Chlormethine (Specialist drug)

How it works

It alkylates and cross-links DNA, inhibiting DNA replication and causing death of rapidly dividing cells in the skin lesions.

Prescribing in practice

• The topical gel commonly causes dermatitis (skin redness, irritation and inflammation), which may require dose-frequency adjustment or interruption.
• It is for cutaneous use only; avoid contact with the eyes, mucous membranes and healthy skin, and wash hands after handling.
• Caregivers should apply with care and avoid their own skin contact, and treated areas should not be occluded unless directed.

Monitoring

Monitor the skin for irritation, dermatitis and secondary infection during treatment.

Counselling the patient

• Apply only to affected skin as directed and allow it to dry; wash your hands thoroughly afterwards.
• Keep the gel away from your eyes, nose and mouth, and rinse immediately with plenty of water if accidental contact occurs.
• Report troublesome skin redness, blistering or signs of infection to your team.

Evidence & guidelines

Topical chlormethine is an established option for early-stage cutaneous T-cell lymphoma, supported by clinical trial evidence and reflected in the SPC.