S-7701

Multiple eruptive dermatofibromas aggravated by mycophenolate mofetil and pirfenidone in a patient with systemic sclerosis

A 48-year-old woman was suffering from Raynaud’s phe- nomenon, followed by sclerodactyly and dyspnoea for 3 years. She was diagnosed with systemic sclerosis accom- panied by interstitial lung disease and was treated with pred- nisone, hydroxychloroquine and beraprost. Two years ago a nodule appeared on her left arm. Similar eruptions extended to her trunk after commencing mycophenolate mofetil treat- ment in the last 6 months. She had a sudden outbreak of nodules after 2 months of pirfenidone treatment for her scleroderma-related interstitial lung disease.
Dermatologic examination revealed multiple indurated reddish nodules scattered on her trunk and the left upper arm (Fig. 1A and B). She had positive ANA at 1:32 000 and anti-Scl-70 of 167 RU/ml. Skin pathology indicated nodular dermal proliferation with profound col- lagens and fibroblasts (Fig. 1C–E). Multiple eruptive der- matofibromas are mostly associated with autoimmune diseases (e.g. SLE, dermatomyositis), leukaemia and HIV infection, which can be aggravated by immunosup- pressive or immunomodulatory drugs [1]. The interfer- ence with down-regulatory T cells in immunodeficiency states might be involved in the pathogenesis [2]. Modification of the previous treatment is usually due to aggravation of the underlying disease, which confuses the precise cause of the eruptive dermatofibromas in these conditions. Nevertheless, the complication and its culprit drugs in the present case were not reported.

Funding: No specific funding was received from any funding bodies in the public, commercial or not-for- profit sectors to carry out the work described in this article.

Disclosure statement: The authors have declared no conflicts of interest.

Rui Wang1,2,3, Guangtao Li4, Lin Nong5 and Mingyue Wang1,2,3 Image
1Department of Dermatology, Peking University First Hospital, Beijing, China, 2National Clinical Research Center for Skin and Immune Diseases, Beijing, China, 3Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China, 4Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China and 5Department of Pathology, Peking University First Hospital, Beijing, China

Correspondence to: Mingyue Wang, Department of Dermatology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034 China.
E-mail: [email protected]

References
1 Niiyama S, Katsuoka K, Happle R, Hoffmann R. Multiple eruptive dermatofibromas: a review of the literature. Acta Derm Venereol 2002;82:241–4.
2 Nestle FO, Nickoloff BJ, Burg G. Dermatofibroma: an abortive process mediated by dermal dendritic cells? Dermatology 1995;190:265–8.

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Multiple eruptive dermatofibromas

(A) Multiple well-defined indurated reddish nodules with sizes ranging from 1 to 2 cm are scattered on the trunk. (B) The spindle-like nodules with their long axis following Langer’s cleavage lines were noted at the waist. (C) Skin biopsy revealed nodular dermal proliferation of S-7701 profound collagens and fibroblasts throughout the dermis (haematoxylin and eosin, ×40). (D) A higher magnification illustrates the hyperplasia of fibroblasts entrapped in collagen fibres (haema- toxylin and eosin, ×200). (E) Masson’s trichrome staining highlights the abundant collagen fibres (×200).