Mechlorethamine (Topical)

This topical gel is a medication which can be applied directly to the skin in the treatment of skin cancer, specifically cutaneous T-cell lymphoma.

Overview

Mechlorethamine belongs to the class of drugs known as alkylating agents, and its usage is primarily intended for the treatment of skin cancer cells. It works by preventing or slowing the growth of those skin cancer cells, so they don't spread all around the body, and don't get any larger in size. It is generally applied once each day, or as recommended by a doctor, and this can be done at home after medical personnel have demonstrated proper procedures and proper handling of the medication.

In most cases, mechlorethamine is only used after other skin cancer treatments have been tried, and have been found to be unsuccessful. Patients should be very careful to avoid getting this gel in their eyes, and if that does happen, the eyes should be thoroughly flushed out with water, without rubbing, for at least 15 minutes. You should still seek emergency medical attention afterwards, because there is a potential for this medicine to cause blindness or other kinds of permanent injury to the eyes.

Condition Treated

  • Cutaneous T-Cell lymphoma

Type Of Medicine

Alkylating agents

Side Effects

There are a number of side effects which are possible when using mechlorethamine topical gel, and it's especially important that both patient and doctor monitor the first few times that this medicine is used by any specific patient. Some patients may experience no side effects at all from using this medicine, while others may undergo particularly severe side effects, which call for additional medical attention in and of themselves.

If you should experience any of the side effects shown below to a degree that makes you uncomfortable, you should contact your doctor right away, and explain which side effects you are experiencing, as well as the level of severity. It could be that you will need to have your medication switched to something which is less bothersome, or you may simply have to discontinue usage of mechlorethamine for a time.

One of the most severe side effects to be on the alert for when using this medication is an allergic reaction. The reason this can be so important is that there is a potential for symptoms experienced with an allergic reaction to become life-threatening. For that reason, if you suspect you are having an allergic reaction to mechlorethamine, you should seek emergency medical help right away, before symptoms become extreme.

The things to look for in an allergic reaction are the following:

  • Itchiness at some locations around the body
  • Hives and or rashes appearing on the skin
  • Dizziness or lightheadedness, sometimes with the sensation that you are about to faint
  • Tightness in the area of the chest, often accompanied by an extreme difficulty with breathing
  • Puffiness or extreme swelling around the eyelids, or on the tongue, lips, and throat. This swelling can appear very quickly, and it can become noticeably worse very quickly.

Some of the other most likely side effects which you might experience from using mechlorethamine are related to skin reactions which might appear in the immediate aftermath of applying the gel:

  • Skin which becomes cracked, scaly, or dry
  • A sensation of warmth, tenderness, or pain on the skin, sometimes accompanied by noticeable swelling
  • Skin changing color to a reddish hue
  • Skin which becomes crusted, blistered, itchy, or otherwise irritated
  • A general darkening of the skin at the application site, and in the surrounding area.
  • Unusual bleeding or bruising
  • Signs of skin infection
  • Fever and or chills

Dosage

This medicine should only be used on the skin, and should not be applied anywhere near the nose, mouth, or eyes. It should also not be applied on any skin surfaces which have burns, scrapes or cuts. If mechlorethamine gets on to any of these undesirable areas, it should be rinsed off immediately, using soap and water, and flushed for at least 15 minutes. Any clothing which has become contaminated with the gel should also be removed and cleaned before wearing again. You should consult with your doctor if you notice that any kind of irritation persists after areas have been washed clean with soap and water.

The proper procedure for applying mechlorethamine is as follows:

  • After removing the tube from the refrigerator, apply the medicine as soon as possible to the affected area, at least within 30 minutes
  • Making sure that the application area is completely dry, apply a very thin layer of medication to the affected area.
  • You should not treat your skin with mechlorethamine until at least 30 minutes after you have showered or bathed, and you should not shower within four hours of having applied the medication to your skin
  • Replace the tube in its box and put it back in the refrigerator
  • Make sure any treated areas have at least 10 minutes to dry before being covered with clothing such as shirts or trousers
  • Do not wrap the treated skin or bandage it, and instead allow it to remain free as much as possible
  • Avoid smoking and any open fires or flames until long after the medicine has dried
  • Make sure to remember and wash your hands with water and soap after having applied this medicine with your fingers
  • If a caregiver is applying this medication for you, he/she should be wearing disposable nitrile gloves during the process, after which they should be disposed of and the caregiver should wash their hands with soap and water
  • Skin moisturizers are allowable on the sites to be treated within two hours of application, or two hours following application
  • A typical dosage for adults being treated for T-cell lymphoma skin cancer would be a single application to the affected area of the skin once each day.
  • Your doctor will determine how long this routine should go on, but that will be determined partially by the effectiveness of the medication, and your body's tolerance to it.

