Background: Pegylated liposomal doxorubicin (PLD) is a highly efficient chemotherapeutic; however, it induces dermal side effects such as palmar-plantar erythrodysesthesia (PPE) in up to 80% of cases, probably by being emitted with the sweat onto the skin surface. Aim: The aim of the present study was to examine whether a topically applied ointment containing antioxidants with a high radical protection factor is able to prevent the formation of PPE. Methods: Twenty patients suffering from ovarian carcinoma and treated with PLD were observed. Results: 60% of the patients tolerated the regular application of the cream and developed no PPE. The remaining 40% interrupted the application. Six of them developed PPE and resumed ointment application thereafter. In these cases the PPE disappeared or was strongly reduced. Conclusion: The results of the observation clearly demonstrate that topical application of the ointment is an efficient strategy against the development of PPE during chemotherapy with PLD.

Tape stripping in combination with spectroscopic measurements is a suitable method for the non-invasive determination of the dermatopharmacokinetics of topically applied substances. The penetration profiles obtained by these methods represent a cut to the stratum corneum, where the distribution of the topically applied substances is shown. For the penetration of these penetration profiles knowledge regarding the penetration pathways is necessary. Laser scanning microscopy is a well-suited method for the analysis of the penetration pathways. In the present paper, the results obtained by the combined tape stripping method and laser scanning microscopy were compared for the interpretation of penetration profiles concerning the penetration pathways of the topically applied substances. µmDistribution of the dye in hair follicles

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5064 Background: Pegylated liposomal doxorubicin has proved to be highly efficient in the treatment of various tumors. Depending on the application protocol, up to 80% of patients develop palmar-plantar erythrodysesthesia (PPE). So far, a prevention strategy is still unknown. Recently, it was shown that parts of the chemotherapeutics were excreted with the sweat onto the skin surface, spreading there homogeneously and penetrating into the stratum corneum. The formation of free radicals in the tissue results in PPE. The aim of the study was to investigate if a topically applied ointment containing antioxidants with high radical protection factor (RPF) can be a PPE prevention strategy. Methods: 20 patients with ovarian carcinoma, who had been treated with pegylated liposomal doxorubicin (40 mg/m2), were investigated. They applied the ointment at least twice daily, 2 days before and during 3 cycles of chemotherapy. Their skin condition was examined by a trained dermatologist. Results: From 20 patients enrolled in the study, only 12 (60%) met the conditions by applying the cream at least twice daily in the palmar and plantar regions. These patients did not develop PPE. One patient died in the 2nd cycle of therapy. 7 patients (35%) did not follow the ointment application protocol for various reasons; 6 of them developed PPE and resumed ointment application thereafter. As a result, PPE disappeared or was strongly reduced in these patients so that chemotherapy could be continued. Due to the small group of patients, the fact that PPE was not induced in patients who had applied the ointment regularly can be generalized only restrictedly. Far more interesting are the findings in those patients, who had stopped ointment application during chemotherapy and developed PPE, which disappeared after they resumed applying the ointment. The regression or distinct reduction of PPE after re-application of the ointment clearly proves the efficacy of this strategy. Conclusions: The topical application of an ointment containing antioxidants with high radical protection factor (RPF) could be an efficient strategy against the development of PPE during chemotherapy.

e19558 Background: The palmar-plantar erythrodysesthesia syndrome (PPE) is a cutaneous side effect often observed in patients under chemotherapy, e.g., with pegylated liposomal doxorubicin. This side effect entails a reduction in the antioxidative potential of the skin due to intensive radical formation. Recently, it was demonstrated that topical treatment of patients with an ointment containing high concentrations of antioxidants is an efficient prevention strategy against PPE when applied before the beginning of chemotherapy. In a 5-year observation period at the Department of Dermatology of the Charité we selected patients, who had developed a PPE during treatment with a variety of chemotherapeutics. The aim of the present study was to investigate whether the antioxidant containing ointment is also suited to treat PPE, which occurred during treatment of 13 types of cancer with chemotherapeutics besides doxorubicin. Methods: In 5 years, 68 patients having developed PPE during treatment with 12 different chemotherapeutics, including pegylated liposomal doxorubicin, capecitabin and sorafenib applied an ointment containing antioxidants with a high radical protection factor (RPF). 46 patients exhibited PPE grade III and 22 patients PPE grade II. All patients were treated with the antioxidant-containing ointment, which was applied at least twice daily in the palmar and plantar regions. Results: Treatment with the antioxidant-containing ointment resulted in a distinct regression or disappearance of PPE. After 4 weeks of treatment the PPE grade III originally diagnosed in 46 patients had reduced to grade II in 6 and to grade I in 33 patients. In 7 patients the PPE had completely disappeared. The PPE grade II diagnosed in 22 patients had alleviated to grade I in 7, and completely disappeared in 15 patients. Conclusions: Obviously, cutaneous side effects entailing radical formation processes are also induced by other types of chemotherapeutics. An antioxidant containing ointment with high RPF is not only suited to prevent PPE in patients under doxorubicin therapy, but is also effective in treating PPE caused by other chemotherapeutics.