Development of Genital Ulcer due to Hydroxyurea Treatment in a Patient with Polycythemia Vera - A Case Report

Case Report

Austin J Dermatolog. 2017; 4(2): 1073.

Development of Genital Ulcer due to Hydroxyurea Treatment in a Patient with Polycythemia Vera - A Case Report

Duarte L¹, González LF²*, Motta A², Rolón M³ and Rojas P²

¹Dermatology Service, Simón Bolivar Hospital, Colombia

²Department of Dermatology, El Bosque University, Colombia

³Pathology Service, Simón Bolivar Hospital, Colombia

*Corresponding author: Luis Fernando González, Department of Dermatology, El Bosque University, Bogotá, Colombia

Received: March 07, 2017; Accepted: May 29, 2017; Published: June 12, 2017


Genital ulcers due to Hydroxyurea treatment, is a very rare entity that requires the skills of dermatology specialists to suspect and diagnose it in early stages. We present a case of 48 years old female with history of polycythemia vera under treatment of Hydroxyurea during 10 years. She developed a painful genital ulcer in 15 days without any other manifestations. Herpetic etiology, HIV and primary syphilis were rejected. The skin biopsy specimen revealed neoangiogenesis associated with lymphoplasmocytic perivascular inflammatory infiltrate without evidence of vasculitis. There was a completely resolution of the lesions, 8 weeks after Hydroxyurea cessation. The patient was referred to the oncology service to continue her hematologic treatment.

Keywords: Hydroxyurea; Genital ulcer; Polycythemia vera


Hydroxyurea is a chemotherapeutic agent used since 1960 to handle different myeloproliferative disorders. It is generally well tolerated, but in approximately 9% of patients, it will be present some side effects like nausea, headache, diarrhea and fever [1]. With its prolonged use, it can cause some skin manifestations, such as xerosis, nail disorders, diffuse hyperpigmentation, dermatomyositis-like lesions and less frequently, ulcers. Ulceration due to hydroxyurea is located in areas of major trauma, predominantly in the lower limbs, mouth and, less frequently, genital area [1-3]. We present this case because of its low prevalence, thinking about the importance of early suspicion and recognition like one of the non infectious skin lesions etiologies. It is mandatory to provide early treatment and improve the patient quality of life.

Case Presentation

We report a 48 year-old female patient, who has a medical history of polycythemia vera since 2006, receiving only oral hydroxyurea 1g per day, without any other coadjuvants treatments. After 10 years of treatment, in 2016, she was admitted to the emergency room with 15 days of a painful ulcer located in the genital area. On physical examination, well defined edge ulcer with fibrous base in the labia majora genitals was found (Figure 1). A clinical diagnosis of the ulcer was suspected, Bechet disease was dismissed since it was confirmed the absence of oral ulcer, eye or skin injuries. Clinical features of herpes simplex and syphilis ulceration, doesn’t belong to the patient type of lesion. The first one usually presents erosive and erythematous halos that follow a neural distribution, the second one, presents as a painless continuity solution, clean background, with microbiological spiroketa in culture specimen. VDRL titers, HIV, IgG and IgM for herpes type I and II was negative. A skin biopsy was performed, including culture and immunochemistry protocols. Histopathology describes an important dermal sclerosis and neoangiogenesis associated with lymphoplasmacytic perivascular inflammatory infiltrate without evidence of vasculitis on genital area (Figure 2,3). Periodic-Acid- Schiff (PAS) and Ziehl-Neelsen (ZN) stains were negative for fungi or bacterial structures. Given the clinical presentation, the background of hydroxyurea exposure and histopathological findings a diagnosis of ulcer due to hydroxyurea was made. The patient was referred to the oncology service and the withdrawal of hydroxyurea resulted in complete resolution of clinical picture in eight weeks (Figure 4).