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
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
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