melphalan and Hand-Dermatoses

Mucocutaneous involvement occurs predominantly in primary systemic amyloidosis as well as in myeloma-associated systemic amyloidosis. It is rarely observed in other types of amyloidoses. Signs of such involvement may aid in the early diagnosis of the disease process. Herein, we describe a 64-year-old white male patient with myeloma-associated systemic amyloidosis in whom the disease presented with unique cutaneous lesions consisting of chronic paronychia and palmodigital erythematous swelling and induration of the hands. Following weekly regimens with prednisone (20 mg/day) and melphalan (2 mg/day) administered every 16 weeks, almost complete resolution of the cutaneous lesions was observed after 1 year of therapy. Also, in response to chemotherapy, modest regression of the myelomatous bone lesions and complete resolution of the underlying gammopathy occurred.

Topics: Amyloidosis; Antineoplastic Agents, Alkylating; Chronic Disease; Drug Therapy, Combination; Erythema; Glucocorticoids; Hand Dermatoses; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Paronychia; Prednisone; Recurrence; Time Factors

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Cytarabine; Drug Hypersensitivity; Female; Fibroblast Growth Factor 7; Foot Dermatoses; Hand Dermatoses; Humans; Lymphoma, B-Cell; Melphalan; Middle Aged; Mitogens; Podophyllotoxin

We present an immunocompetent man with extensive warts on the hands, refractory to a number of conventional treatment modalities and causing substantial morbidity and impairment of normal function. Isolated limb infusion (regional intra-arterial chemotherapy) with melphalan and actinomycin D was performed, with substantial clearing of the warts within 2 months. Treatment-induced morbidity was limited to mild local erythema and oedema which resolved within 3 weeks. After 9 months' follow up, the patient had only a few residual warts and was able to resume normal activities.

Topics: Adult; Antibiotics, Antineoplastic; Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; Dactinomycin; Follow-Up Studies; Hand Dermatoses; Humans; Immunocompetence; Infusions, Intra-Arterial; Male; Melphalan; Recurrence; Severity of Illness Index; Treatment Outcome; Warts