PDF(Pubmed)
Abstract：
Ribociclib, a cyclin-dependent kinase 4/6 inhibitor, is a novel targeted therapy for advanced-stage breast cancer. Although ribociclib-induced cutaneous side effects have been previously noted, they have not been well documented. Herein, we present a case of ribociclib-induced phototoxicity, which manifested as dyschromia over sun-exposed forearms and neck initially and as bullae formation subsequently. A 71-year-old woman with metastatic breast cancer developed dyschromia after daily treatment with ribociclib (600 mg) for 7 months. Skin biopsy of the pigmented lesion revealed interface dermatitis with melanin incontinence and dyskeratotic cells and ballooning keratinocytes with loss of melanocytes in the basal layer. Further, clefting at the basal layer of epidermis was noted in a more hyperpigmented field. Fontana-Masson staining revealed melanophages in the dermis. Human Melanoma Black-45 staining revealed decreased melanocyte numbers in the epidermis above the cleft. Immunohistochemical analyses revealed activated CD1a+ epidermal Langerhans cells and infiltrating CD4+ and CD8+ T cells in the epidermis and dermis, thereby indicating type IV hypersensitivity that was associated with damage to keratinocytes and melanocytes. To prevent progression of bullous dermatitis, we advised the patient to discontinue ribociclib and prescribed oral and topical prednisolone. Due to the risk of phototoxicity, we educated the patient on sun-protection strategies. The patient\'s skin lesions subsided during the 2 months of treatment. Phototoxicity with dyschromia is a rare but significant ribociclib-induced cutaneous side effect. Early diagnosis, rapid ribociclib withdrawal, protection from sunlight, and prompt treatment are critical for preventing subsequent severe bullous dermatosis.
摘要：
Ribociclib,细胞周期蛋白依赖性激酶4/6抑制剂，是晚期乳腺癌的一种新型靶向治疗方法。尽管以前已经注意到ribociclib引起的皮肤副作用，他们没有得到很好的记录。在这里，我们介绍了一例瑞博西尼诱导的光毒性，最初表现为暴露在阳光下的前臂和颈部的色素异常，随后表现为大疱形成。一名71岁的转移性乳腺癌女性在每天接受瑞博西尼（600mg）治疗7个月后出现色素异常。色素性病变的皮肤活检显示界面性皮炎伴有黑色素失禁和角化障碍细胞和膨胀的角质形成细胞，基底层黑素细胞丢失。Further,在色素沉着过多的区域中，发现表皮基底层裂开。Fontana-Masson染色显示真皮中的黑色素细胞。人黑色素瘤Black-45染色显示，裂隙上方表皮中的黑素细胞数量减少。免疫组织化学分析显示活化的CD1a+表皮朗格汉斯细胞和表皮和真皮中浸润的CD4+和CD8+T细胞，从而表明与角质形成细胞和黑素细胞损伤相关的IV型超敏反应。为了防止大疱性皮炎的进展，我们建议患者停止服用瑞博西尼,并口服和外用泼尼松龙.由于光毒性的风险，我们教育病人防晒策略.患者的皮损在2个月的治疗期间消退。色素异常的光毒性是一种罕见但显着的ribociclib诱导的皮肤副作用。早期诊断,瑞博西尼快速戒断,免受阳光照射,及时治疗对于预防随后的严重大疱性皮肤病至关重要。
