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Giornale Italiano di Dermatologia e Venereologia 2006 August;141(4):317-23


language: English

Skin changes secondary to hydroxyurea therapy: a survey of 30 cases and review of the literature

Aste N. 1, Fumo G. 1, Usala E. 2, Aste N. 1

1 Department of Dermatology, University of Cagliari, Cagliari, Italy 2 Division of Hematology, “Businco” Hospital Oncologic, Cagliari, Italy


Aim. Hydroxyurea is a cytostatic drug used in the treatment of chronic myelogenous leukaemia, polycythemia vera, essential thrombocythemia, sickle-cell anaemia and other myeloproliferative disorders. Long-term therapy can produce different cutaneous abnormalities such as: acral ulcers, melanonychia, diffuse melanosis, xerosis, alopaecia, stomatitis, epitheliomas in light-exposed areas and hydroxyurea-induced dermopathy. The aim of this study was to monitor the appearance of skin complaints caused by hydroxyurea in a homogeneous group of patients treated with this drug.
Methods. The study comprised 210 patients, 120 males and 90 females, aged between 25 and 80, all undergoing treatment with hydroxyurea for the following diseases: essential thrombocythemia (135 patients), chronic myelogenous leukemia (33 patients), polycythemia vera (22 patients), chronic myeloproliferative syndromes (20 patients). All patients in whom skin lesions emerged underwent a range of blood chemistry and instrumental tests in order to exclude the presence of other pathologies which might have caused the skin complaints noted.
Results. Out of the 210 patients examined, 30 (14.3%) presented the following skin complaints: melanonychia, acral ulcers, dermopathy, multiple cutaneous carcinomas, diffuse melanosis. All patients suffered from at least one, or several, of these complaints, in various combinations. In all cases, the skin complaints had appeared after the start of treatment with latency of approximately 4 years.
Conclusions. The appearance of skin complaints during the course of treatment with hydroxyurea is relatively frequent but underestimated. Pathogenesis is complex since it is linked to a number of concurring factors which are undoubtedly to be ascribed to the long-term use of the drug.

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