Raynaud's phenomenon of a single digit following local intradermal bleomycin sulfate injection

Abstract

Bleomycin sulfate, administered parenterally alone and in combination with vinblastine sulfate for treatment of various neoplastic diseases, has been associated with the development of Raynaud's phenomenon (1-5). Additionally. bleomycin therapy has been associated with a number of varied skin reactions, including hyperpigmentation, sclerosis, gangrene, indurated plaques, and hyperpigmented nodules (6).Several recent reports have described the use of intralesional injections of bleomycin sulfate for treatment of cutaneous warts, and have noted no complications (7-10). We describe a patient who received this treatment and subsequently developed Raynaud's phenomenon, which was limited to the injected digit.Case report. A 23-year-old, healthy woman sought medical treatment for a wart located over the palmar aspect of the proximal interphalangeal joint (PIP) of the right index finger. An initial, unsuccessful, attempt at electrocautery was followed by multiple local liquid nitrogen treatments over the ensuing 5 months; each treatment was unsuccessful. Four months later, after regrowth of the wart, the patient received a single injection of bleomycin sulfate (1 mg)

Bleomycin in Dermatology: A Review of Intralesional Applications

“…Hypopigmentation, 20,37 pneumonialike symptoms, 38 and both atrophic and hypertrophic scarring 24,31,37 are rare occurrences. Although sporadically seen with intralesional bleomycin, documentation of Raynaud's phenomenon, 34,35,[39][40][41][42][43][44][45][46] anaphylaxis, 17,25,28,41 and flagellate hyperpigmentation 41 does exist in the literature. These events occur more commonly with intravenous administration of the drug.…”

Raynaud's phenomenon following intralesional bleomycin injection

“…Other toxic side effects of BLM are reversible but Raynaud's phenomenon persists after cessation of the drug [10]. In the ease presented here, the lesion was found to persist in the same finger 3 years after the injection.…”

“…To the Editor: Bleomycin (BLM) is recommended as an alternative therapy for cutaneous tumors [l]. Although many complications have been reported to be associated with parenteral administration of BLM [2][3][4][5][6], reports about the complications of intralesional therapy are sparse [7][8][9][10]. We describe a patient who developed Raynaud's phenomenon limited to the intralesional BLM injected digit.…”

“…Raynaud's phenomenon after local administration was first reported by Arnold et al [9], Later. Smith et al [10] reported a patient who developed Raynaud's phenomenon following intralesional BLM injection in a finger. To our knowledge, the patient decribed here is the third case reported in the literature.…”

Intra-arterial chemotherapy in locally advanced or recurrent carcinomas of the penis and anal canal: an active treatment modality with curative potential

“…It is well demonstrated that BLM has a direct action on endothelial cells by production of oxidant agents (Adamson and Bowden, 1974;Lazo and Humphreys, 1983). Raynaud's phenomenon has sometimes been observed following BLM iv administration and is believed to be a clinical manifestation of BLM toxicity to the endothelium (Vogelzang et al, 1981;Cohen et al, 1973;Smith et al, 1985). The location of the skin lesions close to the IA delivery site of the drug suggests that the concentration of BLM at this level may be toxic to the skin capillaries.…”