Cytarabine-induced palmar-plantar erythema

Hand-Foot Syndrome (Hand-Foot Skin Reaction, Palmar-Plantar Erythrodysesthesia): Focus on Sorafenib and Sunitinib

“…This study found that although the incidence of HFS correlated with both the dose level (3 vs. 4.5 g/m 2 ) and length of treatment (≤6 vs. 8 days), the severity of HFS correlated only with length of treatment [4]. Walker et al [78] proposed that a threshold dose must be reached before HFS appears, noting that at traditional cytarabine doses of 700 mg/m 2 /week, HFS was never seen; it was only after raising the dose to >1 g/m 2 /week that HFS began to appear. An interesting case series reported on 2 patients who inadvertently received high-dose cytarabine in 5- to 10-min boluses rather than the intended 1-hour bolus time periods and incurred severe bullous HFS, suggesting that higher peak plasma levels also correlate with increased severity [79].…”

“…The most commonly reported vasoconstrictive modality is localized cooling of the acral areas, both as treatment [77,78,88] and as peri-infusion prophylaxis [79,105,106]. In a recent prospective study of 53 patients receiving PLD, 28 received ice packs to their extremities during the infusions, resulting in a statistically significant decrease in the rate of HFS [107].…”

“…Systemic steroids have also been used with some success to treat established HFS [4]. Several negative studies have also been published, including a series of 8 patients with HFS who achieved no benefit with steroids [78,111]. Data on topical steroids are even more inconclusive, with only scattered positive and negative reports in the literature [88,100].…”

Toxic erythema of chemotherapy: A useful clinical term

“…Unfortunately, over the past 3 decades, multiple, sometimes confusing diagnostic names have been applied to these eruptions (Table I), 1,[7][8][9][10][11][12][13][14][15][16][17][18] including ones that reflect the histologic, but not clinical, findings (Table II). 2,3,[18][19][20][21][22][23][24][25][26][27][28] The latter is best exemplified by the designations ''eccrine squamous syringometaplasia,'' 19,26 ''epidermal dystrophy,'' 25 and ''epidermal dysmaturation,'' 29,30 terms that, while clearly apt and insightful, may not even be that familiar to dermatologists and are certainly foreign to hematologists and oncologists.…”

Methotrexate-induced bullous acral erythema in a child

“…18 Although the precise cause of this reaction is unknown, the clinical and histopathological features suggest a direct toxic effect to the acral epidermis from high concentrations of chemotherapy agents. 19 Therapy is generally supportive and consists of emollients and cold compresses; the reported efficacy of topical, oral, and parenteral steroids has been mixed, 10,13,[19][20][21] but the data is anecdotal and no controlled studies have been performed. Our patient obtained substantial benefit from systemic steroids both in the management of his acute symptoms and in the prevention of recurrences with subsequent chemotherapy cycles, a feature which was also reported in a 15-year-old boy with an osteosarcoma treated with high-dose methotrexate therapy.…”