Toxic erythema of chemotherapy: A useful clinical term

Bolognia, Jean L.; Cooper, Dennis; Glusac, Earl J.

doi:10.1016/j.jaad.2008.05.018

Cited by 155 publications

(159 citation statements)

References 54 publications

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“…Biopsy results were similar to those previously described (see Table 1). 15 The primary histological features were necrotic keratinocytes and vacuolar degeneration of the basal layer. There was also evidence of epidermal dysmaturation in one patient.…”

Section: Toxic Erythema Of Chemotherapy After High-dose Bu Tl Parker mentioning

confidence: 99%

“…This is in contrast to our experience, described below, which suggests that the majority of patients develop skin toxicity that falls within the spectrum of toxic erythema of chemotherapy (TEC). 15 TEC is a clinicopathological term used to unify a group of cutaneous toxic reactions following chemotherapy that are characterized by areas of burning or painful erythema most commonly involving the hands and feet, axillae and groin, and less often, the elbows, knees and neck. These eruptions are self-limited and often resolve with desquamation and postinflammatory hyperpigmentation.…”

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Toxic erythema of chemotherapy following i.v. BU plus fludarabine for allogeneic PBSC transplant

Parker

Cooper

Seropian

et al. 2012

Bone Marrow Transplant

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I.v. BU plus fludarabine is an effective conditioning regimen for myeloid neoplasias with low treatment-related mortality. At standard doses, cutaneous toxicity has been reported in o5% of cases. As we observed a much higher incidence of cutaneous toxicity in patients who received predominantly pharmacokinetically based doses of BU, we performed a retrospective analysis of 61 patients who received i.v. BU plus fludarabine ( þ / À antithymocyte globulin; ATG) as a conditioning regimen before allogeneic PBSC transplant. Of the 58 evaluable patients, 33 (57%) developed cutaneous toxicity that fell within the spectrum of toxic erythema of chemotherapy (TEC). The median onset of TEC was 22 days and most patients had multiple sites of involvement, with the groin, axillae and palms/soles being the favored sites. In men, scrotal involvement, sometimes severe, was also commonly observed. Initially, allergic reactions to antibiotics, fungal infections and GVHD were also considered until the clinical presentation of TEC became well recognized. In all patients, the skin healed without specific therapy but resolution often required several weeks. This series suggests that TEC is common after BU/fludarabine þ / À ATG and it is important for transplant physicians to recognize, particularly as misdiagnosis could lead to inappropriate treatment.

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Section: Toxic Erythema Of Chemotherapy After High-dose Bu Tl Parker mentioning

confidence: 99%

mentioning

confidence: 99%

Toxic erythema of chemotherapy following i.v. BU plus fludarabine for allogeneic PBSC transplant

Parker

Cooper

Seropian

et al. 2012

Bone Marrow Transplant

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“…The term toxic erythema of chemotherapy encompasses a group of overlapping toxic reactions to chemotherapy that are characterized by painful erythema of the hands and feet [1]. Other names for entities within this spectrum include erythrodysesthesia, acral erythema, hand-foot syndrome, and toxic erythema of the palms and soles [1].…”

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confidence: 99%

“…Other names for entities within this spectrum include erythrodysesthesia, acral erythema, hand-foot syndrome, and toxic erythema of the palms and soles [1]. Clinically, toxic erythema of chemotherapy is characterized by painful erythema and edema of the hands, feet, and intertriginous regions (e.g., groin, axillae), but may also involve the elbows, knees, and ears [1].…”

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confidence: 99%

“…Clinically, toxic erythema of chemotherapy is characterized by painful erythema and edema of the hands, feet, and intertriginous regions (e.g., groin, axillae), but may also involve the elbows, knees, and ears [1]. Affected areas may have a dusky appearance and develop bullae with subsequent erosions [1]. The eruption is typically self-limited and usually resolves with desquamation and postinflammatory hyperpigmentation.…”

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Toxic erythema of chemotherapy

2011

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A 56-year-old man was evaluated for a 4-week history of a rash on his hands and feet. Three months before presentation, he had started weekly paclitaxel infusions for metastatic small-cell lung cancer. He complained of pain, burning sensations, and peeling skin on his hands and feet. The bilateral dorsal hands had erythematous, crusted erosions (Image 1A). The bilateral plantar feet and ankles had superficial, moist erosions with a clean base and surrounding desquamative scaling (Image 1B). He also had crusted, scaling erythematous patches on the bilateral cheeks in a periorbital distribution (Image 1C).A skin biopsy from the right cheek and right leg showed vacuolar interface reaction with apoptotic cells; these features were consistent with a cutaneous reaction to paclitaxel. Direct immunofluorescence studies of the skin biopsy were negative for autoimmune blistering skin disorders.Paclitaxel was held, and acetic acid wet dressings with triamcinolone acetonide 0.1% cream, thrice daily, were initiated. Over 2 weeks, the patient's pain and sensation of burning improved with healing of the erosions and resolution of the desquamation.

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