Keratosis Pilaris-like Eruption during Treatment of Chronic Myeloid Leukemia with Tyrosine Kinase Inhibitors: Literature Review and Report of a Case Related to Imatinib

Abstract

The advent of tyrosine kinase inhibitors (TKIs) blocking BCR-ABL activity has revolutionized the therapeutic management of patients with chronic myeloid leukemia (CML). Adverse cutaneous reactions (ACRs) are common nonhematologic adverse events associated with the use of BCR-ABL TKIs. A characteristic pattern of eruption resembling keratosis pilaris (KP) has been described in patients treated with these drugs, especially nilotinib and dasatinib. The pathogenesis of this ACR is still unknown. This type of reaction appears to be uncommon with imatinib. Here, we report the case of an elderly patient with an asymptomatic KP-like eruption, which appeared one month after starting treatment with imatinib for CML. The case presentation is accompanied by a review of similar reactions in patients with CML treated with BCR-ABL inhibitors, attempting to make an excursus on the molecular targets of such drugs and possible mechanisms underlying this ACR.

Keywords: BCR-ABL; adverse cutaneous reaction; chronic myeloid leukemia; imatinib; keratosis pilaris; molecular targets; tyrosine kinase inhibitors.

Figure 1

Multiple tiny follicular, white-colored lesions affecting the patient’s scalp.

Figure 2

Dermoscopic findings consistent with follicular hyperkeratosis in an affected area of the scalp.

Figure 3

Histological photomicrograph showing features suggestive of keratosis pilaris within a dermis with diffuse and severe sclero-elastotic damage (Hematoxylin-Eosin, Original Magnification 10×).

Figure 4

Clinical picture of the patient’s scalp after discontinuation of treatment with imatinib.

Figure 5

Dermoscopic findings after discontinuation of imatinib in the same area shown in Figure 2.