Histologic Patterns of Polyethylene Glycol-liposomal Doxorubicin-related Cutaneous Eruptions

Abstract

Polyethylene glycol (PEG)-liposomal doxorubicin (Stealth R, Doxil) is a formulation of doxorubicin, which is encapsulated in liposomes formulated with PEG. It is favored in the palliative setting over doxorubicin because of its generally favorable side effect profile. Adverse reactions are predominantly skin eruptions. We report 3 cases of women with breast cancer undergoing treatment with liposomal doxorubicin who developed palmar-plantar erythrodysesthesia and diffuse morbilliform eruptions. Biopsies in the 2 cases demonstrated vacuolar interface dermatitis with epidermal dysmaturation and the third case suggested a drug eruption. Additionally, we report a woman with metastatic breast cancer who developed a similar morbilliform eruption soon after completing a regimen of liposomal doxorubicin. The biopsy revealed an atypical squamous proliferation showing epidermal dysmaturation with focal evidence of interface damage. Both clinician and pathologist alike should be cognizant of this cutaneous eruption, as well as the histologic patterns.

Prompt onset of Rowell's syndrome following the first BNT162b2 SARS‐CoV‐2 vaccination

“…5 What has been shown in clinical trials is that the leading vaccines elicit a Th1 response, rising the serum levels of IL-2, TNFa and IFNc. 6,7 These precise cytokines are involved in the appearance of lichen planus. Although we still do not completely understand its pathogenesis, the up-regulation of Th1 and increase of pro-apoptotic cytokines such as TNFa and IFNc have been described as key agents responsible for basal keratinocyte apoptosis seen in this skin condition.…”

A generalized fixed drug eruption associated with mycophenolate

“…FDE has been reported in 1 patient taking abatacept for rheumatoid arthritis, 3 1 patient taking azathioprine, 4 1 patient taking doxorubicin for breast cancer, 5 and 2 patients taking paclitaxel (1 patient for ovarian cancer 6 and the other, who presented with bullous FDE, for breast cancer 7 ). Although not consistent with a fixed drug reaction, the development of a psoriasiform skin eruption after the introduction of mycophenolate mofetil in a 32-year-old man with myasthenia gravis has been described previously 8 …”

Case of severe bullous erythema including intertrigo‐like eruptions with angioedema induced by pegylated liposomal doxorubicin

“…Although PLD is associated with a lower incidence of cardiotoxicity and myelosuppression, it is associated with a higher risk of dermal disorders and specific mucocutaneous side‐effects when compared with conventional doxorubicin . Common PLD dermal disorders include hand–foot syndrome (HFS), intertrigo‐like eruptions, a diffuse follicular rash, melanotic macules, a maculopapular rash and recall phenomenon . However, in Japan, no case of intertrigo‐like eruptions due to PLD has been reported.…”

“…1 Common PLD dermal disorders include hand-foot syndrome (HFS), intertrigolike eruptions, a diffuse follicular rash, melanotic macules, a maculopapular rash and recall phenomenon. 2 However, in Japan, no case of intertrigo-like eruptions due to PLD has been reported. In addition, angioedema has not been reported in patients with intertrigo-like eruptions due to PLD.…”