Protective effect of doxorubicin in vitamin C or dimethyl sulfoxide against skin ulceration in the pig

Abstract

We conclude that the free radical scavengers DMSO and vitamin C are capable of lowering the incidence of doxorubicin-induced skin ulcers and could significantly lessen the morbidity associated with doxorubicin extravasation.

Extravasation injuries: a review

“…A number of early experimental animal studies have shown encouraging results with topical antidotes in cytotoxic extravasations including n -acetylcysteine, vitamin C, basic fibroblast growth factor, and granulocyte macrophage colony stimulating factor (Hajarizadeh et al, 1994; Shamseddine et al, 1998; Vasilev et al, 1992). These agents have not undergone evaluation in human studies, so cannot be recommended for inclusion in therapeutic protocols at present.…”

Intralesional steroids reduce inflammation from extravasated chemotherapeutic agents

“…Several treatment modalities have been suggested to limit skin damage. These include icebag application; 1 the free radical scavengers dimethyl sulphoxide (DMSO), α‐tocopherol, pentoxifylline and vitamin C; 2,3 excision and grafting; 4 and hyaluronidase infiltration 5 . A large amount of intralesional saline injection with topical steroid application under occlusion has been reported to prevent tissue necrosis 6 .…”

Comment on: management of chemotherapy extravasation: ESMO–EONS clinical practice guidelines

“…Studies in animals are generally carried out in murine models. Because of the potential problems of drug testing in rat skin, which has a thin layer of subdermal muscle ( panniculus carnosus), the best model of human skin for intradermal drug testing is the use of white swine [2]. However, studies on such model are scarce.…”

“…In 1988, a case-control pilot study included only 16 fully assessable patients [2]. None of the patients treated with DMSO 99% presented an ulcer on the extravasation area.…”