Sirolimus-Induced Inflammatory Papules with Acquired Reactive Perforating Collagenosis

• Published in: Dermatology (Basel) Vol. 216; no. 3; pp. 239 - 242
• Main Authors: Lübbe, J., Sorg, O., Malé, P.-J., Saurat, J.-H., Masouyé, I.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2008
• Subjects: Acneiform Eruptions - chemically induced; Acneiform Eruptions - drug therapy; Acneiform Eruptions - pathology; Anti-Inflammatory Agents - therapeutic use; Case Report; Collagen - analysis; Collagen Diseases - chemically induced; Collagen Diseases - drug therapy; Collagen Diseases - pathology; Dermatology; Drug Eruptions - etiology; Drug therapy; Female; Humans; Hydroxychloroquine - therapeutic use; Immune system; Immunosuppressive Agents - adverse effects; Liver Transplantation; Medical diagnosis; Medical treatment; Middle Aged; Sebaceous Glands - pathology; Sebum - chemistry; Side effects; Sirolimus - adverse effects; Sirolimus - pharmacokinetics; Skin - pathology; Skin diseases; Sirolimus; Dermatosis, perforating; Follicular papules
• ISSN: 1018-8665; 1421-9832
• DOI: 10.1159/000112934

Sirolimus is an immunosuppressive macrolide with antineoplasic properties that is increasingly used in posttransplantation immunosuppression. The treatment is frequently associated with cutaneous side effects such as sirolimus-associated acneiform facial dermatitis, which has been observed in up to 50% of treated patients. We report a 51-year-old female with liver transplantation who developed inflammatory papules and nodules on the face and the upper chest 3 weeks after the initiation of sirolimus therapy. Sequential biopsies revealed lymphocytic infiltration of the dermis with a peculiar pattern of sebotropism, while older lesions showed acquired reactive perforating collagenosis. The lesions were responsive to hydroxychloroquine treatment despite continued sirolimus treatment.