been reported to a wide variety of drugs.…”

Dermatological Adverse Effects of Chemotherapeutic Agents: Experience From a Tertiary Centre

“…1,9,10,11 Other cutaneous effects in our study such as erythema multiforme, lichenoid eruption, acneiform eruption, photosensitivity, and less frequent ones such as vasculitis, flagellate pigmentation, bullous eruption, and peeling of palms and soles, were also seen, as noticed in previous studies. 1,2,4,5,6,12,13 Among the chemotherapeutic agents, epidermal growth factor receptor inhibitors are associated with intensely itchy papulopustular rash or acneiform eruptions that occur mainly on the seborrheic areas such as the face, scalp and chest. It is hypothesised that the action of the drug alters signalling pathways resulting in keratinocyte growth arrest, apoptosis, decreased cell migration and increased differentiation and elicits an inflammatory response mediated by various cytokines released from keratinocytes.…”