Leg Ulcers in Patients with Myeloproliferative Disorders: Disease- or Treatment-Related?

Bader, Urs; Banyai, M; Boni, Roberto; Burg, G; Hafner, Juerg

doi:10.1159/000018315

Cited by 32 publications

(36 citation statements)

References 17 publications

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“…Therefore, it may cause impaired microcirculation and cutaneous anoxia, which then lead to ulcerative skin lesions and severe pain 9,10 . Bader et al 11 proposed some criteria to help in diagnosis and differentiation. First, the duration of treatment should be at least 1 year, and the dose of hydroxyurea should be at least 1 g/day.…”

Section: Discussionmentioning

confidence: 99%

A Hydroxyurea-induced Leg Ulcer

et al. 2009

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Section: Discussionmentioning

confidence: 99%

A Hydroxyurea-induced Leg Ulcer

et al. 2009

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“…Hydroxyurea has been suspected to promote ulceration in patients with SCD [66][67][68] and other hematological disorders [69][70][71]. A recent study of 3,411 patients with Philadelphia chromosome negative myeloproliferative neoplasms treated with hydroxyurea reported 5% incidence of mucocutaneous complications, 80% of which were leg ulcers [72].…”

Section: Systemic and Local Therapiesmentioning

confidence: 99%

Critical Reviews: How we treat sickle cell patients with leg ulcers

Minniti

Kato

2015

American J Hematol

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The past five decades have seen an improvement in the mortality and morbidity of sickle cell disease (SCD) because of prophylaxis against infectious complications, improved and expanded red cell transfusions, implementation of hydroxyurea therapy, and advances in supportive care. Now that the majority of patients in the western hemisphere reaches adulthood, end organ diseases are frequent, which include vasculopathic complications such as chronic leg ulcers. The management of patients with leg ulcers requires the hematologist to lead a team of health care professionals, and investigates the presence of associated, but potentially still occult signs of vasculopathy, such as pulmonary hypertension, renal disease, priapism and retinopathy. These complications may be asynchronous, and long term careful screening is indicated, in order to ensure early diagnosis and intervention. It is crucial to address both the immediate consequences of pain, infection and disability, and long term effects on quality of life, employment and stigma associated with chronic ulceration. Recent insights into their pathophysiology may have practical implications. We propose a holistic approach to the management of patients' physical and emotional problems and mechanisms of ulcers formation and delayed healing. An overview of topical and systemic therapies for chronic ulcers is given, with the understanding that wound care therapy is best left to the wound specialists, medical and surgical, with whom the hematologist must keep an open line of communication. In the absence of evidence-based guidelines, our opinion is based on both a critical review of the literature and our personal clinical and research experience. Am. J. Hematol. 91:22-30, 2016. V C 2015 Wiley Periodicals, Inc. Clinical CasesCase 1. A 49 year old African American woman with sickle cell anemia, bilateral hip replacements for avascular necrosis of the femoral head, pulmonary arterial hypertension documented by pulmonary artery catheterization, and history of laser treatment and vitrectomy for proliferative retinopathy and vitreous hemorrhage, presented with a very painful ulcer at the right malleolus. She has had three previous ulcers, on both legs, the first at age 32 years, attributed to excessive standing at her job, no trauma, which had responded to topical care and healed within few months of presentation. At that time she was not taking hydroxyurea, but has been taking it now for longer than 10 years with good fetal hemoglobin response: 17%. This current ulcer developed while she was experiencing high personal stress but no physical trauma. She rarely experiences vaso-occlusive pain crisis and has very infrequent hospitalizations. She was referred to the wound care service and after 7 months of unfruitful therapies, including surgical debridement, MIST ultrasound therapy, antibiotics, and compressions, she was started on monthly transfusions and her ulcer healed 5 months later. She has had consistently elevated serum lactate dehydrogenase (LDH) (>600 IU/L), serum dire...

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“…HU-induced leg ulcers are almost identical in appearance to those developing within the natural course of the disease. Differentiation can be difficult [18] since no valid clinical or histopathological criteria allow us to discriminate between them. HU-induced ulcers typically heal within 1-9 months of treatment cessation, an event that remains the only valid option to establish the cause of the ulcers [18,19].…”

Section: Treatment-related Cutaneous Manifestationsmentioning

confidence: 99%

Myeloproliferative disorder therapy: assessment and management of adverse events—a dermatologist's perspective

Soutou

Aractingi

2009

Hematological Oncology

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Development of cutaneous manifestations in patients with myeloproliferative disorders can be either due to the course of the disease itself or induced by some of the treatments given. The cutaneous manifestations may reveal an unknown haemopathy and/or indicate a poor prognosis. Some of these alter quality of life. Hydroxyurea has been shown to induce a variety of cutaneous adverse reactions ranging from benign effects such as hyperpigmentation to more severe leg ulcers and squamous cell carcinomas. Herein, we discuss the importance of undertaking regular physical examinations in order to identify and treat cutaneous manifestations early in their course.

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Leg Ulcers in Patients with Myeloproliferative Disorders: Disease- or Treatment-Related?

Cited by 32 publications

References 17 publications

A Hydroxyurea-induced Leg Ulcer

A Hydroxyurea-induced Leg Ulcer

Critical Reviews: How we treat sickle cell patients with leg ulcers

Myeloproliferative disorder therapy: assessment and management of adverse events—a dermatologist's perspective

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