Hyperpigmentation of the hard palate mucosa in a patient with chronic myeloid leukaemia taking imatinib
Tóm tắt
Imatinib mesylate is an inhibitor of the tyrosine kinase Bcr–Abl and a first-line treatment for Philadelphia chromosome-positive chronic myeloid leukaemia (CML). Dermatological side effects include superficial oedema, pustular eruption, lichenoid reactions, erythroderma, and skin rash. Depigmentation of the skin and/or mucosa is uncommon, and hyperpigmentation is rare. We present the case of a 63-year-old Caucasian male with widespread hyperpigmentation of the hard palate associated with a 9-year history of imatinib therapy to treat CML. He did not complain of any symptoms. Clinical examination did not reveal any abnormal pigmentation of the skin or other region of the oral mucosa. He did not smoke cigarettes or drink alcohol. His medication regimen was a proton pump inhibitor, a beta-blocker, cardioaspirin, atorvastatin, and imatinib 400 mg/day. Histopathologically, melanin and haemosiderin deposits were evident in the lamina propria. The lesion persisted, with no clinical change, through several follow-ups. We reviewed the literature to explore the possible relationship between oral hyperpigmentation and long-term imatinib mesylate treatment. We diagnosed oral pigmentation associated with imatinib intake based on the medical history and clinical features of the pigmented macules. Oral pigmentation may have a variety of causes, and differential diagnosis requires nodal analysis. Clinicians should be aware of possible oral mucosal hyperpigmentation in patients taking imatinib mesylate. Such pigmentation is benign and no treatment is needed, but surveillance is advisable.
Tài liệu tham khảo
Hassona Y, Sawair F, Al-Karadsheh O, Scully C (2016) Prevalence and clinical features of pigmented oral lesions. Int J Dermatol 55:1005–1013
Axell T (1976) A prevalence study of oral mucosal lesions in an adult Swedish population. Odontol Rev 36:1–103
Li CC, Malik SM, Blaeser BF, Dehni WJ et al (2012) Mucosal pigmentation caused by imatinib: report of three cases. Head Neck Pathol 6:290–295
Dereure O (2001) Drug-induced skin pigmentation. Epidemiology, diagnosis and treatment. Am J Clin Dermatol 2:253–262
Ciҫek Y, Ertaş U (2003) The normal and pathological pigmentation of oral mucous membrane: a review. J Contemp Dent Pract 4:76–86
Meleti M, Vescovi P, Mooi WJ et al (2008) Pigmented lesions of the oral mucosa and perioral tissues: a flow-chart for the diagnosis and some recommendations for the management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:606–616
National Institute for Health and Care Excellence (2012) Guidance on the use of imatinib for chronic myeloid leukaemia, TA70. NICE, London
Scheinfeld N (2006) Imatinib mesylate and dermatology part 2: a review of the cutaneous side effects of imatinib mesylate. J Drugs Dermatol 5:228–231
Arora B, Kumar L, Sharma A, Wadhwa J, Kochupillai V (2004) Pigmentary changes in chronic myeloid leukemia patients treated with imatinib mesylate. Ann Oncol 15:358–359
Robert C, Soria JC, Spatz A, le Cesne A, Malka D, Pautier P et al (2005) Cutaneous side-effects of kinase inhibitors and blocking antibodies. Lancet Oncol 6:491–500
Tsao AS, Kantarjian H, Cortes J, O'Brien S, Talpaz M (2003) Imatinib mesylate causes hypopigmentation in the skin. Cancer 98:2483–2487
Ena P, Chiarolini F, Siddi GM, Cossu A (2004) Oral lichenoid eruption secondary to imatinib (Glivec). J Dermatolog Treat 15:253–255
Lim DS, Muir J (2002) Oral lichenoid reaction to imatinib (STI 571, Gleevec). Dermatology 205:169–171
Pascual JC, Matarredona J, Miralles J, Conesa V, Borras-Blasco J (2006) Oral and cutaneous lichenoid reaction secondary to imatinib: report of two cases. Int J Dermatol 45:1471–1473
