Successful Management of Hydroxyurea-induced Leg Ulcers in Essential Thrombocythemia: Report of 3 Cases

Abstract

Essential thrombocythemia is one of the myeloproliferative neoplasms with a plethora of thrombohemorrhagic complications. Hydroxyurea has been proven to be an effective treatment for this condition. However, it is not without side effects. We herein report 3 patients with essential thrombocythemia treated with hydroxyurea who developed refractory leg ulcers, and we outline their successful management. We also review the literature to shed light on the mechanism of this toxicity. Awareness of this important treatment complication is important to avoid the pitfall of futile invasive interventions.

Leg Ulcer in Patient with Sickle Cell Disease on Hydroxyurea

“…6 Another potential cause of ulceration is megaloblastosis, a known side effect of hydroxyurea. 11 Megaloblastosis can lead to enlarged RBCs, decreasing blood circulation in capillaries and depriving the basal cells of oxygen, which can hinder wound repair. 12 Other causes of ulcers seen in sickle cell patient can be related to the underlying disease process itself including mechanical obstruction from sickling, thrombosis, bacterial infections and reduced nitric oxide availability.…”

“…From this case and other cases, it is suggested that wound care including wound dressings, bandaging and antibiotics cannot fully heal the ulcer and requires months of treatment. 11,14 Potential alternative therapies include hyperbaric oxygen treatment which may increase the healing rate of the ulcer, topical application of Molgramostim and analgesics as well as the use of cultured skin grafts. 13,15 Further studies are required to determine a better treatment option for sickle cell patients with hydroxyurea induced leg ulcers.…”