Palmar–plantar erythrodysesthesia (PPE): A literature review with commentary on experience in a cancer centre

Webster-Gandy, Joan; How, Chris; Harrold, Karen

doi:10.1016/j.ejon.2006.10.004

Cited by 121 publications

(135 citation statements)

References 77 publications

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“…If appropriate management is not rapidly implemented, HFS may worsen and QoL impairment may lead to anticancer treatment modification or discontinuation, with the risk for potentially limiting its efficacy [3,23]. It seems necessary to develop a health-related QoL scale enabling investigators to independently assess the effects of anticancer treatment and the effects of the cancer itself on QoL.…”

Section: Discussionmentioning

confidence: 99%

“…The HFS incidence in patients receiving these chemotherapy agents is in the range of 7.3%-63% [1]. HFS is characterized at first by dysesthesia and tingling in the palms, fingers, and soles [2][3][4]. It may then progress, in a few days, to burning pain with diffuse erythema and swelling.…”

Section: Introductionmentioning

confidence: 99%

“…It may then progress, in a few days, to burning pain with diffuse erythema and swelling. In severe cases, it may be accompanied by scaling, blistering, erosions, or, more rarely, ulcerations [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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HFS-14, a Specific Quality of Life Scale Developed for Patients Suffering from Hand–Foot Syndrome

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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HFS-14, a Specific Quality of Life Scale Developed for Patients Suffering from Hand–Foot Syndrome

et al. 2011

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“…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%

“…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%

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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Genital Erythrodysesthesia as a Severe Manifestation of Capecitabine Therapy: A Report of 3 Cases

ín¹

2011

Arch Dermatol

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Palmar–plantar erythrodysesthesia (PPE): A literature review with commentary on experience in a cancer centre

Cited by 121 publications

References 77 publications

HFS-14, a Specific Quality of Life Scale Developed for Patients Suffering from Hand–Foot Syndrome

HFS-14, a Specific Quality of Life Scale Developed for Patients Suffering from Hand–Foot Syndrome

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

Genital Erythrodysesthesia as a Severe Manifestation of Capecitabine Therapy: A Report of 3 Cases

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