Hydroxyurea-Induced Leg Ulcers Treated With a Protease-Modulating Matrix

Abstract

Background: The development of painful leg ulcers in the ankle area is a rare and only partially described complication in patients receiving high-dose, long-term hydroxyurea treatment for myeloproliferative diseases. Several reports have described treatments for chronic wound management with this type of lesion. Observations: We describe 2 patients who were diagnosed as having hydroxyurea-induced leg ulcers that were successfully treated with a freeze-dried sponge containing oxidized regenerated cellulose and bovine purified collagen. This dressing is able to modulate the activity of proteases such as plasmin, neutrophil-derived elastase, and matrix metalloproteinase by physically entrapping them and thus inhibiting their activity. Conclusion: This case demonstrates that topical application of a matrix metalloproteinase modulator can be a successful and safe treatment option for patients with hydroxyurea-induced recalcitrant leg ulcers.

Úlceras por hidroxiurea en paciente con policitemia vera

“…En la literatura se describe el uso de corticoides, oxígeno hiperbárico, antibióticos locales y sistémicos, gasas con hidrogel, ungüentos con fibrinolíticos, pero con resultados poco satisfactorios hasta ahora 3,4,5,7 .…”

“…Esta última, actúa como vasodilatador y flexibiliza a los eritrocitos, mejorando la microcirculación y la entrega de oxígeno a tejidos 9 . Todos estos reportes presentan resultados altamente prometedores, que podrían ayudar al manejo de esta complicación 3,5 .…”

Ulzerationen unter Therapie mit Hydroxyharnstoff

“…2 Einige Autoren weisen darauf hin, dass eine Abheilung nur nach Absetzen von Hydroxyharnstoff erfolgte [3,24]. In Einzelberichten wurde über Therapieerfolge unter Anwendung von GM-CSF [25], rHuEPO [1], Protease-modulierender Matrix [21], bFGF [2] sowie Apligraf [11], einem synthetischen Hautersatz, berichtet.…”

Leg ulcers in sickle cell patients: management challenges

“…Patients are encouraged to keep ulcers clean, with proper cleansing of the wounds using soap and water, or normal saline solution. Numerous types of topical therapies have been described and utilized for local wound care of leg ulcers in patients with SCD, including moisturizing, antibacterial, inflammation-modulating, matrixmodulating dressings, [14][15][16] as well as laser treatments and negative pressure therapy. 17,18 While all these modalities have shown anecdotal efficacy, clear evidence as to the superiority of one over the others is lacking.…”