Dermatology: Practical and Conceptual


340 Letter  |  Dermatol Pract Concept 2018;8(4):20

DERMATOLOGY PRACTICAL & CONCEPTUAL
www.derm101.com

Introduction

Vandetanib is an oral tyrosine kinase inhibitor used in the 

treatment of different types of cancer. It acts by inhibiting 

the vascular and epidermal growth factor receptor and is 

associated with frequent adverse cutaneous reactions such 

as acneiform eruption, photosensitivity, pigmentary changes, 

exanthema, pruritus, and xerosis. We describe an unusual, 

peculiar form of perifollicular pigmentation associated with 

the use of the drug and show its dermoscopic findings.

Case Presentation

A 26-year-old male patient was diagnosed with metastatic 

medullary thyroid carcinoma. After combined treatment 

with surgery, radiotherapy, and chemotherapy, the disease 

progressed and vandetanib was started. Two weeks later, 

the patient developed an acneiform rash with lesions on the 

trunk and face and was subsequently treated with doxy-

cycline 200 mg/day for 6 months with improvement. On 

dermatological follow-up, the patient was still taking van-

detanib, with clearance of the acneiform lesions, but many 

pigmented follicular macules with a comedo-like appearance 

were noted on the face and chest (Figure 1). The pigmenta-

Dermoscopic findings of perifollicular pigmentation 
associated with vandetanib

Jade Cury-Martins1, Jose Antonio Sanches1

1 Department of Dermatology, University of São Paulo, São Paulo, Brazil

Key words: cutaneous adverse events, tyrosine kinase inhibitor, pigmentation, dermoscopy

Citation: Cury-Martins J, Sanches JA. Dermoscopic findings of perifollicular pigmentation associated with vandetanib. Dermatol Pract 
Concept. 2018;8(4):340-341. DOI: https://doi.org/10.5826/dpc.0804a20

Received: March 28, 2018; Accepted: May 7, 2018; Published: October 31, 2018

Copyright: ©2018 Cury-Martins et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are 
credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

All authors have contributed significantly to this publication.

Corresponding author: Jade Cury-Martins, MD, PhD. Email: jadecury@yahoo.com.br

Figure  1. Pigmented follicular macules with comedo-like appear-

ance on the face. [Copyright: ©2018 Cury-Martins et al.]



Letter  |  Dermatol Pract Concept 2018;8(4):20 341

the use of photoprotective measures prevented worsening of 

the condition, [1].

Conclusion

In conclusion, we report the first description of dermoscopic 

findings of this rare pattern of perifollicular pigmentation 

associated with vandetanib use. As oncodermatology is 

involved in the supportive care of cancer patients, it is impor-

tant for dermatologists to identify these possible adverse 

events and use dermoscopy as an additional tool.

References

1. Kong HH, Fine HA, Stern JB, Turner MLC. Cutaneous pigmen-

tation following photosensitivity induced by vandetanib. Arch 

Dermatol. 2009;145(8):923-925.

2. Giacchero D, Ramacciotti C, Arnault JP, et al. New spectrum of 

skin toxic effects associated with the multikinase inhibitor vande-

tanib. Arch Dermatol. 2012;148(12):1418-1420.

tion was apparently follicular; however, on dermoscopy, the 

blue-gray pigment was evident only in the perifollicular area 

with preservation of the center of the hair follicle (Figure 2). 

After orienting the patient on photoprotective measures, 

only a little improvement was noted. One year later, the 

patient had complete clearing, despite the continuous use 

of vandetanib.

Discussion

Among the pigmentary changes associated with vandetanib 

therapy, diffuse pigmentation in the exposed area is the most 

reported form. The blue-gray perifollicular pigmentation was 

rarely reported, and there are no similar reports of it with 

other agents of the same class. This seems to be specifically 

caused by this medication.

The pathogenesis of this peculiar pattern of pigmentation 

is not well established. Previous reports have demonstrated 

the histopathological alterations in a few similar cases reveal-

ing dermal iron and melanin deposition. The presence of 

pigmented macrophages and inflammatory infiltrate in the 

dermis was also documented [1]. Those findings correlate 

with the dermoscopy, with the blue-gray pigmentation cor-

responding to the presence of dermal pigment.

The previous use of doxycycline did not seem to factor 

into the etiology of this condition. Giacchero et al [2] showed 

that less than half of the patients in their series were treated 

with this medication. Prior photosensitivity preceding the 

pigmentation was described in two cases [1].

Definitive treatment of the lesions involves stop-

ping the use of vandetanib followed by improvement 

after 3–6 months. However, recurrence occurs if the medi-

cation is reintroduced [2]. The use of topical depigmentation 

agents such as the combination of hydroquinone, tretinoin, 

and corticosteroids did not show benefits [1]. In a few cases, 

Figure 2. On dermoscopy, the blue-gray pigment is evident only on 

the perifollicular area. [Copyright: ©2018 Cury-Martins et al.]