Cherry angiomas, also known as Campbell de Morgan spots or senile angiomas, are benign vascular lesions that commonly appear on the skin, particularly with increasing age. They are typically small, bright red, dome-shaped papules formed by a collection of tiny blood vessels. While aging, genetics, and hormonal changes are considered primary factors, the sudden and extensive eruption of these lesions, known as eruptive cherry angiomatosis, has been documented as a side effect of certain medications and chemical agents.
Medications with a documented link to cherry angiomas
Cyclosporine and other immunosuppressants
Cyclosporine, a potent immunosuppressive drug used to prevent organ rejection in transplant patients and to treat autoimmune diseases like psoriasis, has been linked to the development of eruptive angiomas. The mechanism is not fully understood but may involve the drug's effect on vascular growth factors or the body's immune response. Chronic immunosuppression, in general, is also considered a potential risk factor. Case reports describe patients on cyclosporine developing multiple angiomas, suggesting a direct pharmacological link.
Bromides and ipratropium bromide
Exposure to bromides, both in industrial settings and via certain medications, has been associated with the formation of cherry angiomas. Ipratropium bromide, an anticholinergic bronchodilator used for asthma, has been specifically implicated in case studies. The resulting angiomas, sometimes termed "bromangiomas," have been noted to have unique features, including a more violaceous color and a tendency to appear on sun-exposed areas. While the link exists, research suggests more controlled studies are needed to confirm the association.
Anti-angiogenic therapies (Ramucirumab)
Ramucirumab is an interesting case, as it is an anti-angiogenic drug designed to inhibit blood vessel growth by blocking vascular endothelial growth factor receptor 2 (VEGFR2), primarily for cancer treatment. Paradoxically, some patients treated with ramucirumab, sometimes in combination with other therapies like paclitaxel, have developed eruptive cherry angiomas. The exact mechanism for this is unknown but may involve a mutation in the VEGFR2 gene or the activation of complementary pro-angiogenic pathways.
Tamsulosin
A case-control study found a significant association between tamsulosin use and the presence of cherry angiomas. Tamsulosin, an alpha-blocker used to treat benign prostatic hyperplasia, acts by relaxing smooth muscle in the prostate and bladder. Its association with angiomas is a novel finding that requires further investigation but suggests a potential link related to its effect on alpha-adrenergic receptors and blood vessels.
Topical nitrogen mustard
Topical nitrogen mustard is a medication used to treat certain skin conditions, such as cutaneous T-cell lymphomas and vitiligo. Case studies have reported the eruption of cherry angiomas following treatment with this agent, suggesting a reaction to its mutagenic effects on skin cells.
Potential mechanisms behind drug-induced angiomas
| Medication/Agent | Class/Use | Proposed Mechanism | Evidence Level |
|---|---|---|---|
| Cyclosporine | Immunosuppressant | Effect on vascular growth factors or immune-mediated processes | Case Reports |
| Bromides (e.g., ipratropium) | Sedatives, anticholinergics | Unknown, potentially photo-induced drug eruption | Case Reports, Anecdotal |
| Ramucirumab | Anti-angiogenic (cancer) | Paradoxical effect, possibly VEGFR2 mutation or alternative pathway activation | Case Reports, Small Studies |
| Tamsulosin | Alpha-blocker (BPH) | Possible association related to its effects on blood vessels | Case-Control Study |
| Topical Nitrogen Mustard | Chemotherapy agent | Mutagenic effects on endothelial cells | Case Reports |
It is important to note that a documented association does not always mean a direct causal link. In many cases, especially with eruptive angiomas, confounding factors such as underlying medical conditions or complex drug interactions may play a role. For instance, certain systemic illnesses like lymphoproliferative disorders and multicentric Castleman disease are known to increase vascular growth factors, potentially leading to eruptive angiomas. The diagnosis and management of drug-induced angiomas should always be done in consultation with a healthcare professional.
Considerations and conclusion
While the exact cause of cherry angiomas often remains unknown, the emergence of a sudden, widespread eruption warrants investigation for underlying medical issues or potential medication-related side effects. Medications like cyclosporine, ramucirumab, tamsulosin, and bromide-containing agents have been implicated in various case studies and observational reports. Discontinuing or altering the medication may lead to the resolution of the angiomas in some cases, though this should only be done under strict medical supervision. Understanding these potential links is crucial for recognizing medication-induced skin changes and ensuring proper patient care. Consult a healthcare provider if you suspect a medication is causing or exacerbating cherry angiomas.
What are cherry angiomas and why do they appear?
Cherry angiomas are common, benign vascular lesions consisting of dilated capillaries, often appearing as small, bright red spots on the skin. They most frequently appear in adults over 30 and increase in number with age. While the exact cause is unknown, factors like genetics and hormonal changes are believed to play a role.
How can I tell if my cherry angiomas are medication-related?
If you experience a sudden and extensive eruption of multiple new cherry angiomas, particularly after starting a new medication, it may be a drug-related phenomenon. You should consult your doctor to evaluate the situation and determine if the medication is a potential cause.
Do I need to stop my medication if it causes cherry angiomas?
No, you should never stop or change a prescribed medication without consulting your doctor. Cherry angiomas are typically harmless, and your doctor will weigh the benefits of your medication against this aesthetic side effect. In some cases, adjusting the dosage or switching to an alternative treatment may be an option.
Are cherry angiomas caused by medication dangerous?
In most cases, drug-induced cherry angiomas are not dangerous. However, a sudden eruption can sometimes signal a more serious underlying systemic condition, especially in the context of certain illnesses. Your doctor will conduct a thorough examination to rule out any other potential causes.
Are there any protective factors against cherry angiomas?
In one study, clopidogrel (Plavix), a medication that has anti-angiogenic properties, was shown to have a potential protective effect against the development of cherry angiomas. However, further research is needed to confirm this effect.
What is the connection between cherry angiomas and pregnancy?
Like some medications, hormonal shifts, such as those that occur during pregnancy, can also lead to the development of cherry angiomas. It is thought that increased estrogen levels may be a contributing factor.
Can cherry angiomas be removed?
Yes, if they are cosmetically bothersome or bleed often, cherry angiomas can be removed by a dermatologist. Removal options include laser therapy, cryotherapy (freezing), or electrosurgery (burning).
Is there a specific type of chemotherapy that causes cherry angiomas?
While some chemotherapy agents have been linked, such as topical nitrogen mustard and the anti-angiogenic agent ramucirumab, available evidence does not suggest that chemotherapy, in general, is a direct cause.
What is the difference between an ordinary and eruptive cherry angioma?
Ordinary cherry angiomas are common, typically age-related, and appear gradually over time. Eruptive cherry angiomas involve the sudden and widespread appearance of numerous lesions, which can be linked to medications, systemic illnesses, or other underlying issues.
