LETTER
Hydroxyurea-Associated Leg Ulceration
B.J. Kennedy, MD
1 August 1998 | Volume 129 Issue 3 | Page 252
TO THE EDITOR:
Best and colleagues' article [1] describes hydroxyurea-induced leg ulceration in 14 patients who were receiving daily therapy. Treatment required cessation of hydroxyurea therapy.
The phenomenon of skin atrophy and ulceration due to hydroxyurea is not new. In 1975 [2], we described hydroxyurea-induced dermatologic toxicity that included atrophy of skin and subcutaneous tissues sometimes accompanied by ulceration. The effects were hydropic degeneration of basal cells, loss of staining of germinative cells of the epidermis, and hypergranulosis. Hyaline bodies similar to the Civatte bodies of lichen planus were positive on periodic acid-Schiff staining but were diastase resistant. The explanation of these changes was based on the selective effect of hydroxyurea on DNA-synthesizing cells. These observations led to the use of hydroxyurea for treating psoriasis, a disease marked by increased DNA synthesis [3].
The cutaneous toxicity associated with prolonged use of hydroxyurea led to the development of a schedule of intermittent drug administration (2 days each week-days 1 and 4) [4]. This schedule has not been associated with major dermatologic toxicity. Physicians who use hydroxyurea to treat diseases should consider this intermittent administration schedule.
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Author and Article Information
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University of Minnesota; Minneapolis, MN 55455
1. Best PJ, Daoud MS, Pittelkow MR, Petitt RM. Hydroxyurea-induced leg ulceration in 14 patients. Ann Intern Med. 1997; 128:29-32.
2. Kennedy BJ, Smith R, Goltz RW. Skin changes secondary to hydroxyurea therapy. Arch Dermatol. 1975; 111:183-7.
3. Leavell UW Jr, Yarbro JW. Hydroxyurea: a new treatment for psoriasis. Arch Dermatol. 1970; 102:144-50.[Medline]
4. Kennedy BJ. The evolution of hydroxyurea therapy in chronic myelogenous leukemia. Semin Oncol. 1992; 19(3 Suppl 9):21-6.
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