Nail pigmentation caused by hydroxyurea: report of 9 cases.

Department of Dermatology, Ospedale S. Giovanni de Dio, University of Cagliari, Via Ospedale 54, 09124-Cagliari, Italy.
Journal of the American Academy of Dermatology (Impact Factor: 5). 08/2002; 47(1):146-7. DOI: 10.1067/mjd.2002.120910
Source: PubMed

ABSTRACT We report a series of 9 patients, 6 men and 3 women, who presented nail hyperpigmentation arising between 6 and 24 months from the start of hydroxyurea therapy. The most commonly observed clinical pattern was that of longitudinal melanonychia. In only 1 patient, who was affected in all 20 nails, we observed longitudinal melanonychia, diffuse melanonychia, and hyperpigmentation of the skin.

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    ABSTRACT: Hydroxyurea is an antitumoral drug mainly used in the treatment of Philadelphia chromosome-negative myeloproliferative syndromes and sickle-cell disease. Ulcers represent a rare but severe long-term adverse effect of hydroxyurea therapy. Hydroxyurea-induced ulcers are often multiple and bilateral, typically developing in the perimalleolar region, although any cutaneous district is potentially affected. They generally look small, well-defined, shallow with an adherent, yellow, fibrinous necrotic base. A constant finding is also an extremely intense, treatment-resistant pain accompanying these ulcerations. Withdrawal of the drug generally leads to spontaneous healing of these lesions. Care providers tend to show insufficient awareness of this highly debilitating cutaneous side effect, and late or missed diagnoses are frequent. Instead, regular dermatologic screening should be performed on hydroxyurea-treated patients. This article will present a comprehensive review of indexed case reports and clinical studies, followed by a discussion about treatment options aiming at increasing knowledge about this specific topic.
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    The Indian Journal of Pediatrics 11/2009; 76(11):1180-2. DOI:10.1007/s12098-009-0275-y · 0.92 Impact Factor
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    ABSTRACT: R e p o r t e7 I NTRO D U C TIO N Hydroxyurea is an antineoplastic agent that inhibits deoxyribonucleic acid synthesis. It is commonly used for the treatment of myeloproliferative diseases such as chronic myeloid leukaemia and essential thrombocytosis. (1) While cases of hydroxyurea-induced hyperpigmentation have been reported, reports of hydroxyurea-induced melanonychia are uncommon, with only two such cases involving all 20 nails. (2) Herein, we present one such rare scenario, where a patient developed hydroxyurea-induced hyperpigmentation and melanonychia within seven weeks after the initiation of therapy. CA S E R EPO RT A 50-year-old Indian woman with essential thrombocytosis complained of progressive darkening of the nails of both her hands and feet. Four months prior to this, she had suffered from right faciobrachial monoparesis. Magnetic resonance imaging of the patient's brain at that time had shown a right basal ganglia infarct. The patient recovered completely, with no residual neurological deficits. Laboratory findings were significant for elevated platelet count, which was at 1,743 × 10 9 /L (normal range 150–400 × 10 9 /L). Bone marrow aspiration and biopsy confirmed essential thrombocytosis. The patient was thus started on hydroxyurea at a dose of 1 g/day. She did not suffer from any side effects at the start of therapy. However, at follow-up seven weeks later, the patient complained of pigmentation involving all her fingernails and toenails. Physical examination revealed bluish-grey longitudinal bands at the proximal aspect of the nail beds with distal progression Melanonychia and mucocutaneous hyperpigmentation from hydroxyurea use for the treatment of essential thrombocytosis ABSTRACT Hydroxyurea is an antineoplastic agent commonly used to treat essential thrombocytosis. We report the case of a 50-year-old woman who was incidentally detected to have essential thrombocytosis after suffering an episode of cerebrovascular accident with faciobrachial monoparesis. She was subsequently initiated on hydroxyurea. Within seven weeks of therapy, the patient noticed irregular hyperpigmented patches over her feet, hands and perioral region, with bluish-grey longitudinal bands on all 20 nails. Hydroxyurea-induced hyperpigmentation and melanonychia are not commonly reported. To the best of our knowledge, this is only the third published report of hydroxyurea-induced hyperpigmentation and melanonychia involving all 20 nails. Physicians need to be aware of such mucocutaneous side effects to avoid misdiagnosis and unwarranted fear in patients. The decision to discontinue the intake of the drug depends heavily on the future risk of thrombotic events.