EXPERIENCE OF SUCCESSFUL ACNEFORM ERUPTIONS TREATMENT IN PATIENT WITH MULTIPLE MELANOMA

Objective: to describe the results of the joint monitoring and diversified treatment of oncologists and dermatologists those patient with multiple recurrent melanoma who received over a long period a targeted anti-cancer therapy, which was complicated by side-effect as widespread acneform rush, resistant to traditional treatment.
Patient A., born in 1988, was followed up and got a treatment more than 2 years in oncology out-patient clinic diagnosed with “Melanoma of the front surface of the left leg T2bN0M0 IIA”. Subsequently, the patient was verified metastasis in the inginal lymph nodes, in the soft tissues of the hips, to liver. Acute adverse reaction has developed in a short time after getting the anti-tumor target therapy as generalized acneform rush and itching of the skin. Skin symptoms accompanied by pronounced psychological and emotional stress, therefore, dermatologists have been invited to provide additional medical assistance to this patient. Due to the fact that subsequent traditional anti-acne algorithms of topical and oral treatment was not such effective, there was made a decision to use an alternative supporting external therapy, which did not have similar examples of usage previously.
Results. External application of tacrolimus ointment in combination with other drugs and then as a mono-therapy, allows us in a rather short period achieve a stable and pronounced regression of skin pathological lesions, to return to the previously cancelled initial drug dose of the anti-tumor target therapy, to change significantly components of the patient’s quality of life.
Conclusion. The search for additional and alternative treatment approaches for similar patients, as in our case, remains relevant for specialists and patients themselves. This case is an example of alternative approach to the tacrolimus topical application in patient with drug-mediated acneform rush.

1. Strebhardt K., Ullrich A. Paul Ehrlich`s magic bullet concept: 100 years of progress. Nat Rev Cancer 2008;8(6): 473–80.

2. Имянитов Е.Н. Общие представления о таргетной терапии. Практическая онкология 2010;11(3):123–30. [Imyanitov E.N. The general idea of targeted therapy. Prakticheskaya onkologiya = Practical Oncology 2010;11(3):123–30. (In Russ.)].

3. Fukushima H., Hirano T., Shibayama N. et al. The role of immune response to Staphylococcus aureus superantigens and disease severity in relation to the sensitivity to tacrolimus in atopic dermatitis. Int Arch Allergy Immunol 2006;141(3): 281–9.

4. Olayioye M.А., Neve R.M., Lane H.A., Hynes N.E. The ErbB signaling network: receptor heterodimerization in development and cancer. EMBO J 2000;19(13): 3159–67.

5. Thatcher N., Nicolson M., Groves R.W. et al. Expert consensus on the management of erlotinib-associated cutaneous toxicity in the U.K. Oncologist 2009;14(8):840–7.

6. Saif M.W., Longo W.L., Israel G. Correlation between rash and a positive drug response associated with bevacizumab in a patient with advanced colorectal cancer. Clin Colorectal Cancer 2008;7(2):144–8.

7. Lacouture M.E., Anadkat M.J., Bensadoun R.J. et al. Clinical practice guidelines for the prevention and treatment of EGFR inhibitorassociated dermatologic toxicities. Support Care Cancer 2011;19(8):1079–95.

8. Khandpur S., Sharma V.K., Sumanth K. Topical immunomodulators in dermatology. J Postgrad Med 2004;50(2):131–9.