Case Report
Cicatricial ectropion: A complication of topical 5-fluorouracil

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Summary

Topical 5-fluorouracil (5-FU) is a simple chemotherapeutic treatment that can be used by the plastic surgeon for indicated skin lesions. We present a case of transient, cicatricial ectropion developing secondarily to topical treatment with 5-FU, and propose an algorithm for the management of this significant complication.

Introduction

Topical 5-fluorouracil (5-FU) is an inexpensive and simple chemotherapeutic treatment that can be used by the plastic surgeon for indicated skin lesions. It is applied to the affected area twice daily and may be applied for up to six weeks or more. An effective response to treatment is frequently indicated by a marked inflammatory reaction that usually subsides upon discontinuation. We present a case of transient, cicatricial ectropion developing secondarily to topical treatment with 5-FU, and propose an algorithm for the management of this rare but significant complication (Figure 1).

Section snippets

Case report

An 83-year-old gentleman was referred from dermatology to the plastic surgery department for excision biopsy of a probable basal cell carcinoma (BCC) in the left post-auricular sulcus. His initial presentation to dermatology was for consideration of the management of this lesion along with actinic keratoses on his face. These were located approximately 1 cm lateral to the right lateral canthus and over the left malar region. The patient was referred to the plastic surgery department for

Discussion

The development of ectropion following systemic 5-FU appears to be more frequently reported than with its topical application.1, 2, 3, 4 Although this complication is rare, it can result in significant secondary changes that include blepharitis, palpebral conjunctival hypertrophy, keratinization and conjunctival scarring. Permanence following discontinuation of topical 5-FU has not been described, however the approach of ‘benign neglect’ may not be appropriate in all cases due to the

Conflict of interest/Funding

All named authors hereby declare that they have no conflicts of interest to disclose. This research received no specific grant from any funding agency in the public, commercial or not-for profit services.

References (4)

  • D.J. Straus et al.

    Cicatricial ectropion secondary to 5-fluorouracil therapy

    Med Pediatr Oncol

    (1977)
  • B.S. Hurwitz

    Cicatricial ectropion: a complication of systemic fluorouracil

    Arch Ophthalmol

    (1993)
There are more references available in the full text version of this article.

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    Residual hypo- or hyperpigmentation may occur. Eye irritation, conjunctivitis, keratitis, and some cases of ectropion have been reported during treatment of periocular lesions, but completely resolved after discontinuation of therapy.8,13,14 Although little 5-FU is absorbed from normal skin, about 20% can reach the bloodstream when it is applied to damaged skin.

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