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Hydroxyurea-Induced Leg Ulceration in 14 Patients

Patricia J. Best, MD; Mazen S. Daoud, MD; Mark R. Pittelkow, MD; and Robert M. Petitt, MD
[+] Article, Author, and Disclosure Information

From Mayo Clinic and Mayo Foundation, Rochester, Minnesota. Requests for Reprints: Mark R. Pittelkow, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Current Author Addresses: Dr. Best: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(1):29-32. doi:10.7326/0003-4819-128-1-199801010-00005
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Background: Hydroxyurea is an antineoplastic agent commonly used to treat myeloproliferative disorders and other nonneoplastic conditions.

Objective: To further define the typical features of hydroxyurea-related cutaneous ulcers of the leg.

Design: Retrospective, descriptive study of the medical records of patients who developed leg ulcers while receiving hydroxyurea therapy.

Setting: A tertiary care medical center.

Patients: Patients with myeloproliferative disorders who were treated with hydroxyurea.

Results: 14 patients with extremely painful leg ulcers were identified. The most common ulcer site was the malleoli. Multiple ulcers were seen in 64% of patients. Patients had received hydroxyurea for an average of 6 years before ulcers developed. All ulcers healed after discontinuation of hydroxyurea treatment, and 2 patients developed ulcers after treatment was restarted.

Conclusion: Hydroxyurea induces painful leg ulcers that are usually difficult to treat and require cessation of hydroxyurea therapy.


ulcer ; hydroxyurea ; leg


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Figure 1.
Hydroxyurea-induced ulcer. Top.Bottom.

Shallow, polyangular, punchedout ulceration on the left lateral malleolus of a patient receiving hydroxyurea treatment. Note the porcelain-colored scar from a healed ulcer. Photomicrograph of a skin biopsy specimen from the border of a typical hydroxyurea-induced ulcer. Note the papillary dermal edema, vessel hyalinization, and perivascular lymphocytic inflammation. (Hematoxylin and eosin; original magnification, x40.).

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