tretinoin and Ulcer

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML). All-trans retinoic acid (ATRA) is the first-choice therapy for the treatment of this disease, but has been associated with side effects, the most serious of which is retinoic acid syndrome (RAS). RAS is characterized by unexplained fever, dyspnea, pulmonary infiltrate, leukocytosis and nephropathy. Genital ulcers have been described in some cases, but only two cases of oral ulcers related to this syndrome have been described in the literature. This paper describes the third case of oral ulceration related to ATRA in a 32-year-old white man with diagnosis of APL. Clinicians should know the side effects of ATRA and identify oral ulcers resulting from this therapy. The prompt identification of these ulcers enables the institution of appropriate treatment and can therefore contribute to continuation of the patient's cancer treatment.

Topics: Adult; Antineoplastic Agents; Humans; Leukemia, Promyelocytic, Acute; Lip Diseases; Male; Tretinoin; Ulcer

Deep erythema and inflammation after re-epithelialization of superficial wounds is a sign of scar formation. Corticosteroids may prevent scarring by suppression of inflammation and fibroblast activity. Tretinoin may increase the efficacy of corticosteroids in this setting.. To evaluate the efficacy of corticosteroids plus tretinoin for prevention of scars after superficial wounds.. In a retrospective study of patients with superficial partial thickness thermal skin burn, we compared the patients who received clobetasol plus tretinoin after re-epithelialization with patients who did not receive any medication. Clobetasol propionate 0.05% ointment was used twice daily with overnight occlusive dressing in conjunction with twice weekly topical tretinoin 0.05% cream.. Among 43 patients who had light pink or no erythema after re-epithelialization and consequently did not receive clobetasol + tretinoin, no scar was developed. Among patients who had deep erythema after re-epithelialization, rate of scar formation was significantly higher in 14 patients who did not receive clobetasol + tretinoin than in 21 patients who received clobetasol + tretinoin (64% and 19%, respectively; p = 0.01).. Clobetasol + tretinoin can significantly decrease the incidence of scar formation in patients with inflammation after re-epithelialization of superficial wounds.

Topics: Adolescent; Adult; Aged; Burns; Child; Child, Preschool; Cicatrix; Clobetasol; Dermatologic Agents; Erythema; Female; Glucocorticoids; Humans; Male; Middle Aged; Occlusive Dressings; Re-Epithelialization; Retrospective Studies; Skin; Tretinoin; Ulcer; Young Adult

Topics: Adult; Antineoplastic Agents; Female; Humans; Ileal Diseases; Leukemia, Promyelocytic, Acute; Tretinoin; Ulcer

Scrotal ulcers are a rare manifestation in patients with acute promyelocytic leukemia. Fournier's gangrene (FG) is even rarer. We describe three adolescents and young adults who developed scrotal ulcerations during induction with all-trans-retinoic acid. One patient developed FG. These lesions are predominantly seen in Asian population. A good outcome with supportive management occurred in all the cases.

Topics: Adolescent; Adult; Antineoplastic Agents; Fournier Gangrene; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Tretinoin; Ulcer

Topics: Adult; Antineoplastic Agents; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Tretinoin; Ulcer

All-trans-Retinoic acid (ATRA) has been shown to improve survival in patients with acute promyelocytic leukemia (APML). It is a well-tolerated drug except for the serious side effect of ATRA syndrome. Dryness of the skin, cheilitis, and xerostomia are the common mucocutaneous side effects. Occurrence of scrotal ulceration is very rare. We report a 13-year-old boy who had scrotal ulceration caused by ATRA during the induction therapy of APML.

Topics: Adolescent; Anti-Bacterial Agents; Antineoplastic Agents; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Scrotum; Steroids; Tretinoin; Ulcer

Topics: Genital Diseases, Male; Humans; Male; Scrotum; Tretinoin; Ulcer

Scrotal ulcer is a unique adverse effect of all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APL). The pathogenesis of scrotal ulceration remains unknown. We describe genital ulcers that developed in four patients with APL who were undergoing ATRA therapy (45 mg/m2 per day p.o.). Two of the patients were female, in whom this condition is quite rare. Genital ulcers with concomitant fever appeared between 17 and 32 days of therapy in all four patients. Genital ulcers healed in three of the patients while another patient developed Fournier's gangrene and underwent left testectomy. Ulcer healing was brought by either local or intravenous corticosteroids. Intravenous dexamethasone actually enabled continued ATRA administration in one patient, while ATRA was discontinued in other two patients. If corticosteroids cannot control progression of genital ulcers nor concomitant fever, ATRA administration should be discontinued so as not to induce Fournier's gangrene nor retionic acid syndrome. Our experience indicates the importance of recognizing genital ulcers associated with ATRA in order that appropriate countermeasures can be taken.

Topics: Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Antineoplastic Agents; Female; Fever; Fournier Gangrene; Genital Diseases, Female; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Tretinoin; Ulcer

Induction therapy with all-trans -retinoic acid has been shown to improve the outcome of patients with acute promyelocytic leukemia, although some side effects occur. Dry skin and lips are among the most common cutaneous side effects. We report a case of scrotal ulcerations induced by all-trans -retinoic acid in an American patient; to our knowledge this is the first such case reported.

Topics: Antineoplastic Agents; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Scrotum; Tretinoin; Ulcer

We report the development of painful scrotal ulceration in two patients during treatment with all-trans-retinoic acid (ATRA) for acute promyelocytic leukaemia (APL). ATRA 45 mg/m2 was administered orally for 8 days prior to the addition of standard induction chemotherapy. Painful scrotal ulceration developed in both cases within 2 weeks of therapy (9 and 13 days) and responded slowly to drug withdrawal and systemic, or topical, corticosteroids. A total of 17 APL patients have been treated with ATRA at our institution during the last 10 years, giving an incidence of approximately 12%. The present report, together with a review of literature, suggests that scrotal ulceration is a specific adverse effect of ATRA therapy and that this complication may be more common than previously documented.

Topics: Adrenal Cortex Hormones; Adult; Genital Diseases, Male; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Scrotum; Tretinoin; Ulcer