Hydroxyurea


Antimetabolite acting primarily on cells in S phase. It is used in patients with myeloproliferative disorders.
 
Incidence
Cutaneous manifestations: 10 to 35% of patients.
 
Fever: 15 cases published (up to 1997).
 
Clinical manifestations
General: fever, appearing within the first few weeks after first exposure;
disappearing rapidly after discontinuation.
 
Cutaneous: generalized dryness and scaling (xerosis), dermatomyositis-like eruption (dorsal hands), cutaneous atrophy, hyperpigmentation of skin and nails, ulcerative lichen planus-like dermatitis, fixed drug eruption (rare), oral or leg ulceration.
 
Respiratory: alveolitis (rare).
 
Diagnostic methods
Skin biopsy: epidermal thickening, flattening of the dermoepidermal junction, basal layer degeneration, colloid body formation.
 
Mechanisms
Cutaneous reactions: Lichenoid hypersensitivity reaction?
 
Hydroxyurea toxicity on the basal layer of the epidermis?
 
Management
Hydroxyurea can be continued if necessary with no worsening of cutaneous lesions.

References

  1. van der Klooster J.M, Sucec P.M, Stiegelis W.F, Hagenbeek A, "Fever caused by hydroxyurea: a report of three cases and review of the literature", Neth. J. Med., 1997; 51 (3): 114-8
  2. Senet P, Aractingi S, Porneuf M, Perrin P, Duterque M, "Hydroxyurea - induced dermatomyositis-like eruption", Br. J. Dermatol., 1995; 133 (3):
    455-9
  3. Lossos I.S, Matzner Y, "Hydroxyurea-induced fever: case report and review of the literature", Ann. Pharmacother., 1995; 29 (2): 132-3
  4. Kelly R.I, Bull R.H, Marsden A, "Cutaneous manifestations of long-term hydroxyurea therapy", Australas. J. Dermatol., 1994; 35 (2): 61-4

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