A Case of Bleomycin-Induced Acral Erythema (AE) with Eccrine Squamous Syringometaplasia (ESS) and Summary of Reports of AE with ESS in the Literature

Abstract

Chemotherapy-induced acral erythema (AE) is primarily induced by hydroxyurea, methotrexate, and cytarabine, although there are rare reports of AE induced by combination chemotherapy containing bleomycin. It is thought that the accumulation of chemotherapeutic drugs in eccrine glands may cause eccrine squamous syringometaplasia (ESS), which is characterized by metaplasia and focal necrosis of the epithelium of the eccrine duct. ESS is occasionally detected in conjunction with AE, but such occurrences are relatively uncommon. This is the first report of AE with ESS induced by the administration of bleomycin alone. We also provide a summary of past cases of AE with ESS in the literature.

Toxic erythema of chemotherapy: A useful clinical term

“…By listing the characteristic clinical (Table III) and histologic features (Table IV), significant overlap becomes readily apparent. For example, eccrine squamous syringometaplasia can be seen histologically in patients diagnosed with acral erythrodysesthesia [31][32][33] and in those with chemotherapy-associated eccrine neutrophilic hidradenitis. 34 In addition, intertriginous eruptions caused by chemotherapy can have evidence of epidermal dysmaturation 23 and eccrine squamous syringometaplasia.…”

Chemotherapy-Induced Acral Erythema in a Pediatric Patient With Acute Monoblastic Leukemia

“…It is characterized by symmetrical, well-demarcated, painful erythema of the palms and soles, which may progress to desquamation [1][2][3][4][5]. Rarely, in a bullous variant, full-thickness necrosis may occur in areas of blister formation [1].…”

“…It occurs most commonly with high-dose cytarabine, doxorubicin, fluorouracil, methotrexate, and bleomycin [1][2][3][4][5][6]. This reaction has also been observed with the use of many other agents, such as mercaptopurine, cyclophosphamide, cisplatin, and hydroxyurea, both with individual use and in combination therapy [1,2,7].…”

Reações tegumentares adversas relacionadas aos agentes antineoplásicos: parte I

“…35 Lesions develop between 2 to 39 days after the start of chemotherapy and improve spontaneously after 4 weeks. 36 The diagnosis is histopathological, characterized by the presence of squamous metaplasia of the eccrine glands in the papillary dermis. Minimal and focal necrosis of the eccrine gland epithelium, fibroblastic proliferation and edema of the periductal estroma may occur.…”

“…Pyridoxine (vitamin B6) in doses of 200 to 300 mg/day can be useful to treat and prevent this reaction, except when cytarabine or vincristine are used. 36,55 Topical dimethyl sulphoxide (DMSO) at 99% four times a day for 14 days has cured some cases of palmoplantar erythrodysesthesia syndrome induced by pegylated liposomal doxorubicin. …”