Skin necrosis from extravasation of vinorelbine

Skin necrosis from intravenous infiltration of soft tissue is a rare but potentially devastating complication of intravenous therapy. Vinca alkaloids are among the intravenous drugs with the highest destructive power. We report two cases of skin necrosis from accidental extravasation of vinorelbine, a semisynthetic analogue of vinblastine, rarely described as being responsible for this event. Histopathologic study showed separation of the dermis from necrotic epidermis, associated with cytologic atypia, in both patients, and focal necrosis of eccrine glands in one of them. We consider that intravenous infusions of vinorelbine should be performed using the preventive measures and care applied for other chemotherapeutic agents with high potential for induction of skin necrosis due to extravasation.

Intermittent short courses of cyclosporine microemulsion for the long-term management of psoriasis: a 2-year cohort study

BACKGROUND

Cyclosporine is effective in psoriasis, but long-term continuous therapy may be limited by renal impairment and hypertension. Intermittent short courses of treatment should minimize side effects and improve the risk-benefit ratio.

OBJECTIVE

Our purpose was to assess the long-term efficacy and safety of intermittent short courses of the microemulsion formulation of cyclosporine (Neoral) in the management of chronic plaque psoriasis unresponsive to topical therapies.

METHODS

In a multicenter open cohort study, 76 subjects were treated intermittently over a 2-year period. Patients with chronic plaque psoriasis were treated with cyclosporine until clearance of psoriasis or for a maximum of 12 weeks. Patients were then randomized into two groups. Group A stopped cyclosporine abruptly, whereas group B had the dose reduced by 1 mg/kg per day each week until cessation, which was within 4 weeks. On relapsing, patients received further courses of cyclosporine. Intermittent treatment was continued in this way for 2 years.

RESULTS

There was no statistically significant difference in the percentage of time in remission during the 2-year period between patients randomized to stop cyclosporine abruptly (56.2%) and patients randomized to taper cyclosporine within 4 weeks (61.8%). The mean percentage of time that patients received treatment during the study was 40.5% for randomization group A, 46.2% for randomization group B, and 42.8% overall. The median time to relapse was 115.5 days after the first treatment course but became progressively shorter after multiple treatment courses. Mean blood pressure and serum creatinine levels did not show any clinically significant changes over time.

CONCLUSIONS

This study indicates that intermittent short courses of cyclosporine are effective in patients with moderate to severe psoriasis for up to 2 years while improving the safety profile relative to continuous cyclosporine monotherapy.