Palmar-Plantar Erythrodysesthesia Associated with Chemotherapy and Its Treatment

Farr, Katherina P.; Safwat, Akmal

doi:10.1159/000327767

Cited by 73 publications

(52 citation statements)

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“…It may appear that numerous clinical trials have been performed, but in fact, the majority of them have limited value (5). Preventive approaches for PPE, including administration of moisturizers, regional cooling of the skin, and avoidance of excessive activities associated with overheating or trauma, have been evaluated in non-randomized trials (4,16). The use of topical antiperspirant with a beneficial effect has also been reported in the literature (17).…”

Section: Discussionmentioning

confidence: 99%

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Skin toxicity in a patient with ovarian cancer treated with pegylated liposomal doxorubicin: A case report and review of the literature

et al. 2016

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Abstract. Pegylated liposomal doxorubicin (PLD) is a form of doxorubicin enclosed in pegylated liposomes. In contrast to conventional doxorubicin, PLD is characterized by a lower incidence of cardiotoxicity and myelosuppression. However, it induces specific mucocutaneous side effects, particularly palmar-plantar erythrodysesthesia (PPE). Other dermal manifestations, such as intertrigo-like dermatitis, diffuse follicular rash, melanotic macules, maculopapular rash or recall phenomenon are less common. Mechanisms that lead to skin toxicity remain unclear, however, certain reports indicate that drug excretion in sweat, host-vs.-altered-host reactions and local mechanical microtrauma play an important role in the development of cutaneous disorders. Effective preventive and curative management has not yet been established. The current study reports a case of a 55-year-old patient with advanced ovarian cancer who developed an uncommon diffuse maculopapular rash and severe PPE during treatment with PLD. Complete regression of the skin disorder was observed after 4 weeks. At present, palliative chemotherapy provides the opportunity to prolong life and alleviate disease symptoms, nonetheless it produces a number of adverse effects. Dermal complications may affect patient quality of life and cause therapy interruption. In the light of widespread use of PLD, skin toxicity associated with this drug creates a major problem.

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Section: Discussionmentioning

confidence: 99%

“…Other, less frequent manifestations are intertrigo-like dermatitis, a diffuse follicular rash, a maculopapular rash, melanotic macules or a recall phenomenon (3). The symptoms of PPE develop usually within 2 to 12 days after the infusion of chemotherapy (4). Initially, dysesthesia, erythema or edema of the palms and plantae is noticed.…”

Section: Introductionmentioning

confidence: 99%

Skin toxicity in a patient with ovarian cancer treated with pegylated liposomal doxorubicin: A case report and review of the literature

et al. 2016

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“…Uma pesquisa mostrou o uso de produtos para cuidados da pele que possuíam Aloe em sua composição para o alívio sintomático da SMP (11) . O manejo mais efetivo da SMP consiste no aumento do intervalo entre as administrações do fármaco capecitabina, diminuição da dose ou interrupção do tratamento (12) , em concordância com a conduta médica realizada. Outras medidas para o tratamento da SMP incluem o uso de emolientes tópicos, antibióticos para prevenção de infecções secundárias, esteroides tópicos, piridoxina e inibidores da ciclooxigenase 2 (1) .…”

Section: Discussionunclassified

Síndrome Mão-Pé Induzida Por Capecitabina: Relato De Caso

et al. 2017

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RESUMO: A capecitabina é um agente quimioterápico indicado, dentre outros casos, como monoterapia no câncer de mama metastático. A síndrome mão-pé consiste numa das reações adversas associadas ao seu uso e caracteriza-se por eritema doloroso, edema, disestesia, descamação, bolhas e úlceras nas regiões palmar e plantar. Objetivou-se descrever o caso de uma paciente portadora de carcinoma de mama esquerda com metástase hepática que apresentou síndrome mão-pé decorrente do tratamento com capecitabina. Trata-se de um relato de caso ocorrido num hospital universitário de um estado do nordeste do Brasil em 2016. Foi necessária a suspensão do protocolo antineoplásico utilizado. Observou-se remissão parcial dos sintomas após o uso do gel de Aloe vera para o tratamento das áreas afetadas. Ressalta-se a importância do relato para conhecimento dessa reação adversa, facilitando sua identificação e manejo, para promover melhora da qualidade de vida do paciente oncológico. DESCRITORES: Síndrome mão-pé; Antineoplásicos; Neoplasias da mama. CAPECITABINE-INDUCED HAND-FOOT SYNDROME: A CASE REPORTABSTRACT: Capecitabine is a chemotherapeutic agent indicated, among other things, as monotherapy for metastatic breast cancer. Hand-foot syndrome is one of the adverse effects associated with its use and is characterized by painful erythema, edema, dysesthesia, desquamation, blistering and ulcers in the palms and soles. This study presents a case report on a patient with left-sided breast cancer metastasized to the liver, who suffered from capecitabine-induced hand-foot syndrome. The patient was being treated at a university hospital in a state in the Northeast of Brazil in 2016. Her antineoplastic protocol had to be suspended. After the use of Aloe vera gel to treat the affected areas, there was a partial remission of symptoms.It is important to expand knowledge about this adverse reaction, facilitating its identification and management, in order to improve quality of life in cancer patients. DESCRIPTORS: Hand-foot Syndrome; Antineoplastic Agents; Breast Neoplasms. Cogitare Enferm. 2017 Jan/mar; 22(1): 01-04 SÍNDROME MANO-PIE INDUCIDO POR CAPECITABINA: RELATO DE CASO RESUMEN: La capecitabina es un agente quimioterápico indicado, entre otros casos, como monoterapia en cáncer de mama metastático. El síndrome mano-pie consiste en una de las reacciones adversas asociadas a su uso, caracterizada por eritema doloroso, edema, parestesia, descamación, ampollas y úlceras en regiones palmar y plantar. Se objetivó describir el caso de una paciente con carcinoma en mama izquierda, con metástasis hepática presentando síndrome de mano-pie derivado del tratamiento con capecitabina. Relato de caso ocurrido en hospital universitario de estado del Noreste brasileño en 2016. Fue necesaria la suspensión del protocolo antineoplásico utilizado. Se observó remisión parcial de los síntomas luego de uso de gel de Aloe Vera para tratamiento de las áreas afectadas. Se destaca la importancia del relato para conocimiento de esta reacción adversa, permitiendo su ide...

