Plantar erythema

A syndrome of palmar-plantar erythema (progressing in some patients to blistering and desquamation) has been reported in seven of eight patients with advanced breast or ovarian cancer who received high-dose doxorubicin (125-150 mg/m ) (79). By contrast, in a similar dose intensification study in which patients received epirubicin 200 mg/m with cyclophosphamide and growth factor support, the pal-mar-plantar syndrome did not occur (80). 

Matsumura Y+, Int J Cancer 65, 778 Palmar-plantar erythema Palmar-plantar hyperhidrosis... 

Haerslev T+, Cutis 52, 45 Palmar-plantar erythema (1990) PagliucaA+, Postgrad Med J 66, 242 Papulo-nodular lesions... 

Bekerecioglu M +, J Surg Res 75, 61 Palmar-plantar erythema (painful)... 

Disanti W +, Clin Gastroenterol Hepatol 4(8), 1025 Palmar-plantar erythema... 

Diarrhea may require fluid and electrolyte replacement warn patients to stop drug if they experience an increase of 4—6 or more stools per day or nocturnal stools hand-foot syndrome (palmar-plantar erythema) numbness, dysesthesia, tingling, swelling, redness, pain, sometimes blistering, ulceration in hands and feet stop drug and restart at lower dose when resolved topical emollients may be helpful nausea common but mild low risk of myelosuppression Myelosuppression fever (onset by day 6, persisting for about 3 days) immunosuppressive severe opportunistic infections occur low emetogenic potential... 

Mucositis and diarrhea resulting from damage to normally rapidly proliferating cells of Gl tract (worse with continuous infusion, concurrent leucovorin regimens) mild emetogen myelosuppression (worse with bolus administration) rash, hyperpigmentation, photosensitivity hand-foot syndrome (palmar-plantar erythema) with... 

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 ]. 

Skin, nails, hair Rash and/or palmar-plantar erythema has been reported in 8-22% of cases. Nail changes are reported in 9-56% of cases. Alopecia of varying severity has been reported in 43-92% of cases [15 3", 154", 155", 156"]. 

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. 

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. 

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