A 53-year-old woman presented with an eruption on her face and body for 2 weeks that had developed first on the face before spreading to the trunk and extremities. There was burning with sunlight exposure. Her medical conditions included diabetes mellitus, vitamin D deficiency, and hyperlipidemia. Her treatment for the past 4 years included metformin, saxagliptin, atorvastatin, vitamin B12, vitamin D, lansoprazole, and aspirin. Because atorvastatin did not control her lipids, fenofibrate was prescribed. At 3 months, she developed photodermatitis on the sun-exposed areas of her skin and also on sun-covered areas of the chest and back. Examination showed facial erythematous scaly plaques and multiple scaly annular erythematous plaques on her trunk and extremities (Figure 1). Methylprednisolone aceponate ointment, pimecrolimus ointment 0.1%, and sunblock were prescribed. Her facial eruption was only minimally lessened, while the dermatitis worsened on the trunk, arms, and legs.
A 64-year-old man participated in a 13.1-mile half marathon in San Diego, CA on April 23, 2023. The ambient temperature when he started the race was 54°F, which increased to 64°F on his completing the race 3 hours and 58 minutes later. Both of his hands and their digits started swelling after the first hour of running. They progressively became larger during the remainder of the race; a positive fist sign developed and the patient could not close his hands into a fist (Figure 1). Neither pruritus, swelling at any other site, nor angioedema was reported.
The 73-year-old non-Hispanic, African-American man with a history of renal cell carcinoma (RCC), status post-nephrectomy receiving Lenvatinib, and metastatic disease, for which he also had received nivolumab for 13½ months. An itchy eruption appeared one month after the discontinuation of nivolumab and after the beginning of axitinib therapy. Physical examination revealed pink-violaceous scaly plaques, some with trailing scales on the anterior aspect of the trunk (Figure 1), a slight erosion on the hard palate, and hypopigmentation on the hands and legs. A punch biopsy revealed spongiotic and interface dermatitis, suggesting a drug eruption. The patient was treated with triamcinolone 0.1% ointment and prednisone 60 mg, with resolution of the eruption. Because the treating oncologist was concerned that the dermatitis was caused by axitinib, the patient was switched to tivozanib; however, the patient developed a new bullous eruption two months after starting tivozanib. Physical examination revealed small papules on the hands, pink patches on the trunk, and small round crusts and tense lesions on the arms (Figure 1).
