Chemotherapy-induced hand-foot syndrome and nail changes: A review of clinical presentation, etiology, pathogenesis, and management

Miller, Kristen; Gorcey, Loren; McLellan, Beth N.

doi:10.1016/j.jaad.2014.03.019

Cited by 171 publications

(184 citation statements)

References 40 publications

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“…The rash is usually associated with mild swelling and desquamation. Symptoms usually resolve within 1 to 3 weeks of its appearance [1]. Histopathology may show dyskeratosis, vacuolation and spongiosis in the epidermis with perivascular lymphohistiocytic infiltrate, syringosquamous metaplasia, or eccrine neutrophilic hidradenitis [2].…”

Section: Discussionmentioning

confidence: 99%

“…MTX is known to accumulate in edematous tissues. Decreased systemic clearance of MTX can also increase the likelihood of CIAE [1,2]. It is possible that Patient 1 had dependent edema on the paretic side, predisposing that side to the accumulation and toxic effects of MTX.…”

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%

“…Bullous presentations may mimic staphylococcal scalded skin syndrome, Steven-Johnson Syndrome, paraneoplastic pemphigus or radiation dermatitis [1,5,6]. In conclusion, awareness about the protean manifestations of CIAE in patients undergoing chemotherapy is key to diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Vatsayan¹,

Hashem²,

Honda³

et al. 2017

Clin Res Trials

View full text Add to dashboard Cite

show abstract

“…Novos inibidores multiquinase como sorafenibe, sunitinibe, axitinibe, pazopanibe, regorafenibe e vemurafenibe também podem ocasionar a SMP (2) .…”

Section: Introductionunclassified

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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Evaluation of Prevention Interventions for Taxane-Induced Dermatologic Adverse Events

2018

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IMPORTANCE Chemotherapy-induced alopecia as well as nail and cutaneous changes occur in up to 89% of patients receiving taxane-based chemotherapy and are associated with cosmetic concerns, psychosocial distress, and overall morbidity.OBJECTIVE To review the efficacy and safety of interventions to prevent taxane-induced dermatologic adverse events.EVIDENCE REVIEW PubMed and Scopus databases were systematically reviewed for studies published in the English language from January 1, 1980, to August 13, 2018. Specific search terms included but were not limited to taxane, docetaxel, paclitaxel, prevent, nail, skin, hair, alopecia, and onycholysis. Primary clinical studies that detailed preventive interventions for taxane-induced dermatologic adverse events and that classified results according to a taxane-specific chemotherapy regimen were reviewed and graded according to a 5-point scale, modified from the Oxford Centre for Evidence-based Medicine.FINDINGS The 34 original reports that met the inclusion criteria consisted of 6 randomized clinical trials, 4 nonrandomized clinical trials, 18 cohort studies, 3 case-control studies, 1 cross-sectional study, and 2 case reports and involved a total of 5647 unique participants. A total of 22 studies addressed preventive interventions for alopecia associated with taxane use, whereas 12 studies focused on taxane-induced skin and nail changes. Specifically, 20 (95%) of 21 studies supported the use of either a cold cap or a scalp cooling system to reduce alopecia but reported substantial differences in efficacy depending on the chemotherapy regimen. Scalp cooling was generally considered safe by all pertinent studies despite a single report of scalp skin metastasis. Similarly, use of frozen gloves and frozen socks in the prevention of nail and cutaneous hand and foot toxic effects was considered safe in 7 (88%) of 8 studies, although discomfort was common and frostbite was noted in 1 patient. Overall, use of frozen gloves was endorsed by 4 (67%) of 6 studies to prevent nail toxic effects and by 3 (60%) of 5 studies to prevent cutaneous hand changes.CONCLUSIONS AND RELEVANCE Scalp hypothermia with cold caps or scalp cooling systems has demonstrated efficacy as a monotherapy in preventing taxane-induced alopecia, and use of frozen gloves and socks has been associated with reduced nail and skin changes. Future studies should establish the routine usage protocols, standard outcome measures, and long-term efficacy and safety for these interventions.

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Chemotherapy-induced hand-foot syndrome and nail changes: A review of clinical presentation, etiology, pathogenesis, and management

Cited by 171 publications

References 40 publications

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

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

Síndrome Mão-Pé Induzida Por Capecitabina: Relato De Caso

Evaluation of Prevention Interventions for Taxane-Induced Dermatologic Adverse Events

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