Palmar plantar erythrodysesthesia pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
The cause of PPE is unknown. Existing theories are based on the fact that only the hands and feet are involved and posit the role of temperature differences, vascular anatomy, differences in the types of cells (rapidly dividing epidermal cells and eccrine glands).
The pathophysiologic mechanism of Palmar Plantar Erythrodysesthesia is under active investigation and different mechanisms have been postulated.[1] Factors that have been implicated involve rapid cell division in palms and soles, gravitational forces, vascular anatomy peculiar to these areas and temperature gradients that may be present in distal end of extremities. The higher drug concentration in the eccrine glands of palms and soles also play a role in this condition. PPE Biopsies appear histologically nonspecific, but a consistenty toxic reaction is seen.[2]
In Palmar Plantar Erythrodysesthesia associated with Pegylated liposomal doxorubicin (PLD), it has been determined that the drug is present is deposited in sweat then smeared onto the skin surfaces. The sweat glands are present in high concentration on the palms and soles. The drug then infiltrates the stratum corneum which is a thick layer in the body. This layer acts as a reservoir for the drug leading to the symptoms of PPE.[3]
References
- ↑ Baack BR, Burgdorf WH (1991). "Chemotherapy-induced acral erythema". J Am Acad Dermatol. 24 (3): 457–61. PMID 2061446.
- ↑ Duvernoy O, Malm T, Thuomas KA, Larsson SG, Hansson HE (1991). "CT and MR evaluation of pericardial and retrosternal adhesions after cardiac surgery". J Comput Assist Tomogr. 15 (4): 555–60. PMID 2061466.
- ↑ Lademann J, Martschick A, Kluschke F, Richter H, Fluhr JW, Patzelt A; et al. (2014). "Efficient prevention strategy against the development of a palmar-plantar erythrodysesthesia during chemotherapy". Skin Pharmacol Physiol. 27 (2): 66–70. doi:10.1159/000351801. PMID 23969763.