Raynaud's phenomenon and acral necrosis after chemotherapy for AIDS-related Kaposi's sarcoma

Reiser, Marcel; Bruns, C.; Hartmann, Peter; Salzberger, Bernd; Diehl, Volker; Fätkenheuer, Gerd

doi:10.1007/bf01584368

Cited by 20 publications

(5 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The odds ratios for Raynaud‐like phenomena in those who received one to four cycles of chemotherapy compared with those who received no chemotherapy were 2.9 [95% CI, 2.2, 3.9] and 8.0 [95% CI, 4.4, 14.7] if they received more than five cycles of chemotherapy. When these drugs have been used to treat Kaposi's sarcoma RP has also been described . Nevertheless, emergence of severe RP with digital necrosis after a single cycle of doxorubicin, bleomycin, vincristine and dacarbazine chemotherapy, with a cumulative dose of only 40 000 IU of bleomycin has also been described .…”

Section: Resultsmentioning

confidence: 99%

Drug‐induced Raynaud's phenomenon: beyond β‐adrenoceptor blockers

Khouri

Blaise

Carpentier

et al. 2016

Brit J Clinical Pharma

View full text Add to dashboard Cite

AIMDrug-induced Raynaud's phenomenon (RP) has long been associated with the use of different drugs, including cancer chemotherapy or β-adrenoceptor blockers. However, sources report extremely variable prevalence and the level of evidence for each class is heterogeneous. Moreover, new signals are emerging from case reports and small series. Our objective was therefore to review available evidence about this adverse drug effect and to propose a mechanistic approach of drug-induced RP. METHODSA systematic review of English and French language articles was performed through Medline (1946Medline ( -2015 and Embase (1974Embase ( -2015. Further relevant papers were identified from the reference lists of retrieved articles. RESULTSWe identified 12 classes of drugs responsible for RP, with a variety of underlying mechanisms such as increased sympathetic activation, endothelial dysfunction, neurotoxicity or decreased red blood cell deformability. Cisplatin and bleomycin were associated with the highest risk, followed by β-adrenoceptor blockers. Recent data suggest a possible involvement of tyrosine kinase inhibitors (TKI), through an unknown mechanism. CONCLUSIONDrug-induced RP is a probably underestimated adverse drug event, with limited available evidence regarding its prevalence. Although rare, serious complications like critical digital ischaemia have been reported. When these treatments are started in patients with a history of RP, careful monitoring must be made and, if possible, alternative therapies that do not alter peripheral blood flow should be considered. IntroductionRaynaud's phenomenon (RP) is characterized by transient ischaemia of the extremities in response to environmental stress or emotions [1]. It typically manifests as changes to the fingers, with pallor (vasospasm and decreased blood flow), cyanosis (deoxygenation of the static venous blood) and rubor (reperfusion), often accompanied by pain. RP can be primary (i.e. idiopathic) or secondary to an underlying cause. In both cases, abnormalities of the cutaneous microcirculation are primarily involved in the pathophysiology of RP [2]. The prevalence of RP in the general population varies between 0.5 and 19%, with major geographic variability [3][4][5][6]. While primary RP is the most frequent form (80-90%) [7], RP may also be secondary to various auto-immune diseases (such as systemic sclerosis (SSc), systemic lupus erythematosus, vasculitis, etc.), or other systemic diseases [1]. Several drugs with peripheral vascular effects leading to decreased microvascular perfusion may induce or aggravate RP. Drug-induced RP probably goes unrecognized because of the limited knowledge of this side effect. British Journal of Clinical PharmacologyLiterature reviews and textbooks usually have comprehensively reviewed drugs that have long been known to be responsible for RP [8]. However, new signals are emerging from numerous case reports. Yet, to our knowledge, no systematic review has been performed and little is known about the prevalence and the level of evidence ...

show abstract

Section: Resultsmentioning

confidence: 99%

Drug‐induced Raynaud's phenomenon: beyond β‐adrenoceptor blockers

Khouri

Blaise

Carpentier

et al. 2016

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…[114] Intralesional interferon-α-2b has been shown to be condition. [105] safe and effective in the treatment of genital warts. [115] However, given the cost of treatment, interferon should be reserved for…”

