A Role Of Prostaglandins In Tissue Repair: Delayed Skin Wound Healing By Celecoxib And Bevacizumab During Herpes Zoster

Recent discovery showed that bevacizumab, a neutralizing antibody against vascular endothelial growth factor, plays a key role in promoting standard chemotherapy for several cancers. Among them, metastatic ovarian cancer has been treated by paclitaxel and carboplatin in combination with bevacizumab. Celecoxib, a selective cyclooxygenase II inhibitor, plays a major role in reducing the production of prostaglandins that promote accelerated wound repair as well as inflammatory tissue response. Therefore, we wondered if celecoxib may further increase the risk for delayed skin wound healing, and whether prostaglandin plays an important role in repairing skin ulcerations. Here, we demonstrate a case of cancer patient who indicated a potential risk of celecoxib for delayed wound healing during chemotherapy combined with bevacizumab. A 65-year-old female suffered from abdominal pain for a month. A series of examination demonstrated her diagnosis as cancer of unknown primary with multiple metastases in the left ovary and liver. The patient received a standard chemotherapy combined with bevacizumab for metastatic ovarian cancer. Thereafter, she developed several complications such as herpes zoster in the head and neck followed by dissemination and severe pain. Intravenous treatment by acyclovir and acetaminophen was initiated as well as oral uptake by celecoxib, which gave rise to skin ulceration and delayed wound healing in the skin. Therefore, we decided to quit oral celecoxib and to initiate topical application by prostaglandin-containing ointment. This treatment successfully induced complete recovery of numerous skin ulcers without slight pain, indicating that prostaglandins play a key role in promoting neovascularization and re-epithelization during skin wound healing. In conclusion, non-steroidal anti-inflammatory drugs such as celecoxib should be carefully concerned and may not be combined with bevacizumab due to an increased risk for impaired tissue remodeling.