Singh N, Bakhshi S (2007) Imatinib-induced dental hyperpigmentation in childhood chronic myeloid leukemia. J Pediatr Hematol Oncol 29:208–209
Singh O, Agrawal P, Agarwal A, Yadav S (2016) Imatinib induced dental hyperpigmentation chronic myeloid leukemia in adult female. J Assoc Physicians India 64:138
Agrawal P, Singh O, Nigam AK, Upadhyay S (2015) Imatinib induced dental hyperpigmentation in chronic myeloid leukemia in an adult female. Indian J Pharmacol 47:685–686
Lewis DM (2009) Diffuse pigmentation of the palate. J Okla Dent Assoc 100:24–25
Wong M, Sade S, Gilbert M, Klieb HB (2011) Oral melanosis after tyrosine kinase inhibition with imatinib for chronic myelogenous leukemia: report of a case and review of the literature. Dermatol Online J 17:4
Mattsson U, Halbritter S, Mörner Serikoff E et al (2011) Oral pigmentation in the hard palate associated with imatinib mesylate therapy: a report of three cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111:e12–e16
Resende RG, Teixeira RG, Vasconcelos Fde O et al (2012) Imatinib associated hyperpigmentation of the palate in post-HSCT patient. J Cranio-Maxillo-Facial Surgery 40:e140–e143
Roeker LE, Wolanskyj AP (2014) Imatinib-associated melanosis of the palate. Am J Hematol 89:564
Song HS, Kang HY (2014) Imatinib mesylate-induced hyperpigmentation of the nose and palate. Ann Dermatol 26:532–533
Lyne A, Creedon A, Bailey BM (2015) Mucosal pigmentation of the hard palate in a patient taking imatinib. BMJ Case Rep 16:2015
Meleti M, Mooi WJ, Casparie MK et al (2007) Melanocytic nevi of the oral mucosa—no evidence of increased risk for oral malignant melanoma: an analysis of 119 cases. Oral Oncol 43:976–981
Reddy GJ, Kanth MR, Kumar DR et al (2015) Oral malignant melanoma. J Clin Diagn Res 9:ZL03
De Schepper S, Boucneau J, Lambert J, Messiaen L, Naeyaert JM (2005) Pigment cell-related manifestations in neurofibromatosis type 1: an overview. Pigment Cell Res 18:13–24
Kim IS, Kim ER, Nam HJ, Chin MO, Moon YH, MR O et al (1999) Activating mutation of GS alpha in McCune-Albright syndrome causes skin pigmentation by tyrosinase gene activation on affected melanocytes. Horm Res 52:235–240
Cinotti E, Couzan C, Perrot JL, Habougit C, Labeille B et al (2015) In vivo confocal microscopic substrate of grey colour in melanosis. J Eur Acad Dermatol Venereol 29:2458–2462
Alawi F (2013) Pigmented lesions of the oral cavity: an update. Dent Clin N Am 57:699–710
Hedin CA, Pindborg JJ, Axell T (1993) Disappearance of smoker’s melanosis after reducing smoking. J Oral Pathol Med 22:228–230
Kauzman A, Pavone M, Blanas N et al (2004) Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations. J Can Dent Assoc 70:682–683
Callender VD, St Surin-Lord S, Davis EC, Maclin M (2011) Postinflammatory hyperpigmentation: etiologic and therapeutic considerations. Am J Clin Dermatol 12:87–99
Vera-Sirera B, Risueńo-Mata P, Ricart-Vaya JM et al (2012) Clinicopathological and immunohistochemical study of oral amalgam pigmentation. Acta Otorrinolaringol Esp 63:376–381
Barrett AW, Scully C (1994) Human oral mucosal melanocytes: a review. J Oral Pathol Med 23:97–103
Gagari E, Rand MK, Tayari L, Vastardis H, Sharma P et al (2006) Expression of stem cell factor and its receptor, C-kit, in human oral mesenchymal cells. Eur J Oral Sci 114:409–415
Kumar B, Saraswat A, Kaur I (2002) Mucocutaneous adverse effects of hydroxyurea: a prospective study of 30 psoriasis patients. Clin Exp Dermatol 27:8–13
McPherson T, Sherman V, Turner R (2009) Imatinib-associated hyperpigmentation, a side effect that should be recognized. J Eur Acad Dermatol Venereol 23:82–83
Romeo U, Palaia G, Fantozzi PJ, Tenore G, Bosco D (2015) A rare case of melanosis of the hard palate mucosa in a patient with chronic myeloid leukemia. Case Rep Dent 2015;9:817094