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RF - Drug-Induced Eruptive Melanocytic Nevi
FR - Nevus melanocíticos eruptivos asociados a medicamentos
P. García-Montero
, J.F. Millán-Cayetano, C. García-Harana, J. del Boz
Corresponding author
Departamento de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain
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García-Montero, J.F. Millán-Cayetano, C. García-Harana, J. del Boz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "García-Montero" "email" => array:1 [ 0 => "garciamonteropablo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.F." "apellidos" => "Millán-Cayetano" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "García-Harana" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "del Boz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR - Nevus melanocíticos eruptivos asociados a medicamentos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The prestigious <span class="elsevierStyleItalic">Journal of the American Academy of Dermatology</span> recently published an interesting article that presents the results of an extensive review of the literature on eruptive melanocytic nevi that develop in association with medication use.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> This type of lesion has historically been associated with severe blistering diseases (epidermolysis bullosa, toxic drug reactions, etc.) and with conditions leading to immunodeficiency (renal transplantation, bone marrow transplantation, malignancy, AIDS, etc.).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to differentiate eruptive nevi associated with medications (ENAM) from acquired melanocytic nevi, the authors propose the following criteria:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0015" class="elsevierStylePara elsevierViewall">Development of more than 5 palmoplantar melanocytic nevi at any age.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0020" class="elsevierStylePara elsevierViewall">Development of more than 10 melanocytic nevi bodywide outside of puberty or pregnancy.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">Development of more than 20 melanocytic nevi bodywide during puberty or pregnancy.</p></li></ul></p><p id="par0030" class="elsevierStylePara elsevierViewall">A diagnosis of ENAM is established when the patient meets 1 or more of these criteria in the last 6 months and there is a temporal relationship with the use of a particular medication. The authors also propose the classification of ENAMs according to the implicated medication (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Using these criteria, the authors identified a total of 66 reported cases of ENAM. Thiopurines, azathioprine, and 6-mercaptopurine were the drugs most frequently associated with ENAM (34.8% of cases). Cases of ENAM in the last 10 years account for 66.2% of all cases reported in the literature, and 44.2% of these cases are associated with biologic therapies. No differences between sexes were identified and a certain predilection for lighter skin types was found. The lesions appear weeks or months after medication use begins and usually present as 1- to 3-mm light or dark brown macules. Dermoscopically, the lesions are usually characterized by globules arranged symmetrically at the periphery.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Histologically, the lesions appear as compound nevi. ENAMs are more likely than acquired melanocytic nevi to be located on the palms and soles.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The pathogenesis of ENAM and the potential risk of development or transformation to melanoma are not completely understood.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> It appears logical that immunosuppression could play an important role in the development of ENAM and larger numbers of nevi could be a risk factor for melanoma. However, further research is needed in order to provide more evidence. For now, in patients diagnosed with ENAM, the authors recommend annual follow-up visits and identification of the drug responsible. They also suggest that alternative treatments be considered in patients with a personal or family history of melanoma.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The number of patients on immunosuppressive medications is on the rise and the subgroup receiving biologics is growing. Although ENAM is rare, the incidence of this entity is expected to rise in the coming years. An understanding of this causal relationship will favor early diagnosis, thereby minimizing the degree of uncertainty for both patient and physician and avoiding unnecessary complementary tests.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec888226" "palabras" => array:4 [ 0 => "Eruptive melanocytic nevi" 1 => "Drugs" 2 => "Biologic therapies" 3 => "Adverse effects" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Montero P, Millán-Cayetano JF, García-Harana C, del Boz J. FR - Nevus melanocíticos eruptivos asociados a medicamentos. Actas Dermosifiliogr. 2017;108:775–776.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: ENAM, eruptive nevi associated with medications.