Successful Topical Treatment of Hydroxyurea-Induced Ulcers Without Drug Discontinuation: A Case Report

Hydroxyurea, an antineoplastic agent, is widely used to treat essential thrombocythemia and polycythemia vera. Although hydroxyurea-induced skin ulcers are uncommon, they are a recognized long-term adverse effect. Current management generally recommends discontinuation of hydroxyurea as the mainstay of treatment; however, drug withdrawal may aggravate the underlying hematologic disease. We report a case of bilateral medial malleolar ulcers associated with hydroxyurea therapy in a 65-year-old man with essential thrombocythemia, who showed marked improvement after two months of topical treatment with recombinant bovine basic fibroblast growth factor (rb-bFGF) gel, without discontinuation of hydroxyurea. Complete healing was confirmed at 25-month follow-up, while hematologic disease control was maintained. This case suggests that localized wound care with topical rb-bFGF may represent a feasible therapeutic option in selected patients when hydroxyurea discontinuation is not feasible.