Letter to the EditorVitiligo-like lesions in an adult patient treated with Imatinib mesylate
Introduction
Imatinib mesylate (Gleveec) is at present the first line treatment for CML and GIST.
The best known side effects of Imatinib mesylate are periorbital edema, fluid retention, nausea, emesis, diarrhea and myelosuppression [1]. In addition, a number of dermatological side effects have been documented, such as a pruritic maculopapular exanthema, follicular mucinosis, erythroderma, graft-versus-host-like-disease, a mycosis fungoides-like reaction, small vessels vasculitis, generalized exanthematous pustolosis, Stevens–Johnson syndrome, a pityriasis rosea-like eruption, Sweet syndrome, and a lichenoid eruption. In some cases, it can also induce local or generalized hyperpigmentation, and hair repigmentation [2], [3], [4].
We describe here a case of CML patient treated with Imatinib who developed vitiligo-like lesions.
Vitiligo is an acquired progressive disorder that results in selective disappearance of epidermal and follicular melanocytes, leaving depigmented spots of the skin, with a consequent disfigurement and possible impact on the quality of life.
Indeed, patients who have face involvement abhor having two skin colours; they may accept depigmentation of the remaining pigmented skin as a reasonable treatment, when repigmentation of involved skin is not possible.
Section snippets
Case report
A 38-year-old Caucasian man was first seen in January 2006. Physical examination showed splenomegaly and hepatomegaly. A blood count showed leukocytes of 260.930 μL−1 with the presence of myeloid precursors at various stages of differentiation in peripheral blood.
Cytogenetic and molecular analyses showed the presence of the Ph chromosome and of the hybrid bcr/abl gene. With a diagnosis of chronic myeloid leukaemia, the patient was initially treated with hydroxyurea at conventional dosage,
Discussion
Imatinib is a selective inhibitor of several tyrosine kinases: it inhibits not only the tyrosine kinase BCR-ABL, but also platelet-derived growth factor receptors (PDGFRs) and c-KIT receptor tyrosine kinases [5]. It is thought that the side effects of Imatinib treatment is due to its action on other tyrosine kinases, especially on PDGFRs and c-KIT. Indeed, mutations in the c-kit gene have been associated with hypopigmentary disorders, such as vitiligo and piebaldism [6], [7], [8], [9].
The
Conflict of interest
None.
Financial disclosure
None.
Acknowledgement
Support: none.
Contributions. All four authors contributed to in the writing and preparation of this manuscript.
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