Section: Bleomycinmentioning

confidence: 99%

Viral Infections Affecting the Skin in Organ??Transplant Recipients

Tan

Goh

2006

American Journal of Clinical Dermatology

111

View full text Add to dashboard Cite

Viral skin infections are common findings in organ transplant recipients. The most important etiological agents are the group of human herpesviruses (HHV), human papillomaviruses (HPV), and molluscum contagiosum virus. HHV that are important in this group of patients are herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), HHV-6 and -7, and HHV-8, which causes Kaposi sarcoma (KS). HSV infections are characterized by their ability to establish latency and then reactivate at a later date. The most common manifestations of HSV infection in organ transplant recipients are mucocutaneous lesions of the oropharynx or genital regions. Treatment is usually with acyclovir, valaciclovir, or famciclovir. Acyclovir resistance may arise although the majority of acyclovir-resistant strains have been isolated from AIDS patients and not organ transplant recipients. In such cases, alternatives such as foscarnet, cidofovir, or trifluridine may have to be considered. VZV causes chickenpox as well as herpes zoster. In organ transplant recipients, recurrent herpes zoster can occur. Acute chickenpox in organ transplant patients should be treated with intravenous acyclovir. CMV infection occurs in 20-60% of all transplant recipients. Cutaneous manifestations, which include nonspecific macular rashes, ulcers, purpuric eruptions, and vesiculobullous lesions, are seen in 10-20% of patients with systemic infection and signify a poor prognosis. The present gold standard for treatment is ganciclovir, but newer drugs such as valganciclovir appear promising. EBV is responsible for some cases of post-transplant lymphoproliferative disorder, which represents the greatest risk of serious EBV disease in transplant recipients. HHV-6 and HHV-7 are two relatively newly discovered viruses and, at present, the body of information concerning these two agents is still fairly limited. KS is caused by HHV-8, which is the most recently discovered lymphotrophic HHV. Iatrogenic KS is seen in solid-organ transplant recipients, with a prevalence of 0.5-5% depending on the patient's country of origin. HPV is ubiquitous, and organ transplant recipients may never totally clear HPV infections, which are the most frequently recurring infections in renal transplant recipients. HPV infection in transplant recipients is important because of its link to the development of certain skin cancers, in particular, squamous cell carcinoma. Regular surveillance, sun avoidance, and patient education are important aspects of the management strategy.

show abstract

“…Raynaud's phenomenon leading to acral gangrene has been reported, 61,62,66 while gangrene without prior onset of Raynaud's phenomenon has also been seen. 74,75 In one case, histological examination revealed leucocytoclastic vasculitis, leading to ischaemic necrosis.…”

Section: Raynaud's Phenomenon and Gangrenementioning

confidence: 99%

“…Several cases of Raynaud's phenomenon have been reported during combination chemotherapy involving bleomycin, [61][62][63][64][65][66] and also following local intralesional injections of bleomycin for recalcitrant warts. [67][68][69][70] Raynaud's phenomenon is a common side-effect in human immunodeficiency virus-positive patients with Kaposi sarcoma who have been treated with bleomycin.…”

Section: Raynaud's Phenomenon and Gangrenementioning

confidence: 99%

Bleomycin and the skin

Yamamoto

2006

British Journal of Dermatology

121

111

View full text Add to dashboard Cite

Bleomycin is frequently used as a chemotherapeutic agent to treat various kinds of malignancy. However, the cytotoxic effects of bleomycin cause a number of adverse responses, in particular in the lung and the skin. Bleomycin is used by dermatologists as a treatment for various skin cancers, recalcitrant warts, keloid and hypertrophic scars. This article discusses the use of bleomycin for various skin disorders, as well as the risk factors and cutaneous side-effects resulting from its use.

show abstract

Raynaud's phenomenon and acral necrosis after chemotherapy for AIDS-related Kaposi's sarcoma

Cited by 20 publications

References 9 publications

Drug‐induced Raynaud's phenomenon: beyond β‐adrenoceptor blockers

Drug‐induced Raynaud's phenomenon: beyond β‐adrenoceptor blockers

Viral Infections Affecting the Skin in Organ??Transplant Recipients

Bleomycin and the skin

Contact Info

Product

Resources

About