Reactions 1680, p163 - 2 Dec 2017 Various toxicities: 2 case reports In a case series, two patients were described, out of whom a 79-year-old woman developed nail plate abnormalities, ecchymoses and actinic keratosis, and a 53-year-old man developed nail plate abnormalities, desquamative dermatitis with red-brown macules and petechiae during treatment with ibrutinib [not all outcomes stated]. Case 1: A 79-year-old woman, who had a history of chronic lymphocytic leukaemia (CLL), was started on systemic treatment with oral ibrutinib 420mg daily. Within six months from the start of ibrutinib, she observed changes in the texture and appearance of her nails. Cutaneous skin examination showed significant changes of her fingernails and toenails with brittle and fragile nature. Therefore, she was started on biotin. In addition to the nail changes, she also developed ecchymoses on her arms and legs. She had ten actinic keratosis, which was treated with cryotherapy. Three months after the start of biotin, her toenails brittleness improved. However, new ecchymoses continued to grow on her extremities. Case 2: A 53-year-old man, who had a history of CLL, was started on systemic treatment with oral ibrutinib 420mg daily. He also received venetoclax (ABT199). Within four months from the start of ibrutinib, he observed changes in the appearance of his nails. Cutaneous skin examination showed significant changes of the nails on finger, thumb and toe with brittle and fragile nature. Therefore, he was started on biotin. In addition to the nail changes, he also developed ecchymoses desquamative dermatitis with red-brown macules. He also had petechiae on the tip of the left great toe. Author comment: "Ibrutinib, a tyrosine kinase inhibitor, is a novel therapy for chronic lymphocytic leukemia that has been associated with nail plate abnormalities." "Bruising, hair changes and nail plate abnormalities, pruritus and rashes are the most common cutaneous side effects of ibrutinib; less common skin adverse events include purpuric painful nodules and pyoderma gangrenosum." Heldt Manica LA, et al. Ibrutinib-Associated Nail Plate Abnormalities: Case Reports and Review. Drug Safety - Case Reports 4: No. 15, Dec 2017. Available from: URL: http://doi.org/10.1007/s40800-017-0060-1 - USA 803284587 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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