Dermatologic toxicity (manifested by erythema, photosensitivity, hyperpigmentation, desquamation, xerosis or the "hand and foot syndrome") occurs in up to 20% of patients with cancer who receive 5-fluorouracil. Rarely, alopecia occurs as well.

A 65-year-old woman with metastatic colorectal carcinoma started receiving chemotherapy consisting of leucovorin and 5-fluorouracil, given simultaneously as a continuous infusion over 24 hours once a week. Within a few months, the patient noticed hyperpigmentation of the hands, excluding the palms. A few months later, she developed desquamating erythema of the palms and hyperpigmentation of the rest of the hands and feet. No noticeable skin changes involved the soles. She also developed pitting of the nails, which were also brittle.

A nicotine patch (7.0 mg) was applied to the skin 1 hour before the 5-fluorouracil infusion was begun and was removed 1 hour after completion of each 24-hour 5-fluorouracil infusion. Since then, the desquamation, erythema, and hyperpigmentation have completely resolved, despite continued chemotherapy.

The improvement of the skin changes may have been caused by the vasoconstricting properties of the nicotine patch, thereby decreasing the delivery of 5-fluorouracil to the skin. Oncologists have been taking advantage of the beneficial effects of ice application to the scalp and to the oral mucosa in reducing the severity of chemotherapy-associated alopecia and mucositis, respectively. Presumably, the reduction of drug delivery to these areas by cooling-induced vasoconstriction is the mechanism of action. If so, chewing a stick of nicotine gum before bolus chemotherapy may help to reduce other dermatologic toxicities, including alopecia.