Topical calcium folinate wet compress for treating skin damage caused by high-dose methotrexate chemotherapy: two case reports

High-dose methotrexate (HDMTX) chemotherapy is a crucial method for consolidating the therapeutic effect of acute lymphoblastic leukemia (ALL). However, its side effects, particularly in patients with mutations in multi-drug resistance gene 1 (ABCB1) and/or methylene-tetrahydrofolate reductase (MTHFR) genes, should not be disregarded, as their abnormal MTX metabolism can lead to increased organ damage. This study reported two cases demonstrating the management of skin damage caused by HDMTX chemotherapy. A mixture of 0.9% saline (100 mL) and 100 mg of calcium folinate (CF) was prepared. CF saline was sprayed onto the skin using a disposable sterile syringe, or sterile gauze soaked in CF saline was applied as a wet compress on the affected skin areas. Ultimately, the skin damage caused by HDMTX chemotherapy in two patients was recovered within a short time. This study suggests that topical calcium folinate wet compress is convenient and effective in treating skin damage caused by HDMTX therapy, especially in patients with slow metabolism.