Interactions

There are not as many drug interactions to worry about with mechlorethamine as there might be with an ingested prescription medication. Since none of the medication is taken internally, there is very little opportunity for it to interact with other medicines that you may have ingested.

However, you should still let your doctor know if you have any kind of allergies such as to pets, fabrics, foods, or preservatives, since it's possible that these can be triggered when using mechlorethamine.

To be on the safe side, you should also prepare a list of all the medications you're currently using, including dietary supplements, vitamins, over-the-counter drugs, and other prescription medications, as well as the dosage levels of each of these. Your doctor can review this list and make a determination on whether any of them presents a danger for potential interaction with mechlorethamine.

It's also a good idea to have a list like this handy if you need to go to an emergency room for treatment, so that any doctor there can review your medication list and make sure that no drug you are currently taking will be interfered with by any may medication he/she might prescribe for treatment.

There are likely to be a higher number of reactions in geriatric patients than in younger ones, so greater caution should be observed for elderly patients.

There is a slight risk to pregnant women when using mechlorethamine, in that undesirable impacts may be imparted to the unborn fetus. You should consult with your doctor if you are pregnant or thinking of becoming pregnant while being treated with mechlorethamine. You and your doctor can discuss whether the benefits of the medication outweigh any risk during pregnancy.

There are no studies which have confirmed that breastfeeding could be problematic for a nursing infant whose mother is being treated with mechlorethamine. However, as with the case of pregnancy, the safe course of action would be to avoid breastfeeding while under a program of treatment which includes mechlorethamine.

Warnings

There are a few precautions you should be aware of when using mechlorethamine topical gel, the first of which is that you should have periodic appointments with your doctor so that he/she can check on the progress of the medication, and can also determine how well your body is tolerating it.

It's possible that mechlorethamine can harm an unborn fetus, so while you are being treated with this medication, you should use an effective form of birth control which will prevent pregnancy. In the event that you do somehow become pregnant while being treated with this medication, you should contact your doctor right away, and have a discussion about the situation.

It's possible for mechlorethamine to trigger a serious allergic reaction such as anaphylaxis, which can be life-threatening, and calls for emergency medical attention as soon as possible.

This medicine should not be allowed to get anywhere near your eyes since there is a potential for it to cause blindness or other kinds of permanent eye injuries, which are irreversible. If even a small amount contacts your eyes, you may notice pain, swelling, redness, blurred vision, or extreme sensitivity to direct light. Your eyes should immediately be flushed out with water or an eyewash solution, and this should be continued for 15 minutes. You should also call your doctor right away, to do everything possible to prevent any kind of permanent injury.

This medication should also not be allowed to get in your nose or your mouth because it can cause pain and ulcers in either of those locations. If any medication accidentally does touch those areas, they should be rinsed out completely for 15 minutes with water, and you should contact your doctor right away.

There's a possibility that mechlorethamine can cause extremely undesirable skin reactions, including non-melanoma skin cancers. You should alert your doctor immediately if you experience anything like swelling, redness, itchiness, blisters, or ulcers which appear on your skin.

Storage

This medication needs to be refrigerated, so it should be stored in your refrigerator, but not near any other food inside, and it should never be frozen. Mechlorethamine must be kept out of the reach of children and should be disposed of according to proper procedures which your doctor or pharmacist will provide for you.

When you have finished using a tube of this medication, you should dispose of it and the disposable gloves you used in the trash bag. No pets or children should be allowed to come in contact with either the gloves or the tube, and if either one does, you'll have to follow the same flushing with water routine for 15 minutes as you would for anyone else. If your medication reaches its expiration date or has not been used within 60 days of issue, it should be disposed of without being used.

Summary

Mechlorethamine is a topical gel which is used for the treatment of certain kinds of skin cancer and requires a prescription from your doctor. It is generally used only after other forms of treatment have been used and have been found to be ineffective. There is a significant danger that this medicine can cause permanent injury to the eyes if it should come in contact with them, and to the nose or mouth as well. For that reason, extreme care should be used when applying the medicine, and the application site should be regularly checked for signs of irritation.