Skin Necrosis and Ulcers Induced by Medications
In recent decades, it has been reported for numerous medications that their systemic administration can lead to the development of skin necrosis and subsequently to ulcerations. Allergic as well as nonallergic etiologic mechanisms have been discussed. Mos
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Joachim Dissemond
Contents
14.1
14.1
Introduction ............................................
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14.2 14.2.1 14.2.2 14.2.3 14.2.4 14.2.5 14.2.6 14.2.7 14.2.8 14.2.9 14.2.10 14.2.11 14.2.12 14.2.13
Medications............................................. Hydroxyurea ............................................ Anagrelide ................................................ Coumarins ................................................ Heparin..................................................... Methotrexate ............................................ Leflunomide ............................................. Hydralazine .............................................. Amezinium Methylsulfate ....................... Diltiazem .................................................. Propylthiouracil........................................ Nicorandil ................................................ Levamisole ............................................... Pentazocine ..............................................
95 95 96 96 98 99 99 99 100 100 100 100 101 101
Conclusion ..............................................................
101
References ...............................................................
102
Introduction
In recent decades, it has been reported for numerous medications that their systemic administration can lead to the development of skin necrosis and subsequently to ulcerations. Allergic as well as nonallergic etiologic mechanisms have been discussed. Most of the relevant pathological reactions induced by these medications should be a type of vasculitis or vasculopathy. Although these reactions often manifest as a rash or other skin diseases, some medications lead to the formation of skin necrosis and ulcers [9]. Therefore, in this chapter, an exemplary number of widely used drugs which had been discussed to be responsible for the development of skin or mucosal necrosis and ulcers should be presented (Table 14.1).
14.2
Medications
14.2.1 Hydroxyurea
J. Dissemond, MD Department for Dermatology, Venerology and Allergology, University of Essen, Hufelandstr. 55, 45122 Essen, Germany e-mail: [email protected]
Hydroxyurea, synonym referred as hydroxycarbamide, is a hydroxylated urea derivative which inhibits as an S-phase-specific inhibitor of ribonucleotide reductase the DNA synthesis. It is clinically used for the treatment of patients with chronic myelogenous leukemia, essential thrombocythemia, and polycythemia vera. In a retrospective study, 41 patients were presented in which a leg ulcer was caused by
L. Téot et al. (eds.), Skin Necrosis, DOI 10.1007/978-3-7091-1241-0_14, © Springer-Verlag Wien 2015
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J. Dissemond
96 Table 14.1 Overview of the systemic given medications that may be associated with the development of skin necroses and ulcerations Amezinium methylsulfate [25] Anagrelide [36] Barbituric acid [32] Coumarin [13, 31] Diltiazem [4] Erythropoietin [16] Estrogen combinations [40] Furosemide [39] Heparin [18, 27] Hydralazine [24] Hydroxyurea [2, 14, 41] Leflunomi
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