Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2024;14(2):e2024082 1 Nilotinib Induced Keratosis Pilaris in a Female with Chronic Myeloid Leukemia Ranjana Beniwal1, Akriti Agrawal2 1 Dr. Sampurnanand Medical College and associated group of hospitals, Jodhpur, India 2 Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India Citation: Beniwal R, Agrawal A. Nilotinib Induced Keratosis Pilaris in a Female With Chronic Myeloid Leukemia. Dermatol Pract Concept. 2024;14(2):e2024082. DOI: https://doi.org/10.5826/dpc.1402a82 Accepted: October 30, 2023; Published: April 2024 Copyright: ©2024 Beniwal et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: Both the authors have contributed significantly to this publication. Corresponding Author: Ranjana Beniwal M.D., Consultant dermatologist, Department of Dermatology, Venereology and Leprology, Dr. Sampurnanand Medical College and associated group of hospitals, Jodhpur, India. Email: ranjanabeniwal@gmail.com Case Presentation A 34-year old female on nilotinib 200 mg twice daily for chronic myeloid leukemia presented with multiple asymp- tomatic gradually progressive raised lesions over body for four years. She was not on any other medications and developed the lesions a few weeks after starting nilo- tinib. Examination revealed skin-colored-to-erythematous follicular hyperkeratotic papules over face, trunk, and bilateral upper and lower limbs. Routine investigations were within normal limits. Histopathology showed orthokerato- sis, follicular plugging with perifollicular fibrosis, and a mild lymphocytic inflammatory infiltrate. Based on temporal cor- relation with drug intake and inexplicability of occurrence of the eruption due to disease or other drugs, it was diagnosed as a case of nilotinib-induced keratosis pilaris. Teaching Point Nilotinib is a second-generation BCR-ABL tyrosine kinase inhibitor (TKI) [1]. The various cutaneous adverse effects of TKIs include alopecia, xerosis, maculopapular rash, photo- sensitivity, hypopigmentation, and edema. Keratosis pilaris- like eruption has been reported with the more potent second and third generation multitargeted TKIs like nilo- tinib, dasatinib, and posatinib and is attributed to their ex- panded spectrum of activity against related kinase targets other than BCR-ABL [2]. The rash is usually asymptomatic 2 Image Letter | Dermatol Pract Concept. 2024;14(2):e2024082 or pruritic and characterized by a generalized distribution on the face, trunk, and extremities. It typically starts several weeks after initiation of the drug and is not dose-dependent. Currently, there is no consensus regarding treatment of ker- atosis pilaris-like eruption induced by nilotinib. The rash is usually refractory to treatment in the majority of cases and may resolve partially or completely after withdrawal of the treatment. References 1. Jabbour E, Cortes J, Kantarjian H. Treatment selection after imatinib resistance in chronic myeloid leukemia. Target Oncol. 2009;4(1):3-10. doi:10.1007/s11523-008-0100-y 2. Delgado L, Giraudier S, Ortonne N, et al. Adverse cutaneous re- actions to the new second-generation tyrosine kinase inhibitors (dasatinib, nilotinib) in chronic myeloid leukemia.  J Am Acad Dermatol. 2013;69(5):839-840. doi:10.1016/j.jaad.2013.07.025 Figure 1. Multiple follicular keratotic papules present over face (A), trunk (B), upper arm, (C) and thighs (D).