Acral erythema

The toxicity of antimetabolites is, as expected, due to their incorporation into the metabolism of normal cells, which is nearly identical to that of the malignant cells that they were designed to injure. The normal cells injured most severely are the rapidly proliferating cells of the bone marrow, the lymphoid system, and the GI epithelium. Thus, the common toxicities are bone marrow depression, nausea and vomiting, diarrhea, and mucositis. Cytarabine and pentostatin can cause conjunctivitis. Capecitabine and prolonged use of fluorouracil or cytarabine can cause cerebellar ataxia and the hand-foot syndrome, that is, palmar-plantar erythrodysesthesia or acral erythema. Pentostatin and high-dose methotrexate can cause renal toxicity. 

Acral erythema (1993) Cohen PR, Cutis 51, 175 Bullous dermatitis (palms and soles)... 

Chemotherapy-induced acral erythema (Cl AE), atoxic reaction to a number of different chemotherapeutic agents, causes a symmetrical, painful erythema of the palms and soles, often culminating in the formation of vesicles or bullae. Some of the well known chemotherapeutic agents responsible are cytarabine, fluorouracil and methotrexate. 

Docetaxel Taxane (Diterpene) Breast, prostate, ovarian, nonsmall cell lung Inhibition mitotic cell-division Acral erythema scleroderma-Uke Neutropenia anemia Dys Br GI symptoms Cross-reaction with paclit el but reactions less frequent Infusion... 

Paclitaxel Taxane (Diterpene) Breast, ovarian, head and neck, lung, bladder, etc. Inhibition mitotic cell division Acral erythema injection site reaction AGEP-Uke EM SJS Neutre nia hypersensitivity pn GI synptoms back pain Dys Incidence 10-16 % without premedication. Risks—atopy, bee sting allergy... 

Doxorubicin Anthracycline Hematological, ovarian, Kaposi s Intercalates with DNA Pr U Angio acral erythema rash St injection site reactions Anaph hypo sens. infusion reaction Br cardiotox-icity Reactions uncommon (U, 0.6-3 %). Hypersensitivity reaction 8 %... 

Capecitabine Derivative of 5-fluorouracil Colorectal, pancreatic, metastatic breast, stomach Prodrag form of 5-fluorouracil Acral erythema erythema palmar-plantar keratoderma exfol. dermatitis St CV GI hematolc ic cytopenias Not to be used with leucovorin... 

Fluorouracil Pyrimidine Colorectal, pancreatic, breast Thymidylate synthase inhibitor Acral erythema maculopap. rash inj. site reaction CD St Anaph diarrhea myelosuppression GI mucositis Palmar-plantar dermatitis risk factor. Diag.—IDT and patch (with care) IgE-mediated Direct cytotoxic effect... 

A recent multi-institution survey in Japan drew attention to an important effect of histamine H2 antagonists on docetaxel-induced skin toxicity. Analyses revealed that administration of H2 blockers was associated with a significantly higher incidence of acral erythema (hand-foot syndrome palmar-plantar erythrodysesthesia compare with hand-foot skin reaction. Sects. 13.3.2 and 13.3.3 and see Fig. 13.1) and facial erythema. Steroids and H2 blockers affect the metabolism of docetaxel by cytochrome P45o3A4 (CYP3A4), but dexamethasone dosage did not change the incidence of hand-foot syndrome or facial edema. 

Skin Hand-foot syndrome (acral erythema, palmoplantar erythrodysesthesia) has been attributed to mercaptopurine in a 4-year-old child with acute lymphoblastic leukemia who developed dry painful palmar and plantar erythema with fissures after receiving mercaptopurine for 3 weeks [149 ]. 

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