Which chemotherapeutic agents are associated with specific morphologic patterns in drug eruptions?

Updated: Feb 15, 2019
  • Author: Jonathan E Blume, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Chemotherapeutic agents associated with specific morphologic patterns are as follows:

  • Acneiform - Cetuximab, [29] dactinomycin, erlotinib, [29] fluoxymesterone, gefitinib, medroxyprogesterone, and vinblastine [30]

  • Acral erythema (erythrodysesthesia) - Capecitabine, cisplatin, clofarabine, cyclophosphamide, cytarabine, docetaxel, doxorubicin, fluorouracil, gemcitabine, MTX, tegafur, and vinorelbine

  • Alopecia: All classes of chemotherapeutic agents are associated with alopecia. Commonly associated drugs include alkylating agents, anthracyclines, bleomycin, doxorubicin, hydroxyurea, MTX, mitomycin, mitoxantrone, vinblastine, and vincristine. Busulfan and cyclophosphamide administered in combination can cause permanent hair loss. Nilotinib (Tasigna) is a potent and selective bcr-abl kinase inhibitor currently used to treat imatinib-resistant chronic myeloid leukemia. Clinically, the reaction can present as pink/fleshy perifollicular papules with diffuse alopecia, without follicular drop-out. Histologically, it can demonstrate scarring or nonscarring alopecia with mixed features. [31, 32] Note the images below.

    Male-pattern diffuse hair loss. Male-pattern diffuse hair loss.
    Pink/fleshy perifollicular papules with diffuse al Pink/fleshy perifollicular papules with diffuse alopecia.
    Horizontal section shows perifollicular fibrosis c Horizontal section shows perifollicular fibrosis consistent with scarring alopecia.
  • EM - Busulfan, chlorambucil, cyclophosphamide, diethylstilbestrol (DES), etoposide, hydroxyurea, mechlorethamine, MTX, mitomycin C, mitotane, paclitaxel, and suramin

  • Erythema nodosum - Busulfan, DES, and imatinib

  • Fixed drug eruptions - Dacarbazine, hydroxyurea, paclitaxel, and procarbazine

  • Hyperpigmentation - Bischloroethylnitrosourea (BCNU; carmustine), bleomycin, busulfan, brequinar, cisplatin, cyclophosphamide, dactinomycin, daunorubicin, docetaxel, doxorubicin, fluorouracil, fotemustine, hydroxyurea, ifosfamide, MTX, mithramycin, mitoxantrone, nitrogen mustard, procarbazine, tegafur, thiotepa, and vinorelbine

  • Lichenoid - Hydroxyurea, imatinib, and tegafur

  • Lupus - Aminoglutethimide, DES, hydroxyurea, leuprolide, and tegafur

  • Morbilliform (exanthematous) - Bleomycin, carboplatin, cis -dichloro-trans -dihydroxy-bis -isopropylamine platinum (CHIP), chlorambucil, cytarabine, docetaxel, DES, doxorubicin, etoposide, 5-fluorouracil, hydroxyurea, MTX, mitomycin C, mitotane, mitoxantrone, paclitaxel, pentostatin, procarbazine, suramin, and thiotepa

  • TEN - Asparaginase, bleomycin, chlorambucil, cladribine, cytarabine, doxorubicin, 5-fluorouracil, MTX, plicamycin, procarbazine, and suramin

  • Urticaria [33] - Amsacrine, bleomycin, busulfan, carboplatin, chlorambucil, cisplatin, cyclophosphamide, cytarabine, daunorubicin, diaziquone, didemnin, DES, docetaxel, doxorubicin, epirubicin, etoposide, 5-fluorouracil, mechlorethamine, melphalan, MTX, mitomycin C, mitotane, mitoxantrone, paclitaxel, pentostatin, procarbazine, teniposide, thiotepa, trimetrexate, vincristine, and zinostatin

  • Vasculitis - Busulfan, cyclophosphamide, cytarabine, hexamethylene bisacetamide (HMBA), hydroxyurea, imatinib, levamisole, 6-mercaptopurine, MTX, mitoxantrone, rituximab, and tamoxifen


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