Extravasation injury, which occurs in about 1% of patients undergoing chemotherapy, is associated with significant morbidity. Topical application of dimethyl sulfoxide (DMSO), an anti-inflammatory agent, has been shown to be effective in treating this problem in several studies.^1-2 In a pilot study, DMSO therapy over 3 months significantly improved anthracycline-associated extravasation in 16 of 20 patients.²

In our experience, regular DMSO application can completelyreverse extravasation injury even when treatment is delayed. Forexample, in one patient receiving continuous-infusiondoxorubicin for hepatoma, chest-wall induration of 5 daysstanding decreased more than 50% after 4 weeks of DMSOtherapy and completely resolved after 8 weeks. The indurationresulted from inadvertent extravasation that occurred when thecatheter needle worked its way out of the port.

Even days after injury, we instruct patients to liberally apply70% DMSO using cotton swabs and remove any excessremaining after 45 minutes with a white cotton cloth or tissue.This treatment is repeated every 3 to 4 hours during the day untilall evidence of injury has disappeared.

In 20 years of using DMSO, the only toxicity we have seen has been a stinging or burning sensation during initial application. If the problem becomes severe, aloe vera gel can be applied after wiping off the remaining DMSO. Patients treated with DMSO also may develop a characteristic breath odor. Other practitioners and researchers also have had positive results with DMSO.^1-10 We suggest that a central repository be formed for the study of extravasation injury and DMSO.

Dr. Strum is a medical oncologist in private practice in CulverCity, Calif.

1. Svingen BA, Powis G, Appel PL, et, al: Protection against adriamycin-induced skin necrosis in the rat with dimethyl sulfoxide and alpha tocopherol. Cancer Res 81; 41:3395.
2. Desai MH, Teres D: Prevention of doxorubicin-induced skin ulcers in the rat and pig with dimethyl sulfoxide (DMSO). Cancer Treat Rep 1982;66:1371.
3. Nobbs P, Barr RD: Soft tissue injury caused by antineoplastic drugs in inhibited by topical dimethy sulphoxide and alph toccopherol. Br J Cancer 83;48:873.
4. Lawrence HJ, Goodnight SH: Dimethyl Sulfoxide and extravasation of anthracycline agents (letter). Ann Intern Med 1983; 98:1025.
5. Ldwig CU, Stoll HR, Obrist R, et al: Prevention of cytotoxic drug-induced skin ulcers with dimethyl sulfoxide (DMSO) and alphatocopherol. Eur J Cancer Clin Oncol 1987; 23:327.
6. Olver IN, Schwartz MA: Use of dimethyl sulfoxide in limiting tissue damage caused by extravasation of doxorubicin (letter) Cancer Treat Rep 1983;67:407.
7. Lawrence HJ, Walsh D, Zapotowski KA et al: Topical dimethylsulfoxide may prevent tissue damage from anthracycline extravasation (Abstract) Proc Am Soc Clin Oncol 1988; 7:279.
8. Olver IN, Aisner J, Hament A, et al: A prospective trial of topical dimethyl sulfoxide (DMSO) for treating anthracycline extravasation (Abstract); Proc Am Soc Clin Oncol 1988; 7:279.
9. Bertelli G, Dini D, Forno G, et al: Dimethylsulfoxide and cooling after extravasation of antitumor agents. Lancet 93;341:1098.
10. .Alberts DS, Dorr RT: Case report: topical DMSO for mitomycin-C induced skin ulceration. Oncol Nurs Forum 1991;4:693.

Source: "Clinical Tip," Contemporary Oncology, October 1993, page 9.

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