Leg ulcer in a patient associated with hydroxyurea therapy

Abstract

Hydroxyurea is a hydroxylated derivate of urea commonly used in the treatment of various hematologic disorders. Cutaneous side-effects such as alopecia, diffuse hyperpigmentation, scaling, poikiloderma, atrophy of the skin and subcutaneous tissues or nail changes can develop after long-term treatment with hydroxyurea. Painful leg ulcers in association with hydroxyurea have only rarely been reported. We present a report of a 52-year-old patient with essential thrombocythemia suffering from painful leg ulcers 3 years after starting therapy with hydroxyurea. We decided to treat the leg ulcers following a modern phase-adapted wound-healing strategy and continued hydroxyurea therapy until complete healing of the ulcers. In conclusion, cutaneous ulceration of the leg is one adverse effect in patients with essential thrombocythemia during hydroxyurea therapy. Healing does not necessarily require discontinuation of the drug. Therefore, therapists should first optimize a conservative and systematic wound-healing strategy. If these interventions fail, discontinuation of hydroxyurea therapy is advisable.

Efeitos colaterais cutâneos após uso prolongado de hidroxiuréia na Policitemia Vera

“…6 There seems to be a platelet deregulation associated with these factors, with microthrombos formation and loss of tissue repair by direct toxic action of the drug. 4 The basic disease seems to influence the risk for ulcer development, which may be evident in around 9% of patients undergoing treatment for Myelodysplastic Diseases and in 29% of Sickle-Cell Disease carriers. 4,12 The ulcers are located almost exclusively in areas of leg trauma and affect more frequently elderly women (65% of cases), who have been using the drug for at least one year.…”

“…4 The basic disease seems to influence the risk for ulcer development, which may be evident in around 9% of patients undergoing treatment for Myelodysplastic Diseases and in 29% of Sickle-Cell Disease carriers. 4,12 The ulcers are located almost exclusively in areas of leg trauma and affect more frequently elderly women (65% of cases), who have been using the drug for at least one year. 12 Studies reveal that spontaneous healing of ulcerated lesions occur during the period from eight weeks to nine months after suspension of the drug.…”

“…Among the observed manifestations are: cutaneous xerosis, diffuse skin hyperpigmentation, ungueal alterations, dermatomyositis-like lesions, ulcerous lesions and even skin carcinomas. [4][5][6][7][8] The pathogenesis for such alterations is still not well clarified and there are several hypotheses being currently examined. The onset of several and rare adverse mucous-cutaneous and ungual reactions in the same patient is reported here, some of them with atypical presentation, during prolonged use of hydroxyurea in the treatment of Polycythemia Vera.…”

Carcinoma skin in association with Chronic Myeloid Leukemia; a case report

“…Ironically, many a times these patients need to discontinue their treatment for resolution of the symptoms, 4-6 and in majority, discontinuation of the medicine results in complete or almost complete healing 7 . Successful treatment of HU-related leg ulcers with topical granulocyte-macrophage colonystimulating factor (GM-CSF) in few patients affected by chronic myeloid leukemia (CML), have also been reported 8 …”

Auftreten von Ulcera crurum in Zusammenhang mit der Einnahme von Anagrelid

“…80 % der Patienten [1]. Neben beispielsweise einer peri− pheren arteriellen Verschlusskrankheit (pAVK), Vaskulitiden oder Diabetes mellitus kann auch die Einnahme verschiedener Medikamente nicht nur die Abheilung bereits bestehender Wunden behindern, sondern auch die Entstehung eines Ulcus cruris primär verursachen [2] (l " Tab. 1).…”