Neutrophilic eccrine hidradenitis in 2 patients treated with BRAF inhibitors: a new cutaneous adverse event

Abstract

Neutrophilic eccrine hidradenitis (NEH) is a rare neutrophilic dermatosis, first described in patients undergoing chemotherapy for a malignant hemopathy. Clinical features are polymorphous. Association of clinical and histological features are necessary to make a diagnosis. We report the first two cases of NEH in patients treated with a BRAF inhibitor (BRAFi), either dabrafenib or vemurafenib, for a stage IV metastatic melanoma. Disseminated erythematous plaques associated with fever and polyarthralgia occurred early after initiation of treatment and were badly tolerated. Histological analyses confirmed the diagnosis of NEH. Symptoms disappeared a few days after interruption of treatment and introduction of topical steroids. Replacement of one BRAFi by the other is a therapeutic alternative as it is not necessarily associated with relapse of NEH. NEH can be added to the spectrum of neutrophilic dermatoses induced by BRAFi. It occurs earlier (3 to 4 days) than previously described drug-induced NEH (9 to 12 days) and might be an earlier stage of eccrine squamous syringometaplasia already reported in the context of BRAFi-treated melanoma patients.

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