Antitumor antibiotic derived from Streptomyces caespitosus; widely used for treatment and prevention of superficial bladder cancer (intravesical instillation).
Incidence
Cutaneous side-effect: 9% of patients treated with intravesical instillations.
Risk factors
Association with vincristine, bleomycin or doxorubicin.
Clinical manifestations
Cutaneous: vesicular dermatitis of the hands, the genitals, and feet. More diffuse reactions involving the trunk.
Respiratory: interstitial lung disease.
Diagnostic methods
Cutaneous testing.
Skin tests: one immediately positive intradermal skin test reported in a patient who presented an immediate reaction.
Patch-tests (concentration ranging from 0.06% to 0.6% in water or in petrolatum) positive in patients with contact allergy.
Mechanisms
Presence of CD I + has been shown in bladder epithelium.
Eczematous eruptions are type IV hypersensitivity reactions; mediated transvesically.
Management
Avoidance.
Topical corticosteroids may be useful.