Hydroxyurea ulcers of unusual location: a case report and review of literature

Abstract Hydroxyurea is a cytotoxic drug that has been used for decades for the treatment of various entities, mostly hematologic, especially polycythemia vera. Its side effects are varied, including dermatological ones, ranging from skin xerosis to hyperpigmentation, lesions like dermatomyositis and shows even a relationship with premalignant processes (actinic keratosis) and non-melanoma cancer (squamous, basal cell, Merkel, and oral tumors). In this paper, we report a clinical case of a relatively frequent adverse effect of hydroxyurea, but of extraordinary localization and clinical presentation. The association of ulcers with taking hydroxyurea is well known. Most of the time, these appear in the lower limbs and in patients with chronic vascular pathology. However, in our patient, the location was both hands and was associated with dermatomyositis-like lesions, nail hyperpigmentation, and skin changes. The therapeutic response with withdrawal was spectacular. Knowledge of this condition is vitally important for the hematologist and dermatologist to ensure adequate care.