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“…Preventive strategies include application of emollients/moisturizer besides avoiding exposure to extreme temperature and trauma/friction to the predisposed areas. Treatment interruption and interval prolongation between consecutive chemotherapy may be effective while subsequent dose reductions have questionable benefit [2,4]. Frequently used interventions include cold packs, steroid creams, and emollients.…”

Section: Discussionmentioning

confidence: 99%

“…Frequently used interventions include cold packs, steroid creams, and emollients. Oral treatment with NSAIDS, pyridoxine and steroids have shown inconsistent results [1,2,4,5].…”

Section: Discussionmentioning

confidence: 99%

Unusual presentations of chemotherapy induced acral erythema after high dose methotrexate: Case series

Vatsayan¹,

Hashem²,

Honda³

et al. 2017

Clin Res Trials

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Typically, chemotherapy induced acral erythema (CIAE) presents with bilaterally symmetrical dysesthesia followed by the development of erythematous plaques on palms and soles after exposure to chemotherapy. We report 2 pediatric patients with atypical presentations (predominantly unilateral) of CIAE after treatment with high dose methotrexate (HD MTX). These cases highlight the unusual manifestations of CIAE that may confound diagnosis and delay appropriate treatment. Case reports Patient 1A 15 year-old female was being treated for mixed lineage leukemia (predominant T cell phenotype) according to the Children's Oncology Group (COG) protocol AALL0434. During induction, she developed left hemiparesis secondary to sagittal sinus venous thrombosis and right intraparenchymal hemorrhage. On Day 1 of interim maintenance (IM), she was started on 5 gm/m 2 of HD MTX. Serial MTX levels showed appropriate clearance with normal creatinine levels. Forty-two hours after starting HD MTX infusion, leucovorin (LCV) was started and continued until MTX level was < 0.4 µmol/L. At 72 hours, she complained of pain with tingling in her left elbow and dorsum of her left foot followed by development of erythematous, well demarcated tender plaques ( Figure 1A, 1B). A desquamating erythematous patch was also noted in the left axillary region abutting the area of her brassiere band ( Figure 1C). Skin biopsy obtained from the left elbow lesion was consistent with CIAE ( Figure 2). Topical application of cold packs, diclofenac gel, lidocaine patch (5%) and oral Celecoxib had minimal response. Her symptoms gradually resolved over the next 2 weeks. For all subsequent doses of HD MTX, she received 5 gm/m 2 / dose with 200 mL/m 2 /h hydration and LCV rescue (15 mg/m 2 /dose) until her MTX level was < 0.1 μmol/L, with no recurrence of CIAE. Patient 2A 16 year-old female with a history of histiocytic sarcoma and Raynaud's disease was being treated for very high-risk precursor B cell acute lymphoblastic leukemia (ALL) according to COG protocol AALL1131. Two days prior to starting the third cycle of HD MTX in IM 1, she had an episode of Raynaud's disease, predominantly involving the right hand. On day 1 of this cycle she was started on 5 g/ m 2 /dose of HD MTX infused over 24 hours with hydration fluid rate of 200 mL/m 2 /hour due to previous delayed MTX excretion. Serial MTX levels showed appropriate clearance. LCV was started 42 hours after initiation of HD MTX and was continued until MTX level was < 0.4 µmol/L. One day after starting HD MTX, she experienced worsening of erythematous rash over the bilateral palms which was more prominent on the right side (Figure 3). Rash was now accompanied by pain and tingling. Based on the history and dermatologic manifestations a clinical diagnosis of CIAE was made. No confirmatory biopsy was performed since it was deemed unnecessary. Significant improvement was noticed after 2 days of topical application of eucerin and triamcinolone cream

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Palmar-Plantar Erythrodysesthesia Associated with Chemotherapy and Its Treatment

Cited by 73 publications

References 14 publications

Skin toxicity in a patient with ovarian cancer treated with pegylated liposomal doxorubicin: A case report and review of the literature

Skin toxicity in a patient with ovarian cancer treated with pegylated liposomal doxorubicin: A case report and review of the literature

Síndrome Mão-Pé Induzida Por Capecitabina: Relato De Caso

Unusual presentations of chemotherapy induced acral erythema after high dose methotrexate: Case series

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