Serpentine supravenous streaks induced by 5-fluorouracil

Abstract

To the Editor: Hrushesky1Hrushesky W.J. Unusual pigmentary changes associated with 5-fluorouracil therapy.Cutis. 1980; 26: 181-182PubMed Google Scholar was the first to report hyperpigmentation of the skin immediately overlying veins used for multiple 5-fluorouracil (5-FU) infusions and used the term “serpentine supravenous fluorouracil hyperpigmentation” for this entity.A 30-year-old male developed asymptomatic serpiginous hyperpigmentation characteristically overlying the right cephalic, basilic, median cubital veins, and median vein of forearm (Fig 1) after receiving 2 cycles of adjuvant 5-FU as continuous intravenous infusion for rectal adenocarcinoma. There was no clinical evidence of thrombophlebitis, and these veins were still patent. The histopathology of the involved skin showed an increase in the epidermal melanin content and melanin incontinence into the dermis (Fig 2). The patient received a third cycle of 5-FU that did not worsen the pigmentation.Fig 2Photomicrograph showing increased epidermal melanin content and melanin incontinence into the dermis. (Hematoxylin-eosin stain; original magnification: ×100.)View Large Image Figure ViewerDownload (PPT)The exact mechanism of this phenomenon is unknown, but it has been postulated that these cytotoxic agents cause endothelial injury. The agent then leaches from the vessel to the overlying epidermal melanocytes and interferes in melanosome packaging with the keratinocytes,2O'Daugherty D. Hyperpigmentation after cancer chemotherapy.Lancet. 1975; 2: 365Abstract Scopus (6) Google Scholar thereby resulting in hyperpigmentation of that skin.This is an isolated occurrence of 5-FU–induced serpentine supravenous streaks; in the absence of other dermatologic, hematologic, or gastrointestinal side effects, this is an extremely rare phenomenon. There is no specific treatment3Perlin E. Ahlgern J.D. Pigmentary effects from protracted infusion of 5-fluorouracil.Int J Dermatol. 1991; 30: 43-44Crossref PubMed Scopus (18) Google Scholar for the pigmentary streaks induced by 5-FU. In time, the pigmentation disappears and may not warrant discontinuation of the drug. To the Editor: Hrushesky1Hrushesky W.J. Unusual pigmentary changes associated with 5-fluorouracil therapy.Cutis. 1980; 26: 181-182PubMed Google Scholar was the first to report hyperpigmentation of the skin immediately overlying veins used for multiple 5-fluorouracil (5-FU) infusions and used the term “serpentine supravenous fluorouracil hyperpigmentation” for this entity. A 30-year-old male developed asymptomatic serpiginous hyperpigmentation characteristically overlying the right cephalic, basilic, median cubital veins, and median vein of forearm (Fig 1) after receiving 2 cycles of adjuvant 5-FU as continuous intravenous infusion for rectal adenocarcinoma. There was no clinical evidence of thrombophlebitis, and these veins were still patent. The histopathology of the involved skin showed an increase in the epidermal melanin content and melanin incontinence into the dermis (Fig 2). The patient received a third cycle of 5-FU that did not worsen the pigmentation. The exact mechanism of this phenomenon is unknown, but it has been postulated that these cytotoxic agents cause endothelial injury. The agent then leaches from the vessel to the overlying epidermal melanocytes and interferes in melanosome packaging with the keratinocytes,2O'Daugherty D. Hyperpigmentation after cancer chemotherapy.Lancet. 1975; 2: 365Abstract Scopus (6) Google Scholar thereby resulting in hyperpigmentation of that skin. This is an isolated occurrence of 5-FU–induced serpentine supravenous streaks; in the absence of other dermatologic, hematologic, or gastrointestinal side effects, this is an extremely rare phenomenon. There is no specific treatment3Perlin E. Ahlgern J.D. Pigmentary effects from protracted infusion of 5-fluorouracil.Int J Dermatol. 1991; 30: 43-44Crossref PubMed Scopus (18) Google Scholar for the pigmentary streaks induced by 5-FU. In time, the pigmentation disappears and may not warrant discontinuation of the drug.