From the FDA Drug Label
- 5 Vasculitic Toxicities Cutaneous vasculitic toxicities, including vasculitic ulcerations and gangrene, have occurred in patients with myeloproliferative disorders during therapy with hydroxyurea. These vasculitic toxicities were reported most often in patients with a history of, or currently receiving, interferon therapy. If cutaneous vasculitic ulcers occur, institute treatment and discontinue hydroxyurea capsules.
Hydroxyurea can cause vasculitic ulcerations as part of its adverse reaction profile. If cutaneous vasculitic ulcers occur, the recommended course of action is to:
- Institute treatment for the ulcers
- Discontinue hydroxyurea capsules 1 1 There is no information on how to treat ulcers caused by hydroxyurea, only that the drug should be discontinued.
From the Research
Hydroxyurea is not a treatment for ulcers, but rather a chemotherapeutic agent that can cause leg ulcers as a side effect in some patients. For patients who develop ulcers while on hydroxyurea, the primary approach should be to consider dose reduction or discontinuation of the medication in consultation with the prescribing hematologist or oncologist, as this often leads to spontaneous healing of the lesions 2.
Key Considerations
- Hydroxyurea-induced ulcers are often multiple, bilateral, and typically develop in the perimalleolar region, accompanied by intense, treatment-resistant pain 2.
- Withdrawal of hydroxyurea generally leads to healing of these lesions, suggesting that discontinuation of the drug is a crucial step in managing hydroxyurea-induced leg ulcers 2.
- In addition to discontinuing hydroxyurea, providing appropriate wound care and pain management for the ulcers is essential for patient comfort and to promote healing.
Treatment Options
- For wound care, options such as the use of a protease-modulating matrix have been successfully used in treating hydroxyurea-induced leg ulcers, as it can modulate the activity of proteases and thus inhibit their harmful effects on the wound healing process 3.
- Hyperbaric oxygen therapy has also been suggested as a potential treatment option, especially in diabetic patients, as it can increase blood and tissue oxygen content, enhancing tissue healing 4.
- In severe cases complicated by squamous cell carcinoma, multiple debridement stages and skin grafting surgeries may be necessary for successful management 5.
Recommendations
- Regular dermatologic screening should be performed on hydroxyurea-treated patients to early detect and manage cutaneous side effects, including leg ulcers.
- Care providers should be aware of the potential for hydroxyurea to cause leg ulcers and the importance of discontinuing the drug if such side effects occur, to prevent further morbidity and promote healing.