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Correspondence to Dr Ashok Kumar Pannu; [email protected]
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A man in his 60s, a known case of essential thrombocythaemia, was receiving cytoreductive therapy with hydroxyurea for 2 months. After 1 month of chemotherapy, he started developing nail discolouration. There was pandigital knuckle hyperpigmentation and diffuse uniform hyperpigmentation of the lunula without thickening or atrophy of nails (figure 1). Oral mucosa was normal, and no other cutaneous lesions were noted. The patient was anxious considering the possibility of skin cancer; however, he was otherwise well and did not have a previous history of skin diseases or a family history of skin cancer. He was not taking any medication except for hydroxyurea. Because of a temporal association, melanonychia and hyperpigmentation were attributed to hydroxyurea. The absence of the suggestive clinical features and normal basic investigations excluded the alternate causes of hyperpigmentation, including vitamin...