Skin toxicity in a patient with ovarian cancer treated with pegylated liposomal doxorubicin: A case report and review of the literature

Abstract

Abstract. Pegylated liposomal doxorubicin (PLD) is a form of doxorubicin enclosed in pegylated liposomes. In contrast to conventional doxorubicin, PLD is characterized by a lower incidence of cardiotoxicity and myelosuppression. However, it induces specific mucocutaneous side effects, particularly palmar-plantar erythrodysesthesia (PPE). Other dermal manifestations, such as intertrigo-like dermatitis, diffuse follicular rash, melanotic macules, maculopapular rash or recall phenomenon are less common. Mechanisms that lead to skin toxicity remain unclear, however, certain reports indicate that drug excretion in sweat, host-vs.-altered-host reactions and local mechanical microtrauma play an important role in the development of cutaneous disorders. Effective preventive and curative management has not yet been established. The current study reports a case of a 55-year-old patient with advanced ovarian cancer who developed an uncommon diffuse maculopapular rash and severe PPE during treatment with PLD. Complete regression of the skin disorder was observed after 4 weeks. At present, palliative chemotherapy provides the opportunity to prolong life and alleviate disease symptoms, nonetheless it produces a number of adverse effects. Dermal complications may affect patient quality of life and cause therapy interruption. In the light of widespread use of PLD, skin toxicity associated with this drug creates a major problem.

Case of severe bullous erythema including intertrigo‐like eruptions with angioedema induced by pegylated liposomal doxorubicin

“…Pegylated liposomal doxorubicin is used to treat both ovarian cancer and AIDS‐related Kaposi's sarcoma in Japan. The most common cutaneous adverse effect induced by PLD is HFS, which usually occurs within 2–12 days after the administration of PLD . A previous study found that approximately 0.08% of patients showed intertrigo‐like reactions after taking PLD .…”

“…Pegylated liposomal doxorubicin (PLD), an anthracycline‐based drug, is a form of doxorubicin enclosed in pegylated liposomes. Although PLD is associated with a lower incidence of cardiotoxicity and myelosuppression, it is associated with a higher risk of dermal disorders and specific mucocutaneous side‐effects when compared with conventional doxorubicin . Common PLD dermal disorders include hand–foot syndrome (HFS), intertrigo‐like eruptions, a diffuse follicular rash, melanotic macules, a maculopapular rash and recall phenomenon .…”

Liposome-Mediated Immunosuppression Plays an Instrumental Role in the Development of “Humanized Mouse” to Study Plasmodium falciparum

“…Skin lesions usually appear in regions prone to trauma such as the palms and soles. This was reported in a patient suffering from ovarian cancer showing partial response to chemotherapy [61].…”

“…These PEGylated liposomes show a lower rate of cardiotoxicity and myelosuppression but show some obvious adverse effects including palmar-plantar erythrodysesthesia (PPE and some dermal manifestations such as intertrigo-like dermatitis, diffuse follicular rash, melanotic macules, maculopapular rash [61]. Some studies have advocated that dimethyl sulfoxide or corticosteroids may be beneficial in the treatment of PLD-induced dermal complications as they accelerate skin recovery.…”

In vivo detection of changes in cutaneous carotenoids after chemotherapy using shifted excitation resonance Raman difference and fluorescence spectroscopy

“…The chemotherapeutics subsequently spread on the skin surface as if topically applied and re‐penetrate into the upper skin layers . Here, they can lead to radical formation and inflammatory or toxic skin effects, including development of palmar‐plantar erythrodysaesthesia, also known as a hand‐foot syndrome …”