Nilontinib induced keratosis pilaris atrophicans.

Keratosis pilaris (KP) is a disorder of follicular keratinization that is characterized by keratin plugs in the hair follicles with surrounding erythema. A 46-year-old man with chronic myelogenous leukemia (CML) was started on nilotinib, a second generation tyrosine kinase inhibitor (TKI). Two months later the patient noticed red bumps on the skin and patchy hair loss on the arms, chest, shoulders, back, and legs. Cutaneous reactions to nilotinib are the most frequent non-hematologic adverse effects reported. However, it is important to distinguish KP-like eruptions from more severe drug hypersensitivity eruptions, which can necessitate discontinuing the medication. Also, it is important to classify the cutaneous eruptions in patients on TKI according to the morphology instead of labeling them all as "chemotherapy eruption" to be able to better manage these adverse effects.

Vemurafenib-induced interface dermatitis manifesting as radiation-recall and a keratosis pilaris-like eruption.

Vemurafenib is a specific inhibitor of the V600E mutated BRAF protein kinase used for the treatment of unresectable or metastatic melanoma harboring this mutation. Multiple predictable side effects have been described with use of this targeted therapy, and implicate BRAF and mitogen activated protein kinase (MAPK) signaling pathways in their pathogenesis. Herein, we report the novel finding of an interface dermatitis in radiation recall and a keratosis pilaris-like clinical reaction in a patient treated with vemurafenib.

Cutaneous toxicities of RAF inhibitors.

The RAF inhibitors vemurafenib and dabrafenib are emerging as the standard of care for Val600 BRAF-mutant metastatic melanoma. These drugs have shown clinical benefit over the standard care (dacarbazine); however, they are associated with frequent cutaneous adverse events, which can be concerning to the patient and their physician. Herein, we review the range of cutaneous disorders that seem to be induced by RAF inhibitors, including cutaneous squamous-cell carcinoma, hyperkeratotic lesions, Grover's disease, keratosis pilaris-like reactions, and photosensitivity. These disorders often affect patients' quality of life; therefore, dermatological assessment and timely management is essential to ensure that patients continue to use RAF inhibitors.

Exacerbation of Darier disease by lithium carbonate.

INTRODUCTION: Darier disease (DD) and Hailey-Hailey disease (HHD) are rare autosomal dominantly inherited genodermatoses with mutations in the respective genes, ATP2A2 and ATP2C1, that encode the respective calcium adenosine triphosphatases SERCA2 and PMRI/SPCA1. Lithium is an effective therapy used in psychiatry as prophylaxis against recurrent mania and to treat acute schizoaffective, impulsive, and alcoholic disorders. METHODS: We discuss a patient with DD who claimed that her skin condition had flared after she was administered lithium therapy for bipolar disorder. DISCUSSION AND CONCLUSIONS: DD may flare after lithium therapy, an association that has rarely been reported. Not uncommonly, DD has been observed to coexist with affective disorders, with reports of the bipolar disorder susceptibility locus cosegregating with a separate DD gene. A mechanism by which lithium worsens disease has recently been studied in rats. DD's coexistence with affective disorders and the mechanisms by which lithium may cause exacerbation of DD and HHD are reviewed.

[Penicillamine-induced elastosis perforans serpiginosa]. / Penicillamin-induzierte Elastosis perforans serpiginosa.

Elastosis perforans serpiginosa is a rare disease with variable etiology. We report on a 33-year-old male patient in whom the disease was induced by long-term treatment with the chelating agent D-penicillamine.

Autopsy of patients with yusho.

Autopsy findings of 12 patients with yusho including 2 stillborn babies are reported. Characteristic pathological changes were acne-like eruptions and cutaneous pigmentation with histological features of follicular hyperkeratosis, dilated hair follicles, and an increase of melanin pigment of the epidermis. In addition to the skin lesions, multiplication of the duct epithelium of the esophageal gland was found in 6 patients. Unusual multiple small foci of myocardial necrosis and fibrosis with basophilic myofibrillar degeneration were found in one patient, suggesting a relation to PCB exposure. Five cases with carcinomas (two involving the liver, two the lung, and one the esophagus) were also found, but their causal relationship with PCB was not certain. Nine cases showed the characteristic gas chromatographic pattern of yusho, but two cases had the same one as that of healthy controls.

[Drug eruptions caused by lithium salts]. / Toxidermies dues aux sels de lithium.

The systemic complications of therapy with lithium are well known, but toxidermia has only been recognised since 1968. The carbonate (Teralithe) is the lithium salt which is mainly responsible, leading to minor dermatoses: oedema, pruritus, alopecia, urticaria, purpura, allergic vasculitis, pretibial ulceration. Some more specific conditions have been individualised by their severity and rarity: acne form eruptions, seborrheic dermatitis, follicular keratoses and psoriasis-like dermatosis as well as true psoriasis induced or aggravated by lithium. The authors review the literature and discuss the pathogenesis of these toxidermias. The cause of some dermatoses can be explained, especially the allergic vasculitis and psoriasis lesions. The underlying mechanism of most of these conditions remains unknown, but excessive tissue concentrations of the drug probably play an important role in inducing these complications.

[Solar acne]. / Acne solar.

Acne solaris a form of acne that appears and relapses after sun exposure, is almost always itchy and is preferably localized on the upper anterior chest, the deltoid regions and the shoulders. The use of greasy or oily sun protectors helps in the obstructions of the follicular openings, which is seen in the tissue sections, presumably initiated by sun irradiation causing initially hyperkeratosis. The essential lesion is a small hemispheric or conic erythematous papule which may show a yellow point in its top. True comedos are not seen and compression after punction provokes the appearance of a yellow mass-essentially keratinic and sebaceous. The usual treatment of acne vulgaris is useful specially if a topical corticosteroid is associated. The systemic use of corticosteroids usually worsens the disease.

[Studies on the effect of vitamin A acid in experimentally induced follicular keratosis (author's transl)]. / Untersuchungen zur Wirkung der Vitamin-A-Süre bei experimentell ausgelöster Follikelkeratose

Topical application of Benzoxazole to the inner surface of the ear of the rabbit induced a considerable and histologically verified follicular keratosis. This effect could be intensified by a preceding treatment of the animal with androgens. Vitamin A acid, applied topically, is able to eliminate this follicular keratosis.