Eosinophilic, Polymorphic, and Pruritic Eruption Associated With Radiotherapy

Abstract

Objective: To characterize the epidemiological, clinical, and histopathological features of patients with cancer who develop widespread polymorphic and pruritic skin lesions following radiotherapy.Patients, Design, and Interventions: During phase 1, epidemiological and clinical features of 103 patients with cancer, 83 treated with radiotherapy (71 women and 12 men) and 20 controls who did not undergo radiotherapy (16 women and 4 men), were explored during 3 months (October 1995 to January 1996. During phase 2, in 30 additional patients with cancer who were treated with telecobalt or linear accelerator, 18 with skin lesions (15 women and 3 men) and 12 without lesions (10 women and 2 men), the following were investigated: (1) hematoxylin-eosin-stained sections for routine histopathological examination and direct immunofluorescence, and lymphocytic markers;(2) blood, skin, and primary tumor eosinophilia; and(3) the presence of antiepidermal autoantibodies. Patients were examined during 5 months (February 1996 to June 1996). Setting:A dermatology department at a university hospital.Results: During phase 1, 14 (17%) of the 83 patients undergoing radiotherapy developed an eruption. Acral excoriations, erythematous papules, vesicles, and bullae were the most frequent lesions. During phase 2, in 18 patients, a superficial and deep lymphocytic perivascular infiltrate with numerous eosinophils, intraepidermal and interstitial eosinophilic infiltrates, eosinophilic panniculitis, IgM and C3 perivascular deposits, and slightly predominant CD4 + cells wereobserved.Noantiepidermalautoantibodieswerefound. Conclusions:The clinical, histopathological, and immunopathologic features in patients with cancer undergoing radiotherapy are described. To our knowledge, this condition has not been well characterized. Because of its unique presentation, the denomination "eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy" is suggested.

Epper Syndrome: An Additional Case

“…A group of patients shows cutaneous lesions that develop after deep radiation therapy, especially in patients with brain tumors in association with anticonvulsant therapy. In our and Rueda et al's [1] experience, such lesions occur in 0.02-1.2% of all treated patients. Clinically, they resemble erythema multiforme, although they do not fulfill all its clinical and/or histological criteria [3,4].…”

“…Despite its frequency, this syndrome has been reported only in two articles, and the majority of the patients had genital cancers [1,2]. We report an additional case in a patient with esophageal carcinoma.…”

“…These lesions have been described by Rueda et al [1] as erythematous papules, pruritic rash and excoriations affecting predominantly the lower and upper limbs (EPPER syndrome). Our patient exhibited all the clinical and histological features of EPPER syndrome.…”

“…Rueda et al [1] suggested the name of eosinophilic polymorphic and pruritic eruption associated with radiotherapy, or EPPER syndrome, for these lesions.…”

Métastases cutanées d’un mélanome sur un territoire de radiothérapie au niveau du sein : traitement par vémurafénib et chirurgie d’exérèse large

“…Les manifestations cliniques de la radiodermite aiguë sont l'érythème, l'oedème, la douleur, la desquamation, l'ulcéra-tion et le suintement [2]. Les autres complications cutanées aiguës de la radiothérapie sont le phénomène recall, la « comédo-réaction », l'atteinte des phanères, des éruptions variées [3]. Les effets secondaires tardifs surviennent et s'aggravent progressivement.…”