Hand eruption after intravenous administration of bevacizumab

Abstract

EditorA 61-year-old man was diagnosed with adenocarcinoma of the colon and multiple liver metastases in April 2008. A left hemicolectomy was performed and six cycles of FOLFOX chemotherapy were administered from June to September, the same year. Liver metastases decreased significantly in size after 12 cycles. In May 2009, CEA and metastases increased, coinciding with the completion of the chemotherapy regimen. It was decided to restart FOL-FOX chemotherapy with the addition of bevacizumab. After the second infusion of the drug, the patient developed brownish erythematous papules with a pseudo-vesicular appearance on the palms of both hands and sides of fingers, accompanied by a mild burning sensation (Fig. 1).Histopathology revealed severe dermatitis and superficial perivascular level spongiosis with microvesicles in epidermis, consistent with diagnostic criteria for toxicodermia (Fig. 2).Topical clobetasol propionate cream was given and palmar lesions improved slightly. It was therefore decided to administer 3% allopurinol cream once a day and lesions healed completely.The patient currently remains under treatment with bevacizumab monotherapy. The rash recurs after each infusion, but is controlled with cream of allopurinol 3%.

Acute and severe acne in a patient treated with bevacizumab

“…12 Accounts of cutaneous reactions to bevacizumab are limited and typically include itching, exfoliative dermatitis, skin dryness, skin discoloration, impaired wound healing, and stomatitis. 1,13 More recently reported cutaneous adverse effects associated with the use of bevacizumab include nonspecific and acneiform skin rash resembling that seen after the administration of EGFR antagonists, 2-6 cutaneous lupus erythematosus, 14 hand eruption, 15 scalp ulceration 16 , perforating dermatosis, 17 and localized skin necrosis of steroid-induced striae distensae 18 (Table 1).…”