Capecitabine-induced lichenoid drug eruption: a case report

Gehlhausen, Jeff R.; Strausburg, Matthew B.; Aouthmany, Mouhammad; Katona, Terrence M.; Turner, Matthew J.

doi:10.5070/d3232033962

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…Furthermore, six cases (1.9%) of LDE induced by gout medications (uricostatics and alkaloids) were identified 112–114 . Also, vaccines have been reported to cause LDE in a total of 8 (2.5%) cases (hepatitis A/B, influenza, herpes zoster, human papillomavirus) 115–119 Four cases (1.24%) of Capecitabine‐induced LDE were reported 120–123 . Two cases (0.62%) for each of the following drugs were identified: Thioridazine, leflunomide, ibuprofen, sildenafil and ursodeoxycholic acid 124–133 .…”

Section: Resultsmentioning

confidence: 99%

“…[112][113][114] Also, vaccines have been reported to cause LDE in a total of 8 (2.5%) cases (hepatitis A/B, influenza, herpes zoster, human papillomavirus) [115][116][117][118][119] Four cases (1.24%) of Capecitabine-induced LDE were reported. [120][121][122][123] Two cases (0.62%) for each of the following drugs were identified: Thioridazine, leflunomide, ibuprofen, sildenafil and ursodeoxycholic acid. [124][125][126][127][128][129][130][131][132][133] Single cases of a large number of additional drugs were identified as listed in Table S1.…”

Section: Culprit Medicationsmentioning

confidence: 99%

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Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Maul

Guillet

Oschmann

et al. 2023

Acad Dermatol Venereol

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Cutaneous lichenoid drug eruptions (LDE) are adverse drug reactions (ADR) characterized by symmetric, erythematous, violaceous papules reminiscent but rarely fully characteristic of lichen planus (LP). We aimed to analyse the literature describing cases of LDE within the last 20 years to provide additional insight into culprit drugs, typical latency to onset of the eruption, the spectrum of clinical presentations, severity and management. A literature search was conducted in MEDLINE between January 2000 and 27 January 2021. The keywords ‘lichenoid drug rash’ and ‘lichenoid drug eruption’ were used. Cases were included if LDE diagnosis was made, and culprit drugs were identified. A total of 323 cases with LDE were identified from 163 published case reports and studies. The mean patient age was 58.5 years (1 month to 92 years), and 135 patients (41.8%) were female. Checkpoint inhibitors (CKI) were the most frequently reported culprit drugs (136 cases; 42.1%), followed by tyrosine kinase inhibitors (TKI) (39 cases; 12.0%) and anti‐TNF‐α‐monoclonal antibodies (13 cases; 4.0%). The latency between initiation of the drug and manifestation was 15.7 weeks (range: 0.1–208 weeks). After discontinuing the culprit drug, the median time to resolution was 14.2 weeks (range: 0.71–416 weeks). One hundred thirty‐six patients (42.1%) were treated with topical, and 54 patients (16.7%) with systemic glucocorticoids. Overall, we conclude that, albeit rare, LDE is challenging to diagnose ADR induced by mostly CKI, TKI, and biologics. Treatment modalities resemble that of lichen planus, and the culprit drugs had to be discontinued in only 26%, which is low compared with other types of adverse drug reactions. This is probably due to the low risk of aggravation (e.g. toxic epidermal necrolysis) if the drug is continued and the benefit/risk ratio favouring the drug, as is often the case in cancer therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Culprit Medicationsmentioning

confidence: 99%

Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Maul

Guillet

Oschmann

et al. 2023

Acad Dermatol Venereol

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“…Another supporting theory is that microtrauma to the capillaries due to mechanical stress can cause chemotherapy agents to escape from the blood vessels and cause cytotoxic effects on the surrounding tissues. 6 Capecitabine has also been reported to cause a variety of dermatologic reaction, such as lichenoid drug eruption, 7 leukocytoclastic vasculitis, 8 skin hyperpigmentation, 9 oral stomatitis, 10 although less frequently reported than HFS. HFS skin lesions can develop into PPK if chemotherapy agents are not stopped, 2 although rarely reported.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case on Capecitabine Induced Acquired Palmoplantar Keratoderma

Tsaqilah,

Mudia,

Usman

et al. 2023

CCID

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Acquired palmoplantar keratoderma (PPK) is a non-hereditary hyperkeratosis of the palms and soles that is caused by various factors, including chemotherapeutic agents. The purpose of this case report is to present a rare case of acquired PPK caused by the chemotherapeutic agent capecitabine. A 54-year-old female complained of painful erythematous plaques on her palms and soles with history of consuming capecitabine. Physical examination revealed scaly erythematous plaques on the palmoplantar surface and knuckle pads on both hands. Histopathological features showed hyperkeratosis, acanthosis, vasodilatation, and perivascular lymphocytic infiltration. Therefore, the patient was diagnosed with acquired PPK due to capecitabine. The dose of capecitabine was reduced and the patient was administered topical corticosteroid and emollient. Improvement of skin lesions was strongly observed after discontinuation of capecitabine. The underlying cause of PPK should be identified to determine the appropriate treatment. Dose reduction or drug discontinuation is the mainstay therapy for patients with acquired PPK caused by chemotherapeutic agents.

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Section: Discussionmentioning

confidence: 99%

“…As many as 50% of individuals receiving capecitabine chemotherapy experience hand-foot syndrome, 16,17 and this medication has been associated with skin eruptions in case reports, though dermatological manifestations are usually present in a lichenoid and/or palmoplantar distribution. [18][19][20][21][22][23][24][25][26][27] Our patient presented with what was initially thought to be a drug eruption. Preliminary findings from his skin biopsy supported this diagnosis, but additional dermatopathological review detected disseminated VZV infection.…”

Section: Discussionmentioning

confidence: 99%

Beware the Unexpected Infection: Disseminated Varicella Zoster Virus Mimicking A Drug Eruption

Adimora-Onwuka

Hall

2022

Journal of Investigative Medicine High Impact Case Reports

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Adverse cutaneous reactions to medications are not uncommon and may resemble viral infection and vice versa, complicating diagnosis. We describe the case of a 79-year-old male with cholangiocarcinoma with liver and presumed lung metastasis who presented with abdominal pain and was admitted with ileitis with partial small bowel obstruction. He had a widespread papulovesicular rash with hemorrhagic center, mostly on his face, chest, and back. The rash was initially thought to be a drug eruption, but was eventually diagnosed via dermatopathological examination as disseminated varicella zoster virus (VZV) infection. Steroid treatment was discontinued, and airborne precautions were initiated. Polymerase chain reaction for VZV was obtained and intravenous acyclovir treatment was begun. This case of VZV, initially suspected to be an adverse drug reaction, highlights the importance of early identification of a highly infectious lesion and the importance of early infection control measures, given the implications of exposure to VZV for health care personnel.

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Capecitabine-induced lichenoid drug eruption: a case report

Cited by 6 publications

References 11 publications

Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications

A Rare Case on Capecitabine Induced Acquired Palmoplantar Keratoderma

Beware the Unexpected Infection: Disseminated Varicella Zoster Virus Mimicking A Drug Eruption

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