Cutaneous Adverse Reactions to Imatinib: A Case Report of a Successful Slow Protocol for Induction of Drug Tolerance

As well as other Multikinase Inhibitors (MKI), Imatinib has been related to cutaneous adverse reactions. The majority of these seem to directly depend on its mechanism of action, namely the inhibition of the physiologic function of cutaneous protein kinases, and appear to be dose dependent. Like other traditional chemotherapy agents, MKI cause alopecia, mucositis and xerosis. Cutaneous findings more specifically related to MKI include follicular or papulopustolar exanthemas of the face or chest, dermal atrophy and pruritus. A typical cutaneous side effect in patients treated with MKI is the Hand-Foot Skin Reaction (HFSR) that presents with pain, hyperkeratosis and palmo-plantar blistering, generally occurring in the first 2-4 weeks of treatment. Pathogenesis of HFSR has been related to drug leakage from capillaries damaged by subclinical traumas in areas of frictions, resulting in the histological finding of a superficial perivascular lymphovcytic infiltrate in the dermis, eventually associated to non-leukocytoclastic vasculitis [1].