Treatment of adriamycin‐lnduced skin ulcers: A prospective controlled study

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Abstract
Extravasation into the skin and subcutaneous tissues of vesicant antineoplastic agents such as Adriamycin can be a serious clinical problem causing indolent necrotic ulcers. Several methods of therapy have been advocated but none has convincingly demonstrated superiority. A controlled animal experiment was designed to test four methods of therapy. Sixty‐three 200‐g Sprague Dawley rats were divided into six groups of ten and one group of three. Groups I through V each received an intradermal injection of 0.2 mg Adriamycin diluted in 1 cc saline. Group I rats served as Adriamycin ulcer controls. Group II rats underwent immediate excision of the area discolored by the Adriamycin injection with primary closure of the wound. Five group III rats underwent excision and closure at 48 hours and five at seven days. Group IV rats received an immediate injection of 0.2 mg of hydrocortisone into the area of Adriamycin discoloration. Group V rats received immediate injection of 200 mg alphatocopherol (vitamin E) into the discolored area. Group VI rats received no Adriamycin injection but served as controls, five receiving hydrocortisone injections and five receiving vitamin E injections, intradermally. Group VII rats also served as controls, one receiving 2 cc saline injection, one receiving 1 cc saline and 1 cc hydrocortisone, and one receiving 1 cc saline and 1 cc vitamin E. The rats were observed for ten weeks. Biopsies were taken for histologic examination and measurements of ulcer size were made. Group II, III, VI, and VII animals did not develop ulcers and all excised injections in groups II and III healed within seven days of closure; no ulcers recurred in these rats within the ten‐week observation period. All animals in groups I, IV, and V developed ulcers which showed no difference in size at 16 days.We conclude that local injection of hydrocortisone and vitamin E are ineffectual in the treatment of the Adriamycin extravasation. Excision of the involved area to the underlying fascia with primary closure as soon as possible after the extravasation is more likely to be beneficial.