Skip to main content
SpringerLink
Log in

Intranasal Efudix reduces epistaxis in hereditary hemorrhagic telangiectasia

  • Letter
  • Published:
Angiogenesis Aims and scope Submit manuscript

Abstract

Background

Local application of fluorouracil (Efudix, 5-FU) induces sclerosis in patients with sinonasal tumors and superficial basocellular skin carcinoma. As a ‘back against the wall’ treatment, we investigated the local effect of nasally applied 5-FU and whether this could decrease the burden of severe epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT).

Methods

HHT patients with severe and frequent epistaxis, subsequent anemia and a necessity for blood and/or iron infusions were treated with a nasal tampon with 5-FU. This tampon was placed unilaterally in the nasal cavity on the side of the most severe epistaxis and replaced once weekly during 4 weeks. Outcome measures were safety and side effects, the aspect of the nasal mucosa measured with the mucosal HHT score, the epistaxis severity score (ESS), hemoglobin and ferritin plasma levels, and quality of life assessment pre-treatment, one and three months post-treatment.

Results

Six HHT patients participated. During treatment and follow-up, the nasal mucosa turned more pale and sclerotic and the number of telangiectases diminished. The mucosal HHT score improved and the ESS declined (p = 0.01). The decline of ESS persisted up to 3 months post-5-FU treatment. Moreover, mean hemoglobin levels increased from 6.0 pre-5-FU to 6.8 after one month post-5-FU.

Conclusion

Unilateral application of 5-FU on a nasal tampon diminished the severity and frequency of epistaxis in all HHT patients. This effect sustained up to three months post-treatment, despite the fact that the contralateral side remained untreated. Subsequently, hemoglobin levels increased. Intranasal 5-FU is a promising entity for further research on epistaxis treatment in HHT patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Shovlin CL (2010) Hereditary haemorrhagic telangiectasia: pathophysiology, diagnosis and treatment. Blood Rev 24:203–219. https://doi.org/10.1016/j.blre.2010.07.001

    Article  CAS  PubMed  Google Scholar 

  2. Mahoney EJ, Shapshay SM (2006) New classification of nasal vasculature patterns in hereditary hemorrhagic telangiectasia. Am J Rhinol 20:87–90. https://doi.org/10.1177/194589240602000116

    Article  PubMed  Google Scholar 

  3. Geirdal AØ, Dheyauldeen S, Bachmann-Harildstad G, Heimdal K (2012) Quality of life in patients with hereditary hemorrhagic telangiectasia in Norway: a population based study. Am J Med Genet Part A 158A:1269–1278. https://doi.org/10.1002/ajmg.a.35309

    Article  PubMed  Google Scholar 

  4. Chin CJ, Rotenberg BW, Witterick IJ (2016) Epistaxis in hereditary hemorrhagic telangiectasia: an evidence based review of surgical management. J Otolaryngol Head Neck Surg 45:3. https://doi.org/10.1186/s40463-016-0116-8

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bulstrode NW, Mudera V, McGrouther DA et al (2005) 5-fluorouracil selectively inhibits collagen synthesis. Plast Reconstr Surg 116:209–221. https://doi.org/10.1097/01.prs.0000169701.16509.d6. discussion 222-3

    Article  CAS  PubMed  Google Scholar 

  6. Prince GT, Cameron MC, Fathi R, Alkousakis T (2018) Topical 5-fluorouracil in dermatologic disease. Int J Dermatol 57:1259–1264. https://doi.org/10.1111/ijd.14106

    Article  CAS  PubMed  Google Scholar 

  7. Knegt PP, Ah-See KW, Vd Velden L-A, Kerrebijn J (2001) Adenocarcinoma of the ethmoidal sinus complex. Arch Otolaryngol Neck Surg 127:141. https://doi.org/10.1001/archotol.127.2.141

    Article  CAS  Google Scholar 

  8. Almeyda R, Capper J (2008) Is surgical debridement and topical 5 fluorouracil the optimum treatment for woodworkers’ adenocarcinoma of the ethmoid sinuses? A case-controlled study of a 20-year experience. Clin Otolaryngol 33:435–441. https://doi.org/10.1111/j.1749-4486.2008.01790.x

    Article  CAS  PubMed  Google Scholar 

  9. Hoag JB, Terry P, Mitchell S et al (2010) An epistaxis severity score for hereditary hemorrhagic telangiectasia. Laryngoscope. https://doi.org/10.1002/lary.20818

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was secured for this treatment, and there is no financial disclosure.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Sint Antonius Hospital, Nieuwegein, The Netherlands

    D. V. C. de Jel, F. J. M. Disch & F. J. Verdam

  2. Department of Pulmonology, Sint Antonius Hospital, Nieuwegein, The Netherlands

    S. Kroon & J. J. Mager

Authors
  1. D. V. C. de Jel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. J. M. Disch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Kroon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. J. Mager
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. J. Verdam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. V. C. de Jel.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 59 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Jel, D.V.C., Disch, F.J.M., Kroon, S. et al. Intranasal Efudix reduces epistaxis in hereditary hemorrhagic telangiectasia. Angiogenesis 23, 271–274 (2020). https://doi.org/10.1007/s10456-020-09712-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10456-020-09712-2

Keywords

Search

Navigation