leuprolide and Skin-Diseases

Leuprorelin acetate, an agonist of gonadotropin-releasing hormone (GnRH), is indicated in the treatment of prostate cancer. Recently, depot formulations of leuprorelin acetate have been widely used. We report three patients who showed a granulomatous reaction after treatment using a leuprorelin acetate 3-month depot formulation. These patients presented with 5-6-cm subcutaneous nodules at injection sites, which developed after the depot type was changed from a 1-month to a 3-month formulation. Skin biopsy showed epithelioid cells and foreign body giant cells containing round, translucent microspheres which formed sarcoidal granulomas. Changing to other GnRH agonists resulted in no further problems. We have reviewed the previous reports of leuprorelin acetate-induced granuloma formation. The formation of such granulomas may be related to the polymers that allow slow release after injection, or leuprorelin acetate itself may be responsible. The depot injection methods using leuprorelin also seem to have a causal effect in granuloma formation. Dermatologists need to know that depot leuprorelin acetate may cause a granulomatous reaction which produces a subcutaneous nodule that might be misdiagnosed as a malignant tumour.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Delayed-Action Preparations; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Prostatic Neoplasms; Skin Diseases

A 73-year-old man presented with an ulcer and a subcutaneous nodule where he was receiving leuprorelin acetate injections to treat his prostatic carcinoma. Pathological findings of a skin biopsy showed many epithelioid granulomas with multinuclear giant cells, which contained small vacuoles. Recently, these lesions have been suggested to be caused by a type IV allergic response to the copolymer of lactic and glycolic acids used as a vehicle for drug administration. When urologists treat a prostatic adenocarcinoma with subcutaneous infusion of leuprorelin acetate, they should be aware of this potential side effect of the drug because the resulting granulomar formation may interfere with the effect of the drug. If patients suffer from subcutaneous nodules, urologists should consider changing the drug to an other type of luteinizing hormone-releasing hormone analogues such as goserelin acetate. This reaction to leuprorelin acetate has been reported in only seven cases including our case.

Topics: Aged; Antineoplastic Agents, Hormonal; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Prostatic Neoplasms; Skin Diseases

Topics: Aged, 80 and over; Antineoplastic Agents, Hormonal; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Prostatic Neoplasms; Skin Diseases

We present our experience with 7 patients who developed injection site granuloma with leuprorelin acetate injection. Although isolated case reports exist, this is the largest collection of cases from a single center. The exact mechanism of the granuloma formation is not well understood, although theories are associated with the vehicle used for injection. Our discussion focuses on the nature of the granuloma formation and its etiology. The reaction appears to be more common with leuprorelin acetate than with other forms of luteinizing hormone-releasing hormone analogues.

Topics: Antineoplastic Agents, Hormonal; Granuloma; Humans; Injections; Leuprolide; Male; Prostatic Neoplasms; Skin Diseases

Leuprorelin acetate is a luteinizing hormone-releasing hormone (LH-RH) analog, which is used for chemical castration. Chemical castration treatment has an especially important role for prostate cancer. To ensure ongoing chemical castration, a novel sustained-action injection system using spherical microcapsules has been developed. We report a patient who had granuloma caused by administration of the 11.25 mg leuprorelin acetate product. Histological examination revealed many giant cells with vacuoles. On the basis of reported cases, these vacuoles are characteristic for the granuloma caused by leuprorelin acetate product. The vacuoles in the granuloma are the same size as the microcapsules, and their shape is almost spherical. We assume that the vacuoles in the granuloma are actually the microcapsules. We expect that there will be investigations regarding the procatarctic cause of granuloma formation.

Topics: Aged; Antineoplastic Agents, Hormonal; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Skin Diseases

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Diagnosis, Differential; Granuloma; Humans; Injections; Leuprolide; Male; Neoplasm Recurrence, Local; Prostatic Neoplasms; Skin Diseases; Skin Neoplasms

The skin is a target organ of estrogens. Thus, theoretically, a hypoestrogenic state induced by gonadotropin-releasing hormone analog (GnRHa) treatment may have effects on skin condition. The aim of this study was to evaluate skin condition during GnRHa treatment. Sixteen premenopausal women undergoing GnRHa treatment for 16 weeks, as a presurgical treatment for uterine leiomyomas, were studied. Measurement of serum estradiol levels and epidermal hydration, and evaluation of subjective findings on skin condition using a questionnaire, were performed every 4 weeks during the treatment period. Serum estradiol levels were significantly suppressed at 4 weeks of treatment, and remained low afterwards. Epidermal hydration measured by corneometer did not show any significant difference at any time point examined, compared with that before treatment. No particular subjective findings relating to the skin (dryness, wrinkling, roughness, pigmentation, itching, formication, reaction to cosmetics) were reported during treatment, whereas complaints about hot flushes and sweating were notable. The results of this preliminary study support the notion that GnRHa treatment for 16 weeks is unassociated with apparent changes in skin condition.

Topics: Adult; Body Water; Estradiol; Female; Humans; Leiomyoma; Leuprolide; Middle Aged; Postmenopause; Premedication; Premenopause; Prospective Studies; Skin; Skin Diseases; Surveys and Questionnaires; Uterine Neoplasms

Cutaneous or subcutaneous endometriosis is a rare entity that should be suspected in any female presenting with cyclic pain emanating from a mass in the vicinity of an abdominal surgical scar or the umbilicus.. The purpose of this report is to examine the diagnostic procedures for endometriosis and to review the therapeutic value of surgical excision alone or in combination with hormonal treatment.. Endometriosis presenting cutaneously in an infraumbilical laparoscopy scar and endometriosis occurring subcutaneously in a cesarean section scar were both diagnosed via incisional biopsy. Both lesions were treated with hormonal therapy followed by surgical excision.. Hormonal therapy with danazol or with leuprolide resulted in reduction of symptoms but was associated with amenorrhea in both cases and with dyspareunia in the second patient. Subsequent laparoscopy and surgical excision of the endometrioma were curative.. Preoperative hormonal therapy, although sometimes associated with such side effects as amenorrhea, may be used in cases of large endometriotic masses to reduce the size of the surgical defect, but surgical excision remains the treatment of choice.

Topics: Adult; Combined Modality Therapy; Danazol; Endometriosis; Female; Humans; Leuprolide; Skin Diseases