title: Sirolimus-induced inflammatory papules with acquired reactive perforating collagenosis.
abstract: 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.
authors.affiliation: Clinique et Policlinique de Dermatologie et Vénéréologie, Hôpital Cantonal Universitaire de Genève, Geneva, Switzerland. jann.lubbe@hcuge.ch
authors.forename: J
authors.initials: J
authors.lastname: Lübbe
authors.forename: O
authors.initials: O
authors.lastname: Sorg
authors.forename: P J
authors.initials: PJ
authors.lastname: Malé
authors.forename: J H
authors.initials: JH
authors.lastname: Saurat
authors.forename: I
authors.initials: I
authors.lastname: Masouyé
mesh_terms: D017486:Acneiform Eruptions / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003094:Collagen / Q000032:analysis; D003095:Collagen Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D003875:Drug Eruptions / Q000209:etiology*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation; D008875:Middle Aged; D012627:Sebaceous Glands / Q000473:pathology; D012629:Sebum / Q000737:chemistry; D020123:Sirolimus / Q000009:adverse effects* / Q000493:pharmacokinetics; D012867:Skin / Q000473:pathology
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D006886:Hydroxychloroquine; D003094:Collagen; D020123:Sirolimus