Lowitt M H, Eisenberger M, Sina B, Kao G F
Department of Dermatology, University of Maryland Cancer Center, Baltimore, USA.
Arch Dermatol. 1995 Oct;131(10):1147-53. doi: 10.1001/archderm.131.10.1147.
During a trial of suramin for advanced solid tumors, a high rate of cutaneous adverse reactions was observed. We present a prospective study, describing the clinical, histopathologic, histochemical, and immunochemical findings of the cutaneous reactions observed in 60 patients treated with suramin.
Forty-nine (82%) of the 60 patients studied experienced at least one cutaneous reaction attributable to suramin therapy. Although morbilliform reactions predominated, a wide variety of eruptions was observed. Most reactions occurred within the first 24 hours of therapy and were self-limited despite continued drug infusion. Distinctive cutaneous findings included scaling erythematous papules (suramin keratoses) and a predilection of many eruptions for previously sun-exposed areas. Six patients experienced severe cutaneous reactions, but no patient permanently withdrew from therapy because of cutaneous toxic reactions. Common histopathologic findings included hyperkeratosis, parakeratosis, spongiosis, acanthosis, exocytosis, apoptosis, a perivascular lymphohistiocytic infiltrate, upper dermal edema, and increased dermal mucin. Staining with S100 antigen was markedly positive in several specimens. Only trace amounts of suramin were detected in skin samples tested with high-pressure liquid chromatography.
The incidence of cutaneous toxic reactions from suramin greatly exceeds that seen with other medications. A wide spectrum of skin manifestations were observed, including suramin keratoses and UV recall, although serious reactions were infrequent. Cutaneous toxic reactions neither predicted nor correlated with other toxic reactions from suramin. Suramin may soon become more widely used; practitioners should be aware of the high incidence and wide spectrum of cutaneous toxic reactions to this drug.
在一项针对晚期实体瘤的苏拉明试验中，观察到皮肤不良反应的发生率很高。我们开展了一项前瞻性研究，描述了60例接受苏拉明治疗的患者所观察到的皮肤反应的临床、组织病理学、组织化学和免疫化学结果。
在研究的60例患者中，有49例（82%）经历了至少一种可归因于苏拉明治疗的皮肤反应。尽管麻疹样反应占主导，但观察到了各种各样的皮疹。大多数反应发生在治疗的头24小时内，尽管继续输注药物，但这些反应具有自限性。独特的皮肤表现包括鳞屑性红斑丘疹（苏拉明角化病），并且许多皮疹好发于先前暴露于阳光的部位。6例患者出现严重的皮肤反应，但没有患者因皮肤毒性反应而永久停止治疗。常见的组织病理学表现包括角化过度、不全角化、海绵形成、棘层肥厚、细胞外渗、凋亡、血管周围淋巴细胞和组织细胞浸润、真皮上层水肿以及真皮粘蛋白增加。用S100抗原染色在几个标本中呈明显阳性。在用高压液相色谱法检测的皮肤样本中仅检测到微量的苏拉明。
苏拉明引起的皮肤毒性反应的发生率大大超过其他药物。观察到了广泛的皮肤表现，包括苏拉明角化病和紫外线回忆反应，尽管严重反应很少见。皮肤毒性反应既不能预测苏拉明的其他毒性反应，也与之无关。苏拉明可能很快会得到更广泛的应用；从业者应该意识到这种药物引起的皮肤毒性反应的高发生率和广泛表现。
