sodium-bicarbonate and Skin-Diseases

Extravasation of certain cytotoxic agents during peripheral intravenous administration may cause severe local injuries. Most extravasation can be prevented with the systematic implementation of careful administration techniques. However, the management of this complication, the aim of which is to prevent progression to tissue necrosis and ulceration, remains an important challenge in the care of cancer patients. Many antidotes have been evaluated experimentally and a few may be able to reduce the local toxicity of the more common vesicant cytotoxic drugs. Because no randomised trial on the management of cytotoxic drug extravasation in humans has ever been completed, recommendations must be based on the more consistent experimental evidence and on cumulative clinical experience from available case reports and uncontrolled studies, which are reviewed in this article. Empirical guidelines recommend the use of topical dimethylsulfoxide (DMSO) and cooling after extravasation of anthracyclines or mitomycin, locally injected hyaluronidase after extravasation of vinca alkaloids, and locally injected sodium thiosulfate (sodium hyposulfite) after extravasation of chlormethine (mechlorethamine; mustine). Plastic surgery may be necessary when conservative treatment fails to prevent ulceration. The possibility of late local reactions must also be considered in the management of patients receiving chemotherapy.

Topics: Adrenal Cortex Hormones; Animals; Antidotes; Combined Modality Therapy; Dimethyl Sulfoxide; Extravasation of Diagnostic and Therapeutic Materials; Hot Temperature; Humans; Hyaluronoglucosaminidase; Infusions, Intravenous; Injections, Intravenous; Skin Diseases; Skin Transplantation; Skin Ulcer; Sodium Bicarbonate; Thiosulfates

Approximately 30% of patients affected of PCT present scleroderma-like lesion of the skin. Two cases of PCT, presenting scleroderma-like lesions are reported. The patients were diabetic but not alcoholic and tolerate relatively well sunshine. Porphyrin elimination diminished with urine alkalinization and phlebotomies, and the scleroderma-like lesions improved with N-acetyl-hydroxy-proline administration.

Topics: Aged; Animals; Bicarbonates; Cricetinae; Diabetes Complications; Diagnosis, Differential; Hemorrhage; Humans; Hydroxyproline; Inflammation; Male; Middle Aged; Porphyrias; Scleroderma, Systemic; Skin; Skin Diseases; Sodium; Sodium Bicarbonate

The pathophysiology and mechanisms of toxicity of anthracycline-induced skin damage are reviewed, and the various available therapeutic interventions are discussed. Skin ulcers caused by the vesicant antineoplastic agents doxorubicin hydrochloride and daunorubicin hydrochloride begin slowly, and the extent of the tissue damage produced is often underestimated. Within a week, untreated infiltrations of these agents can advance to serious indurations and ulcerations, causing extensive damage to underlying structures such as tendons and bones. Two theories have been proposed to explain the mechanism of action of anthrocycline-induced tissue damage; one holds that doxorubicin-DNA complexes form causing cell death, and the other holds that these agents are reduced to free radicals that can cause cell-membrane damage. Nonpharmacologic treatment of extravasation consists of stopping the infusion at the first sign of a problem and attempting to aspirate fluid and drug back through the same needle. The application of ice packs for the next 24-72 hours is recommended. A variety of pharmacologic approaches have been evaluated to ameliorate tissue damage. Corticosteroids, sodium bicarbonate, beta-adrenergic agents, and dimethyl sulfoxide have been used with some success. Patients who do not respond to initial conservative treatments should be referred to a plastic surgeon for skin grafting and reconstruction. The best treatment for anthracycline toxicity is prevention.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adrenergic beta-Antagonists; Anti-Inflammatory Agents; Bicarbonates; Daunorubicin; Dimethyl Sulfoxide; Doxorubicin; Extravasation of Diagnostic and Therapeutic Materials; Humans; Skin Diseases; Sodium Bicarbonate; Vitamin E

Topics: Animals; Bicarbonates; Doxorubicin; Injections, Intradermal; Necrosis; Rats; Skin Diseases; Sodium Bicarbonate; Time Factors