Imatinib-Associated Hyperkeratotic Eruptions: A Rare Extensor Surface Manifestation

Imatinib is one of the fundamental chemotherapeutic agents used in the treatment of Ph+ CML, GIST and ALL.It selectively inhibits receptor tyrosine kinases. 1 Imatinib-associated pruritic lesions often manifest as exanthematous maculopapular eruptions 2 , typically appearing on the forearm or torso. 1 These reactions may vary with dosage. 1 Evidence suggests that these skin pathologies could arise from the inhibition of KIT or PDGFR. 3However, no specific pathology has been identified as the cause within restricted populations.In our case, there was development of hyperkeratotic, crusty lesions with scaling and pruritus in a 39-year-old female patient(on no other medication) undergoing treatment for CML with imatinib (400 mg orally, once a day) after 6 months.The lesions are most prominent on the extensor regions (Fig. 1)-a distribution seldom mentioned in the literature, along with thorax, abdomen, and back, with mild involvement of the face (Fig. 2).Skin biopsy was not done due to patient unwillingness and the lesions already being well documented.The lesions were treated with oral steroids and topical emollients, with the exanthema lasting for 15 days.Discontinuation was not done since most lesions are self-limited 4 .In a comprehensive review by Amitay-Laish et al 5 , various dermatologic side effects associated with imatinib treatment were identified, including superficial edema (48-65%), erythematous maculopapular rash (66.7%), pigmentary changes, and rare severe reactions such as Stevens-Johnson syndrome.