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Drug-induced nevi
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Drug-induced nevi

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Contributors: Vivian Wong MD, PhD, Susan Burgin MD
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Synopsis

Eruptive nevi associated with medications (ENAMs) refers to the sudden eruption of nevi temporally associated with medication use. Numerous medications have been linked to ENAMs. Azathioprine and 6-mercaptopurine are the most common culprits. Other medications include corticosteroids, cyclosporine, methotrexate, etanercept, alefacept, infliximab, rituximab, capecitabine, interferon alfa-2b, cyclophosphamide, octreotide, BRAF inhibitors (encorafenib, vemurafenib), sorafenib, sunitinib, erlotinib, regorafenib, Melanotan, and corticotrophin.

ENAMs are more common in individuals with lighter skin phototypes and in those who received renal transplantation or chemotherapy for a hematologic malignancy. There is no gender predilection. The risk for malignant transformation of these nevi is unclear. Concurrent transformation of preexisting nevi into dysplastic nevi has been reported.

Codes

ICD10CM:
T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter

SNOMEDCT:
402554002 – Eruptive melanocytic nevi

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Eruptive nevi have also been associated with immunosuppression from AIDS, following organ transplantation, and following blistering in Stevens-Johnson syndrome, bullous pemphigoid, and epidermolysis bullosa.
  • Eruptive blue nevi
  • Eruptive Spitz nevi
  • Familial eruptive lentiginosis / familial generalized lentiginosis without systemic abnormalities
  • Generalized lentiginosis – Spontaneous eruption of lentiginosis without a positive family history. While this could be an idiopathic diagnosis, there are numerous reported triggers including pregnancy, trauma, immunosuppression, malignancy, blistering diseases, renal and bone marrow transplantation, mastocytosis, and AIDS.
  • Leopard syndrome – Multiple lentigines, electrocardiographic conduction abnormalities, ocular hypertelorism, pulmonary stenosis, abnormal genitalia, retardation of growth, and sensorineural deafness.
  • Carney complex / LAMB – Lentigines (mucous membranes, lips, face, external genitalia), atrial myxoma, mucocutaneous myxoma, and blue nevi.
  • Peutz-Jeghers syndrome – Lentigines (perioral and oral), multiple gastrointestinal polyps, and visceral tumors (pancreas, ovary, testes).
  • Cronkhite-Canada syndrome – Lentigines (buccal mucosa, face, palmoplantar), alopecia, nail dystrophy, and intestinal polyps.
  • Touraine centrofacial lentiginosis – Lentigines (central face and lips, spares mucosa, none elsewhere), bone abnormalities, dysraphia, endocrine disorders, and neurologic disease.
  • Inherited patterned lentiginosis in patients of African descent – Lentigines (central face, hands, feet, buttocks; spares mucous membranes), no other associated systemic abnormalities.
  • Segmental and agminated lentiginosis – Eruption of grouped lentigines within a segmental pattern in an otherwise healthy individual.
  • Laugier-Hunziker syndrome – Benign pigmentary condition with lentigines (buccal mucosa, lips, gums, tongue, palate, neck, abdomen, genitalia, fingers, toes) and longitudinal melanonychia.
  • Cantú (hyperkeratosis-hyperpigmentation) syndrome – Rare syndrome with pigmented lesions and palmoplantar hyperkeratosis.
  • Bannayan-Riley-Ruvalcaba syndrome – Pigmented genital nevi, macrocephaly, intestinal polyps, hamartomas, and lipomas.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 01/11/2017
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Drug-induced nevi
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Drug-induced nevi : Hyperpigmented macules
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