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October 1992

Iontophoresis of Vinblastine Into Normal Skin and for Treatment of Kaposi's Sarcoma in Human Immunodeficiency Virus-Positive Patients

Author Affiliations

USA; USA; USN; USN; USN; USA; USA; and the Military Medical Consortium for Applied Retroviral Research

From the Walter Reed Army Institute of Research, Washington, DC (Dr Smith); Henry M. Jackson Foundation, Bethesda, Md (Drs Konzelman and Wagner); Cancer Treatment Section, Hematology-Oncology Service (Dr Lombardo), and Infectious Disease Service, Department of Medicine (Drs Oster and Chung), Walter Reed Army Medical Center, Washington, DC; Department of Dermatopathology, Armed Forces Institute of Pathology, Washington, DC (Drs Skelton and Holland); and Department of Dermatology, National Naval Medical Center, Bethesda, Md (Dr Yeager).

Arch Dermatol. 1992;128(10):1365-1370. doi:10.1001/archderm.1992.01680200075010

• Background.—  Patients who test positive for human immunodeficiency virus type 1 (HIV-1) and who have disfiguring and/or painful cutaneous lesions of Kaposi's sarcoma (KS) may not be candidates for systemic chemotherapy and/or immunotherapy. Intralesional vinblastine sulfate, as a single-agent chemotherapeutic drug, has been used with some success to treat KS in patients who are HIV-1 positive. However, some patients may not tolerate the pain asociated with injection of vinblastine. Transcutaneous iontophoresis of vinblastine was evaluated for therapy of KS in HIV-1-infected patients. Prior to therapy of patients, we iontophoresed vinblastine into the normal skin of volunteers who were not infected with HIV-1 to document the clinical and histologic features that occurred.

Observations.—  Iontophoresis produced a localized erythematous papular eruption in non-HIV-infected volunteers but not in HIV-1-infected patients. Histologic changes in the biopsy specimens taken from non-HIV-infected volunteers consisted primarily of scattered necrotic keratinocytes and a mild to moderate superficial lymphohistiocytic infiltrate. Thirty-one lesions of KS were treated with partial to complete clearing and symptomatic improvement.

Conclusion.—  Clinical and histologic features of iontophoresed normal skin suggest an immunologic mechanism of action. lonotophoresis of vinblastine for KS is well tolerated and results in symptomatic improvement as well as varying degrees of clearing of the lesions.(Arch Dermatol. 1992;128:1365-1370)