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Types of ENAM \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drugs Involved \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ia. Nonbiologic immunosuppressants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Azathioprine, 6-mercaptopurine, corticosteroids, cyclosporin, and methotrexate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ib. Biologic immunosuppressants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Etanercept, alefacept, infliximab, and rituximab \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IIa. Nonbiologic chemotherapeutics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Capecitabine, interferon alfa-2b, cyclophosphamide, and octreotide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IIb. Biologic chemotherapeutics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vemurafenib, encorafenib, sorafenib, sunitinib, erlotinib, regorafenib, and rituximab \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III. Melanocyte stimulators \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Melanotan <span class="elsevierStyleSmallCaps">I</span> and <span class="elsevierStyleSmallCaps">II</span> and corticotrophin \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1527677.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Types of Eruptive Nevi Associated With Medication and Drugs Involved.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eruptive nevi associated with medications (ENAMs)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.M. 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Alaibac" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Melanoma Res" "fecha" => "2005" "volumen" => "15" "paginaInicial" => "223" "paginaFinal" => "224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15917707" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immunosuppression and melanocyte proliferation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Zattra" 1 => "A.B. Fortina" 2 => "M. Bordignon" 3 => "S. Piaserico" 4 => "M. Alaibac" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CMR.0b013e328322fc20" "Revista" => array:6 [ "tituloSerie" => "Melanoma Res" "fecha" => "2009" "volumen" => "19" "paginaInicial" => "63" "paginaFinal" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19194340" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eruptive nevi of the palms and soles" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Woodhouse" 1 => "E.V. Maytin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2004.08.009" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2005" "volumen" => "52" "paginaInicial" => "S96" "paginaFinal" => "S100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15858520" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010800000008/v1_201710010015/S1578219017302433/v1_201710010015/en/main.assets" "Apartado" => array:4 [ "identificador" => "34945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010800000008/v1_201710010015/S1578219017302433/v1_201710010015/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017302433?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 6 | 22 |
| 2024 October | 102 | 36 | 138 |
| 2024 September | 129 | 23 | 152 |
| 2024 August | 134 | 49 | 183 |
| 2024 July | 137 | 39 | 176 |
| 2024 June | 148 | 36 | 184 |
| 2024 May | 102 | 23 | 125 |
| 2024 April | 97 | 30 | 127 |
| 2024 March | 106 | 32 | 138 |
| 2024 February | 86 | 27 | 113 |
| 2024 January | 103 | 37 | 140 |
| 2023 December | 63 | 25 | 88 |
| 2023 November | 90 | 23 | 113 |
| 2023 October | 77 | 20 | 97 |
| 2023 September | 97 | 35 | 132 |
| 2023 August | 61 | 21 | 82 |
| 2023 July | 79 | 37 | 116 |
| 2023 June | 80 | 28 | 108 |
| 2023 May | 56 | 23 | 79 |
| 2023 April | 67 | 26 | 93 |
| 2023 March | 44 | 24 | 68 |
| 2023 February | 53 | 26 | 79 |
| 2023 January | 37 | 29 | 66 |
| 2022 December | 56 | 32 | 88 |
| 2022 November | 25 | 26 | 51 |
| 2022 October | 45 | 24 | 69 |
| 2022 September | 35 | 36 | 71 |
| 2022 August | 32 | 45 | 77 |
| 2022 July | 47 | 57 | 104 |
| 2022 June | 46 | 28 | 74 |
| 2022 May | 55 | 59 | 114 |
| 2022 April | 55 | 47 | 102 |
| 2022 March | 62 | 61 | 123 |
| 2022 February | 48 | 26 | 74 |
| 2022 January | 54 | 38 | 92 |
| 2021 December | 45 | 47 | 92 |
| 2021 November | 63 | 50 | 113 |
| 2021 October | 149 | 63 | 212 |
| 2021 September | 59 | 40 | 99 |
| 2021 August | 50 | 43 | 93 |
| 2021 July | 42 | 39 | 81 |
| 2021 June | 36 | 32 | 68 |
| 2021 May | 39 | 50 | 89 |
| 2021 April | 99 | 73 | 172 |
| 2021 March | 74 | 35 | 109 |
| 2021 February | 60 | 34 | 94 |
| 2021 January | 40 | 25 | 65 |
| 2020 December | 41 | 17 | 58 |
| 2020 November | 35 | 25 | 60 |
| 2020 October | 37 | 13 | 50 |
| 2020 September | 38 | 22 | 60 |
| 2020 August | 47 | 26 | 73 |
| 2020 July | 28 | 15 | 43 |
| 2020 June | 51 | 36 | 87 |
| 2020 May | 27 | 20 | 47 |
| 2020 April | 30 | 16 | 46 |
| 2020 March | 32 | 16 | 48 |
| 2020 February | 7 | 0 | 7 |
| 2020 January | 4 | 0 | 4 |
| 2019 December | 7 | 0 | 7 |
| 2019 November | 6 | 0 | 6 |
| 2019 September | 8 | 0 | 8 |
| 2019 August | 4 | 0 | 4 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 5 | 0 | 5 |
| 2019 May | 5 | 0 | 5 |
| 2019 April | 2 | 0 | 2 |
| 2019 March | 4 | 0 | 4 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 4 | 0 | 4 |
| 2018 October | 6 | 0 | 6 |
| 2018 September | 4 | 0 | 4 |
| 2018 May | 0 | 1 | 1 |
| 2018 February | 46 | 6 | 52 |
| 2018 January | 38 | 6 | 44 |
| 2017 December | 63 | 13 | 76 |
| 2017 November | 42 | 8 | 50 |
| 2017 October | 125 | 39 | 164 |
| 2017 September | 3 | 6 | 9 |
| 2017 August | 6 | 8 | 14 |
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