Lower leg ulcers associated with long - term hydroxyures therapy

Lee, Sang Yeop; Oh, Hyun A; Lee, Ku; Ryu, Hun Mo; Lee, Kyung Hee; Hyun, Myung Soo

Abstract

Hydroxyurea is an antineoplastic agent with selective cytotoxicity for cells in the DNA synthesizing phase, or S phase, of the cell cycle. It is commonly used in the treatment of myeloproliferative disorders, e.g., chronic myelogenous leukemia, essential thrombocythemia and polycythemia vera. Its major adverse reactions are reversible and dose dependent marrow suppression and gastroenteric disturbances. Cutaneous side effects such as erythema, hyperpigmentation, lichen planus-like dermatitis, nail discoloration and alopecia, atropy of the skin occur, especially with long-term treatment. Painful leg ulcers in association with hydroxyurea have only rarely been reported. The ulcers were usually extremely painful and typically located near the malleoli but were occasionally found over the tibia, on the dorsal aspect of the feet, calves, knees, heels, and hands. Any minor trauma could precipitate skin breakdown and ulceration and these ulcers tended to heal slowly. No consistent correlation between the dose or duration of hydroxyurea therapy and the occurrence of ulcers. Complete wound healing was achieved by simply discontinuing treatment with hydroxyurea. We describe 2 patients who developed spontaneous painful lower leg ulcers during long-term hydroxyurea therapy for a myeloproliferative disorder(chronic myelogenous leukemia and essential thrombo cythemia). All ulcers were painful and typically located both lateral malleoli. These ulcers healed only after hydroxyurea was withdrawn and with conservative therapy including manual debridement and occlusive dressing.