Systemic Toxicity from Occlusive Therapy with Topical 5-Fluorouracil: A Case Report and Review of the Literature

Generalized pustular drug eruption caused by topical 5-fluorouracil

“…With widespread erosion and ulceration, however, hematogenous absorption can approach 60% (Sargen et al, 2012). In our case, the patient's compliance with repetitive antigen exposure despite the early sign of localized hypersensitivity reaction may have led to this generalized eruption.…”

“…It usually elicits an irritant contact dermatitis at the application site and can uncommonly cause an allergic contact dermatitis (Meijer & de Waard-van der Spek, 2007). Systemic reactions are rare (Sargen et al, 2012). We, herein, describe the first reported case of a diffuse pustular drug eruption to topical 5-FU.…”

Triple therapy with intralesional 5-fluorouracil, chemowraps, and acitretin: A well-tolerated option for treatment of widespread cutaneous squamous cell carcinomas on the legs

“…Intralesional 5-FU and chemowraps have been used for SCC treatment2, 3 and acitretin for prevention 4 . A PubMed search from 1970 until April 2019 using various combinations of the terms acitretin or retinoid and fluorouracil or chemotherapy and leg or extremity finds that their combination has never been reported as a therapeutic option for SCCs.…”

“…Chemowraps with 5-FU have demonstrated successful response for actinic keratoses and SCCs 7 . Overuse of 5-FU, including one report of systemic toxicity with chemowraps, must be kept in mind, with myelosuppression and gastrointestinal toxicity being the most commonly observed manifestations of systemic toxicity 3 . In the particular case of a patient who had systemic toxicity with chemowraps, the proposed etiology was that her chemowraps were continued in the setting of widespread skin erosion and ulceration, which has shown hematogenous absorption of 5-FU approaching 60% 8 …”

Cryotherapy-Enhanced Chemowrap Treatment of Squamous Cell Carcinoma: A Case Series

“…One such modality typically used is chemowraps, in which topical 5-fluorouracil (5-FU) 5% cream (e.g., Efudex) along with zinc oxide is applied under occlusion and bandage-wrapped around the patient’s lower extremity for approximately five to seven days each week. The SCC-impacted lesions are typically cleansed and replaced every week for at least four weeks and up to 12 weeks [ 4 , 5 ]. The mechanism behind chemowraps is thought to be related to induction of cellular apoptosis.…”