sirolimus and Acneiform-Eruptions

Several drugs have been associated with the development of eruptions that may simulate acne vulgaris. These drugs include corticosteroids, epidermal growth factor receptor inhibitors, cyclosporine, anticonvulsants, antipsychotics, antidepressants, tumor necrosis factor-alpha (TNF-alpha) inhibitors, anabolic steroids, danazol, antituberculosis drugs, quinidine, azathioprine and testosterone. In some cases, the eruption is clinically and histologically similar to acne vulgaris while, in other cases, the eruption is clinically suggestive of acne vulgaris without any histologic information. Additionally, in other cases of drug-associated acneiform eruptions, despite clinical similarity, histologic features are not consistent with acne vulgaris.

Topics: Acne Vulgaris; Acneiform Eruptions; Adrenal Cortex Hormones; Cyclosporine; Dactinomycin; ErbB Receptors; Humans; Lithium Carbonate; Sirolimus; Tumor Necrosis Factor-alpha

Mammalian target of rapamycine (mTOR) inhibitors are being increasingly prescribed as antitumoural drugs, and associated adverse cutaneous effects are frequent but poorly described. The aim of this study was to describe such adverse effects and to assess the quality of life of patients experiencing them.. Over a period of 18 months, 18 patients treated with mTOR inhibitors for renal carcinoma were included and 77 dermatological examinations performed. Wherever a cutaneous adverse event was present, quality of life was evaluated using the Skindex 30 questionnaire.. Fifteen of the 18 patients included presented adverse cutaneous events, consisting of buccal ulcers (61.1%), xerosis (55.5%), distal onycholysis (50%), acneiform eruption (38.8%), paronychia (22.2%) and pruritus (22.2%). Buccal ulcerations and perionyxis had an especially marked impact on quality of life, which was greatest in terms of physical score (19%), followed by emotional (9%) and functional (6%) scores.. Cutaneous adverse effects of mTOR inhibitors are frequent and have a considerable impact on quality of life, particularly as regards physical scores. Dermatological examination appears useful to allow early management of cutaneous adverse effects and improve the quality of life of these patients.

Topics: Acneiform Eruptions; Aged; Aged, 80 and over; Antineoplastic Agents; Carcinoma, Renal Cell; Drug Eruptions; Emotions; Everolimus; Female; Humans; Ichthyosis; Kidney Neoplasms; Male; Middle Aged; Onycholysis; Paronychia; Prospective Studies; Pruritus; Quality of Life; Severity of Illness Index; Sirolimus; Stomatitis, Aphthous; TOR Serine-Threonine Kinases

Sirolimus is an immunosuppressive macrolide with antineoplasic properties that is increasingly used in posttransplantation immunosuppression. The treatment is frequently associated with cutaneous side effects such as sirolimus-associated acneiform facial dermatitis, which has been observed in up to 50% of treated patients. We report a 51-year-old female with liver transplantation who developed inflammatory papules and nodules on the face and the upper chest 3 weeks after the initiation of sirolimus therapy. Sequential biopsies revealed lymphocytic infiltration of the dermis with a peculiar pattern of sebotropism, while older lesions showed acquired reactive perforating collagenosis. The lesions were responsive to hydroxychloroquine treatment despite continued sirolimus treatment.

Topics: Acneiform Eruptions; Anti-Inflammatory Agents; Collagen; Collagen Diseases; Drug Eruptions; Female; Humans; Hydroxychloroquine; Immunosuppressive Agents; Liver Transplantation; Middle Aged; Sebaceous Glands; Sebum; Sirolimus; Skin

Sirolimus is a new immunosuppressive agent used to prevent rejection in renal allograft recipients in order to reduce the need of potentially nephrotoxic calcineurin inhibitors (cyclosporine, tacrolimus). The cutaneous side effects of sirolimus are not well known and they may have been underestimated. We report 2 cases of follicular acneiform eruptions induced by sirolimus in renal allograft recipients. This dermatologic complication was severe and difficult to treat, and resolved only after discontinuation of sirolimus.

Topics: Acneiform Eruptions; Adult; Drug Eruptions; Facial Dermatoses; Female; Graft Survival; Humans; Immunosuppressive Agents; Kidney Transplantation; Sirolimus; Transplantation, Homologous