Benign dermoscopic parallel ridge pattern in plantar hyperpigmentation due to capecitabine

Abstract

We report the case of a 37-year-old woman (phototype II) who presented at our outpatient clinic with a two-month history of hyperpigmented plantar macules. Medical history revealed that the patient had taken capecitabine in the past three months as adjuvant chemotherapy for recurrent breast cancer. Dermoscopic examination of the plantar macules showed parallel ridge pattern with pigmentation in the furrows without obliteration of eccrine gland apertures. Besides in acral melanoma, parallel ridge pattern can also be observed in benign plantar lesions, such as congenital or acquired acral nevi, subcorneal hemorrhage, dye-related pigmentation and drug-induced hyperpigmentation, especially in patients with phototypes III-VI. The few reported cases of capecitabine-induced hyperpigmentation have been associated with hand and foot syndrome in patients with phototypes IV-V and palmar as well as plantar involvement.

Oral hyperpigmentation as an initial clinical aspect of hand foot syndrome

“…Caprez et al ( 4), rise the hypothesis that palmar-plantar hyperpigmentation from HFS and the oral mucosa hyperpigmentation by capecitabine administration are distinct entities, precisely due to the atypical pattern that these lesions present. In some situations, individuals have hyperpigmentation without a previous diagnosis of HFS (20). Other authors argue that oral stains occurs as an early manifestation of HFS, especially in the primary stages of the disease, thus constituting an important clinical predictor of HFS (8,17,22), as the case of aforementioned patient, whose oral lesions appeared before the grade 1 HFS clinical diagnosis.…”

“…In the present report, the patient is a black-skinned woman who presents hyperpigmentation of the oral mucosa, hands, and feet, associated with continuous and prolonged use of capecitabine. In his study, Tognetti et al (20) states that capecitabine hyperpigmentation can be found in the palmar-plantar skin and oral mucosa, being rarer in the latter, even in patients with no history of HFS. Howhever other authors consider hyperpigmentation as an initial manifestation of the syndrome (8,17).…”

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

“…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 - 27 …”

“…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.…”

Non-Invasive Diagnosis of Angioma Serpiginosum Plantaris: High-Resolution Dermoscopy, High-Frequency Ultrasound, and Line-Field Confocal Optical Coherence Tomography

“…Recently, new non-invasive imaging devices that provide high-resolution skin images, such as high-resolution videodermoscopy (HRVD) [14][15][16], high-frequency ultrasound [15], and line-field confocal optical coherence tomography (LC-OCT) [15,[17][18][19], have been successfully employed in vascular skin lesions [14,15,17,18], orienting the diagnostic suspect in atypical/featureless cases.…”