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High risk HPV strain linked to ruxolitinib associated sebaceous neoplasms: IJDVL study
High‑risk HPV strain may cause ruxolitinib‑associated sebaceous neoplasms, finds a IJDVL study
Ruxolitinib is a JAK1/2 inhibitor approved for hematologial conditions in adults. Its use in dermatology is rising, especially in dermatoses like atopic dermatitis, vitiligo, psoriasis and alopecia areata.2 Cutaneous malignancies have been reported with its use.
A 57‑year‑old male with myelofibrosis, maintained on ruxolitinib over the past year presented with complaints of 2 growing nodules on the scalp of 5 & 2 months duration respectively. Histopathology from nodule showed papillomatous epidermal proliferations with koilocytic changes and mounds of parakeratosis admixed with hemorrhage at the top of the papillae, simulating the diagnosis of verruca vulgaris. Immunoreactivity to the androgen receptor and epithelial membrane antigen confirmed its sebaceous nature. The bigger lesion with more than 50% germ cells was diagnosed as sebaceoma and the smaller one with mature sebocytes as sebaceous adenoma.
Analysis was done for the 30 high and low risk HPV subtypes by 2 step polymerase chain reaction (EUROArray HPV detection kit, EUROIMMUN AG, Germany). HPV 66 strain was detected in both lesions.
Sebaceous carcinomas can harbor TP53 or RB1 mutations or are HPV driven. Two main viral proteins, E6 and E7 inhibit two tumor suppressor proteins TP53 and Rb. This explains sebaceous carcinomas in cases negative for the driving mutations (p53 and Rb) but positive for human papillomavirus infections.
HPV‑associated sebaceous tumors differ from others in that they-
- Are more likely to occur in younger individuals
- are less aggressive
- Rarely display worrisome histological phenotypes
- Warrant less aggressive postoperative surveillance
In conclusion sebaceous tumors can occur in patients on ruxolitinib; HPV can be a major cause in them which should be looked for as HPV associated sebaceous tumors have different behaviour than the others.
Source-
- Hamie L, Bardawil T, Khalifeh I. High‑risk human papillomavirus in ruxolitinib‑associated sebaceous neoplasms. Indian J Dermatol Venereol Leprol 2021;87:404-8.
- Tegtmeyer K, Ravi M, Zhao J, Maloney NJ, Lio PA. Off-label Studies on the Use of Ruxolitinib in Dermatology. Dermatitis. 2021 May-Jun 01;32(3):164-172. doi: 10.1097/DER.0000000000000658. PMID: 33443378.
MBBS
Dr Manoj Kumar Nayak has completed his M.B.B.S. from the prestigious institute Bangalore medical college and research institute, Bengaluru. He completed his M.D. Dermatology from AIIMS Rishikesh. He is actively involved in the field of dermatology with special interests in vitiligo, immunobullous disorders, psoriasis and procedural dermatology. His continued interest in academics and recent developments serves as an inspiration to work with medical dialogues.He can be contacted at editorial@medicaldialogues.in.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751