Palmar plantar erythrodysesthesia natural history, complications, and prognosis: Difference between revisions
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* PPE is not life threatening, but it can be very debilitating and impair quality of life. | * PPE is not life threatening, but it can be very debilitating and impair quality of life. | ||
*If chemotherapy is continued despite the appearance of the PPE: | |||
** The lesions deteriorate, and tenderness and edema may restrict of the fine movements of the fingers<sup>95</sup> | |||
** The erythema becomes darker or violaceous, and spreads to involve the entire surface of the palms and soles. | |||
** The pain may be severe enough to limit activities of daily living (ADL). | |||
** In some patients lesions may evolve into a palmoplantar keratoderma<sup>70,96</sup>. | |||
===Prognosis=== | ===Prognosis=== | ||
Revision as of 13:37, 28 June 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mandana Chitsazan, M.D.
Overview
If left untreated, PPE can progress rapidly.
Prognosis is generally good and symptoms usually resolve within 1-2 weeks after stopping the causative chemotherapeutic agent.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of PPE usually develop 1–21 days after higher-dose pulse therapies and up to 2-10 months after continuous low-dose therapies.
- PPE appears to be dose-dependent.
- Both peak drug concentration and total cumulative dose determine its occurrence since both bolus infusions and continuous low-dose administration can cause a dose-dependent drug reaction [1] [2][3] [4]
- In addition, combined administration of two chemotherapy drug which both can cause PPE usually results in an increase in the frequency and severity of PPE.
Complications
- PPE is not life threatening, but it can be very debilitating and impair quality of life.
- If chemotherapy is continued despite the appearance of the PPE:
- The lesions deteriorate, and tenderness and edema may restrict of the fine movements of the fingers95
- The erythema becomes darker or violaceous, and spreads to involve the entire surface of the palms and soles.
- The pain may be severe enough to limit activities of daily living (ADL).
- In some patients lesions may evolve into a palmoplantar keratoderma70,96.
Prognosis
- If appropriate management is not implemented rapidly, PPE can progress rapidly.
- Symptoms usually resolve within 1–2 weeks after stopping the causative chemotherapeutic agent.
- Re-exposure to the causative agent with similar dosage has resulted in the reaction to reoccur in the majority but not all patients.[5] [6][7] [8]
References
- ↑ Baer MR, King LE, Wolff SN (1985). "Palmar-plantar erythrodysesthesia and cytarabine". Ann Intern Med. 102 (4): 556. doi:10.7326/0003-4819-102-4-556_1. PMID 3977204.
- ↑ Lokich JJ, Ahlgren JD, Gullo JJ, Philips JA, Fryer JG (1989). "A prospective randomized comparison of continuous infusion fluorouracil with a conventional bolus schedule in metastatic colorectal carcinoma: a Mid-Atlantic Oncology Program Study". J Clin Oncol. 7 (4): 425–32. doi:10.1200/JCO.1989.7.4.425. PMID 2926468.
- ↑ Herzig RH, Wolff SN, Lazarus HM, Phillips GL, Karanes C, Herzig GP (1983). "High-dose cytosine arabinoside therapy for refractory leukemia". Blood. 62 (2): 361–9. PMID 6223674.
- ↑ Kroll SS, Koller CA, Kaled S, Dreizen S (1989). "Chemotherapy-induced acral erythema: desquamating lesions involving the hands and feet". Ann Plast Surg. 23 (3): 263–5. PMID 2528937.
- ↑ Curran CF, Luce JK (1989). "Fluorouracil and palmar-plantar erythrodysesthesia". Ann Intern Med. 111 (10): 858. doi:10.7326/0003-4819-111-10-858_1. PMID 2817635.
- ↑ Demirçay Z, Gürbüz O, Alpdoğan TB, Yücelten D, Alpdoğan O, Kurtkaya O; et al. (1997). "Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases". Int J Dermatol. 36 (8): 593–8. PMID 9329890.
- ↑ Lokich JJ, Moore C (1984). "Chemotherapy-associated palmar-plantar erythrodysesthesia syndrome". Ann Intern Med. 101 (6): 798–9. doi:10.7326/0003-4819-101-6-798. PMID 6497196.
- ↑ Peters WG, Willemze R (1985). "Palmar-plantar skin changes and cytarabine". Ann Intern Med. 103 (5): 805. doi:10.7326/0003-4819-103-5-805_1. PMID 4051360.