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Perimalleolar ulcers in hydroxyurea treated patients with concomitant chronic venous disease: diagnostic pitfalls

Vikas Jain1, Kavita Gupta, Nitin Nagpal

  • 1Department of Surgery, Kasturba Medical College, Manipal 576104, Kamataka, India. dr_vikasin@yahoo.co.in

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
|October 9, 2009
PubMed

Insights

Hydroxyurea treatment for blood disorders may cause non-healing ulcers. Discontinuation of hydroxyurea is crucial for healing chronic venous ulcers potentially induced by the drug.

Area of Science:

  • Vascular Medicine
  • Dermatology
  • Hematology

Background:

  • Chronic venous disease (CVD) management often involves treating non-healing ulcers.
  • Hydroxyurea is a medication used for myeloproliferative neoplasms like CML and PV.

Observation:

  • Three male patients with confirmed CVD and non-healing perimalleolar ulcers were treated with hydroxyurea.
  • Standard ulcer treatments were ineffective, with one patient undergoing varicose vein surgery without resolution.
  • Ulcer healing occurred only after hydroxyurea discontinuation in some cases.

Findings:

  • Hydroxyurea may induce or exacerbate non-healing ulcers in patients with underlying chronic venous disease.
  • Differentiating drug-induced ulcers from typical venous ulcers is clinically challenging.
  • One patient's persistent ulceration despite hydroxyurea withdrawal suggested a primary CVD etiology.

Implications:

  • Clinicians should consider hydroxyurea as a potential cause of non-healing ulcers in patients with CVD.
  • Careful patient history and diagnostic evaluation are essential to distinguish between drug-induced and primary venous ulcers.
  • Discontinuation of hydroxyurea may be a critical step in managing these refractory ulcers.

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