Livedo reticularis associated with interferon α therapy in two melanoma patients

Abstract

We report two patients who developed intense livedo reticularis clearly related to the administration of interferon alpha 2b as an adjuvant therapy for melanoma. Histological studies showed scattered perivascular infiltrates without vasculitis. Laboratory tests excluded any underlying condition. Resolution of the symptoms was observed in both patients when interferon alpha was withdrawn. These cases highlight the occurrence of livedo reticularis as an uncommon side-effect of interferon alpha treatment.

Livedo Reticularis: A Side Effect of Interferon Therapy in a Pediatric Patient with Melanoma

“…Documented toxicities from interferon alpha‐2B in adult patients with melanoma include acute constitutional symptoms, chronic fatigue, myelosuppresion, high liver enzymes, neurologic symptoms, development of autoimmune disease, and vascular complications (7,8). Cutaneous adverse events in adults include alopecia, local injection reactions, ulcerations, and psoriasis (8–11).…”

“…Although medications such as amantadine are known to elicit livedo reticularis, only a few reports of livedo reticularis have been documented in adults with melanoma receiving interferon therapy (11–13). In those cases, laboratory profiles did not suggest secondary disease, and treatment was continued (11).…”

“…Although medications such as amantadine are known to elicit livedo reticularis, only a few reports of livedo reticularis have been documented in adults with melanoma receiving interferon therapy (11–13). In those cases, laboratory profiles did not suggest secondary disease, and treatment was continued (11). In one prospective study of patients receiving interferon treatment, 10 of 33 developed Raynaud’s phenomenon or livedo reticularis, and two of these had an associated increase in circulating autoantibody titer (13), similar to our patient, who had a weakly positive ANA titer of 1:40.…”

Livedo Reticularis and Related Disorders

“…LR can complicate chronic lobular panniculitis due to subcutaneous interferon-beta injections and has been associated with interferon-alpha injections as well [29,30]. Nicolau's syndrome or livedo-like dermatitis is a known complication of intramuscular injections of various medications that includes bismuth, corticosteroids, penicillin, vaccinations, diclofenac, and ibuprofen.…”

A Review of Adverse Cutaneous Drug Reactions Resulting from the Use of Interferon and Ribavirin

“…There is a single case report of pyoderma gangrenosum secondary to interferon treatment (83). Single cases have also been reported for granuloma annulare (84), facial erythema (85), livedo reticularis (86), 'oil cysts' (87), polyarteritis nodosa (88), systemic sclerosis (89), acral sclerosis (90), erythema elevatum diutinum (91), atrophie blanche (92), dermatomyositis (93), scleromyxedema (94), cutaneous mucinosis (95) and immune thrombocytopenic purpura (96).…”