Mechlorethamine


Antimitotic alkylating agent known as nitrogen mustard administered intravenously in the treatment of hematological disorders and applied topically in the treatment of mycosis fungoids and severe psoriasis.
 
Incidence
Frequent when applied topically.
 
Uncommon when administered intravenously.
 
Clinical manifestations
General: anaphylactic shock.
 
Respiratory: dyspnea.
 
Cutaneous: pruritus, urticaria, angioedema, bullous reactions, contact dermatitis (topical use), erythema multiforme.
 
Diagnostic methods
Cutaneous testing: prick-tests and patch-tests positive in patients with reactions to topical mechlorethamine.
 
Mechanisms
Unknown for immediate reactions.
 
Cell-mediated hypersensitivity for contact dermatitis.
 
Management
Desensitization in patients with mycosis fungoids.
 
  • Topical desensitization: from 0.01 mg/100 ml to 20 mg/100 ml
  • Intravenous desensitization.

Not always successful.

References

  1. Pariser D.M, Childers R.C, Kechijian P, Halprin K.M, Taylor J.R, "Intravenous desensitization to mechlorethamine in patients with psoriasis", Arch. Dermatol., 1976; 112 (8): 1113-4
  2. Constantine V.S, Fuks Z.Y, Farber E.M, "Mechlorethamine desensitization in therapy for mycosis fungoids. Topical desensitization to mechlorethamine (nitrogen mustard) contact hypersensitivity", Arch. Dermatol., 1975; 111 (4): 484-8

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.