Hydroxyurea: a reappraisal of its cutaneous side effects and their management

Abstract

Hydroxyurea (HU) is known to cause a broad spectrum of cutaneous side effects, ranging from relatively benign to severe. Although dermatologists are often consulted for the treatment of these side effects, a comprehensive resource discussing the different types and their management is lacking. In this study, we conducted a literature search in order to critically evaluate the reported types and management of hydroxyurea's cutaneous side effects, as well as review its mechanism of action, dermatologic uses, and common systemic side effects. Relatively common and benign side effects include hyperpigmentation, xerosis, and skin atrophy. While serious cutaneous side effects such as leg ulcers or nonmelanoma skin cancers occur in a substantial proportion of patients, these may resolve with HU discontinuation and proper dermatologic management. Therefore, it is crucial for dermatologists to be aware of these various cutaneous side effects and their management as prompt diagnosis and proper treatment will improve patient outcomes.

Non-melanoma Skin Cancers in Patients on Hydroxyurea for Philadelphia Chromosome-Negative Myeloproliferative Neoplasms: A Systematic Review

“…Eight out of 10 studies reported an association between HU and NMSC [ 7 , 11 , 15 - 18 , 20 , 22 ]. Two studies found no statistical significance between HU and the development of secondary solid cancers (including cutaneous malignancies) [ 19 , 21 ].…”

“…This is consistent with the extremely low incidence of skin cancers in sickle cell patients on relatively low doses of HU for a shorter duration [ 24 ]. Most lesions improved or remained stable after the drug withdrawal [ 7 , 20 ]. In very few cases, tumor recurrence was seen several years after discontinuation of HU [ 16 ].…”

“…HU is considered to be well-tolerated, but a quick literature search highlights the varied presentation of cutaneous side effects of this drug [ 4 ]. The adverse cutaneous reactions range from alopecia, hyperpigmentation, melanonychia, xerosis, keratoderma, ulcers, dermatomyositis-like eruptions, actinic keratosis to various types of malignancies [ 7 - 8 ]. Chronic nonhealing ulcers, dermatomyositis-like eruptions, and actinic keratosis are pre-malignant, and if not recognized, can progress to full-blown malignancy.…”

“…Chronic nonhealing ulcers, dermatomyositis-like eruptions, and actinic keratosis are pre-malignant, and if not recognized, can progress to full-blown malignancy. The cutaneous malignancies include Squamous cell carcinoma (SCC), Basal cell carcinoma (BCC), and Merkel cell carcinoma (MCC) [ 7 , 9 ]. According to the reported studies, these carcinomas were observed in patients on medication with this drug for a longer duration [ 7 - 8 ].…”

“…The cutaneous malignancies include Squamous cell carcinoma (SCC), Basal cell carcinoma (BCC), and Merkel cell carcinoma (MCC) [ 7 , 9 ]. According to the reported studies, these carcinomas were observed in patients on medication with this drug for a longer duration [ 7 - 8 ]. Patients with Ph-MPN are usually on a relatively high steady dose for an extended period of time.…”