Leg ulcers and hydroxyurea - Forty-one cases

Background: Hydroxy urea is an antitumor agent used to treat chronic myelop roliferative disorders. Leg ulcerations have been reported in patients unde rgoing longterm hydroxyurea therapy for myeloproliferative diseases. To bet ter define this dermatological adverse effect of hydroxyurea therapy and to try to understand the pathophysiological process of this disease, we colle cted medical information for such patients in a multicenter retrospective s tudy. Observations: Forty-one patients (mean age, 67 years) developed leg ulcerat ions while undergoing hydroxyurea therapy (mean therapy duration, 5 years). The sex ratio was 1, and there was no underlying vascular disease. Hematol ogic abnormalities were identified. Complete recovery from the ulcerations occurred quickly after withdrawal of treatment in 33 (80%) of the cases. Conclusions: This longest-reported series of patients confirms the role of hydroxyurea therapy in the onset of leg ulcerations. Healing or improvement requires cessation of treatment. Cutaneous atrophy and impaired wound heal ing may explain the relationship between hydroxyurea and leg ulcers. In add ition, the megaloblastic erythrocytes resulting from the presence of hydrox yurea may circulate poorly through the capillary network. A prospective stu dy in hematologic centers would be valuable.