Stevens-Johnson syndrome associated with topical nitrogen mustard therapy

A Prospective Study of Cutaneous Intolerance to Topical Mechlorethamine Therapy in Patients With Cutaneous T-Cell Lymphomas

“…Short-term adverse reactions include pruritus, xerosis, hyperpigmentation, and less commonly urticaria, bullous reactions, and StevensJohnson syndrome. 3,7,[22][23][24] The most common adverse reaction is CIM, defined by erythema and pruritus at the site of application. [1][2][3] In our study, 23 (53%) of the 43 patients developed CIM; this percentage is similar to those reported in the literature.…”

Anaphylaxis and toxic epidermal necrolysis or Stevens–Johnson syndrome after nonmucosal topical drug application: fact or fiction?

“…With regard to the occurrence of TEN or SJS following topical drug administration, five articles reporting about five patients were identified (8–12). However, four of the five reports were excluded because the drug was administered to mucous membranes (conjunctivae, intranasal).…”

“…However, four of the five reports were excluded because the drug was administered to mucous membranes (conjunctivae, intranasal). The fifth article (10) reported about a 67‐year‐old woman with mycosis fungoides stage IB with plaques who developed SJS following the application of nitrogen mustard (mechlorethamine) to the entire body. Impaired skin barrier with increased resorption because of inflammation may be assumed as an underlying risk factor in this patient.…”

“…contact dermatitis, have also long been recognized as ADRs. However, drug induced anaphylaxis following topical drug application has been only rarely (1–7), and the occurrence of TEN or SJS associated with topical drug application has even less rarely been described (8–12). A systematic analysis of such cases is, thus, mainly hampered by the limited number of reports.…”

Practical evaluation and management of cutaneous lymphoma

“…160 Rare complications of nitrogen mustard therapy include localized bullous reactions, 161 urticarial, anaphylactoid, 162 and Stevens-Johnson-type reactions. 163 BCNU ointment or solution appears to have comparable efficacy when compared with nitrogen mustard with a 98% total response rate (86% complete response) in stage T1. 164 In comparison with nitrogen mustard, there is a lower frequency of contact dermatitis, 165 but BCNU often leaves persistent telangiectasia at treated sites.…”