Perimalleolar ulcers in hydroxyurea treated patients with concomitant chronic venous disease: Diagnostic pitfalls

We report three male patients, with duplex confirmed chronic venous disease, who were on treatment with hydroxyurea for chronic myelogenous leukaemia (CML) and polycythemia vera (PV), referred to us for the management of non-healing perimalleolar ulcers of varying durations. Treatment of the ulcers, based on standard venous ulcer treatment protocols, proved futile, and one patient actually underwent surgery for varicose veins. The ulcers healed only after the discontinuation of hydroxyurea. In another patient, the ulcer continued to progress along with emergence of ankle oedema, venous eczema and lipodermatosclerosis, even after discontinuation of hydroxyurea. The short duration of treatment with the drug before the onset of ulcer and characteristic skin changes of chronic venous disease (CVD), in this patient, made us reconsider our diagnosis and this patient ultimately benefited from varicose veins surgery. Based on our experience with these cases, we have made an attempt to differentiate between the chronic venous ulcer and the drug-induced ulcer on clinical grounds.