Mitomycin


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.

References

  1. de Groot A.C, Conemans J.M, "Systemic allergic contact dermatitis from intravesical instillation of the antitumor antibiotic mitomycin C", Contact. Dermatitis., 1991; 24 (3): 201-9
  2. Colver G.B, Inglis J.A, Mc Vittie E, Spencer M.J, Tolley D.A, Hunter J.A, "Dermatitis due to intravesical mitomycin C: a delayed-type hypersensitivity reaction ?", Br. J. Dermatol., 1990; 122 (2): 217-24
  3. Nissenkorn I, Herrod H, Soloway M.S, "Side effects associated with intravesical mitomycin", J. Urol., 1981; 126 (5): 596-7

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