MANAGING SKIN DAMAGE INDUCED BY DOXORUBICIN HYDROCHLORIDE AND DAUNORUBICIN HYDROCHLORIDE
MANAGING SKIN DAMAGE INDUCED BY DOXORUBICIN HYDROCHLORIDE AND DAUNORUBICIN HYDROCHLORIDE
复制标题
DOI：
10.1093/ajhp/41.11.2410
复制
发表时间：
1984-01-01
期刊：
影响因子：
--
通讯作者：
COX, RF
中科院分区：
文献类型：
--
作者：
COX, RF
综述了蒽环类药物致皮肤损伤的病理生理机制和毒性机制，并讨论了各种有效的治疗措施。发泡剂抗肿瘤药物盐酸阿霉素和盐酸柔红霉素引起的皮肤溃疡起病缓慢，组织损伤的程度往往被低估。在一周内，未经治疗的这些药物的渗透可能会进展为严重的硬结和溃疡，对肌腱和骨骼等潜在结构造成广泛损害。人们提出了两种理论来解释人类环素引起的组织损伤的作用机制；一种认为阿霉素-DNA复合体形成导致细胞死亡的阿霉素-DNA复合体，另一种认为这些药物被还原为自由基，导致细胞膜破坏。渗出的非药物治疗包括在出现问题的第一个迹象时停止输液，并试图通过同一根针吸回液体和药物。建议在接下来的24-72小时内使用冰袋。已经评估了各种药理学方法来改善组织损伤。皮质类固醇、碳酸氢钠、β-肾上腺素能药和二甲基亚砜的使用取得了一定的成功。早期保守治疗无效的患者应转介至整形外科医生进行皮肤移植和重建。预防是治疗蒽环类药物中毒的最好方法。
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.