Asymmetric Acral Spared Phenomenon Related to Systemic Anticancer Therapies

Abstract

We have observed three patients on anticancer therapies presenting with asymmetric acral spared phenomenon and found six identical cases in the literature. All of them had common features, an alteration of the peripheral nerves affecting a limb unilaterally that was spared by a hand-foot syndrome or hand-foot skin reaction. A drug-induced neurotropic effect sounds logical for developing such alterations with specific chemotherapeutic agents (taxanes, cap­ecitabine), while we have not found good explanations concerning the multikinase inhibitor sorafenib nor the topo isomerase inhibitor adriamycin. Nevertheless, we know that clinical manifestations of many inflammatory diseases need intact neural components.

Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines☆

“…Similarly, a phototoxic mechanism for photo-onycholysis has been advanced by some authors but remains to be confirmed [87]. The integrity of peripheral nerves appears to be a substantial factor for developing nail unit alterations with taxanes, suggesting a drug-induced neurotropic effect [88]. It is hypothesised that the higher incidence of onycholysis with the weekly paclitaxel regimen (1-hour infusion) may be correlated to an increased systemic exposure to the cremophor vehicle (paclitaxel solvent) [89].…”