Several patterns of cutaneous hyperpigmentation in patients receiving the multikinase inhibitor vandetanib (ZD6474) were recently described.1 We describe herein a patient with perifollicular dark blue-gray macular hyperpigmentation secondary to vandetanib who was successfully treated with 755-nm Q-switched alexandrite laser.
A 38-year-old woman with Fitzpatrick skin type II and Von Hippel-Lindau syndrome with associated clear-cell renal-cell carcinoma enrolled in a phase-2 study and received once-daily oral doses of vandetanib for treatment of her renal tumors. Within 2 weeks of initiating treatment, the patient developed an acneiform eruption of scattered erythematous papules and pustules on the face and trunk. After 7 months, she also developed multiple perifollicular 1- to 2-mm slate blue macules on the forehead, cheeks, neck, and conchal bowls at sites of existing scars and vandetanib-induced acneiform lesions (Figure, A). She was treated with doxycycline (100 mg, twice daily) and strict photoprotection. Her acneiform lesions improved substantially with doxycycline treatment but recurred when she discontinued therapy.
Brooks S, Linehan WM, Srinivasan R, Kong HH. Successful Laser Treatment of Vandetanib-Associated Cutaneous Pigmentation. Arch Dermatol. 2011;147(3):364-365. doi:10.1001/archdermatol.2011.30