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Development of Psoriasis Vulgaris in a Chronic Myeloid Leukemia Patient on Second-Generation Tyrosine Kinase Inhibitor Therapy

Shinto Francis Thekkudan, Soniya Nityanand

Development of psoriasis during Imatinib therapy has been described only as few case reports. Psoriasis developing during Nilotinib therapy is also rare, with only two cases reported. In psoriasis, the suppressor activity of T-regulatory cells is decreased, either due to a reduction in the number or due to a reduced ability of T-regulatory cells to produce suppressive cytokines. Imatinib and Nilotinib inhibited the proliferation and immunosuppressive effect of T-regulatory cells in a dose dependent manner. This is the first case report of Dasatinib causing worsening of Psoriasis vulgaris, possibly due to the more potent action of Dasatinib on T regs. Most cases can be managed without any dose reductions in tyrosine kinase inhibitor therapy along with topical therapies and oral methotrexate.