Palmar plantar erythrodysesthesia natural history, complications, and prognosis: Difference between revisions
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===Prognosis=== | ===Prognosis=== | ||
*If the causative chemotherapeutic agent is stopped within a few days of the reactions appearing: | |||
** Areas of pallor with blisters develop, and eventually desquamate with extensive, but superficial cracking and exfoliation. | |||
** A gradual clearing of symptoms will occur over a period of 2 weeks. | |||
** Rarely, long term sequelae may occur despite cessation of chemotherapy, with persistence of abnormal sensation and appearance of the affected digits <ref name="pmid7629773">{{cite journal| author=Banfield GK, Crate ID, Griffiths CL| title=Long-term sequelae of Palmar-Plantar erythrodysaesthesia syndrome secondary to 5-fluorouracil therapy. | journal=J R Soc Med | year= 1995 | volume= 88 | issue= 6 | pages= 356P-357P | pmid=7629773 | doi= | pmc=1295248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7629773 }} </ref> | |||
* If appropriate management is not implemented rapidly, PPE can progress rapidly. | * If appropriate management is not implemented rapidly, PPE can progress rapidly. | ||
* Re-exposure to the causative agent with similar dosage has resulted in the reaction to reoccur in the majority but not all patients.<ref name="pmid2817635">{{cite journal| author=Curran CF, Luce JK| title=Fluorouracil and palmar-plantar erythrodysesthesia. | journal=Ann Intern Med | year= 1989 | volume= 111 | issue= 10 | pages= 858 | pmid=2817635 | doi=10.7326/0003-4819-111-10-858_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2817635 }} </ref> <ref name="pmid9329890">{{cite journal| author=Demirçay Z, Gürbüz O, Alpdoğan TB, Yücelten D, Alpdoğan O, Kurtkaya O et al.| title=Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases. | journal=Int J Dermatol | year= 1997 | volume= 36 | issue= 8 | pages= 593-8 | pmid=9329890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9329890 }} </ref><ref name="pmid6497196">{{cite journal| author=Lokich JJ, Moore C| title=Chemotherapy-associated palmar-plantar erythrodysesthesia syndrome. | journal=Ann Intern Med | year= 1984 | volume= 101 | issue= 6 | pages= 798-9 | pmid=6497196 | doi=10.7326/0003-4819-101-6-798 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6497196 }} </ref> <ref name="pmid4051360">{{cite journal| author=Peters WG, Willemze R| title=Palmar-plantar skin changes and cytarabine. | journal=Ann Intern Med | year= 1985 | volume= 103 | issue= 5 | pages= 805 | pmid=4051360 | doi=10.7326/0003-4819-103-5-805_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4051360 }} </ref> | * Re-exposure to the causative agent with similar dosage has resulted in the reaction to reoccur in the majority but not all patients.<ref name="pmid2817635">{{cite journal| author=Curran CF, Luce JK| title=Fluorouracil and palmar-plantar erythrodysesthesia. | journal=Ann Intern Med | year= 1989 | volume= 111 | issue= 10 | pages= 858 | pmid=2817635 | doi=10.7326/0003-4819-111-10-858_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2817635 }} </ref> <ref name="pmid9329890">{{cite journal| author=Demirçay Z, Gürbüz O, Alpdoğan TB, Yücelten D, Alpdoğan O, Kurtkaya O et al.| title=Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases. | journal=Int J Dermatol | year= 1997 | volume= 36 | issue= 8 | pages= 593-8 | pmid=9329890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9329890 }} </ref><ref name="pmid6497196">{{cite journal| author=Lokich JJ, Moore C| title=Chemotherapy-associated palmar-plantar erythrodysesthesia syndrome. | journal=Ann Intern Med | year= 1984 | volume= 101 | issue= 6 | pages= 798-9 | pmid=6497196 | doi=10.7326/0003-4819-101-6-798 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6497196 }} </ref> <ref name="pmid4051360">{{cite journal| author=Peters WG, Willemze R| title=Palmar-plantar skin changes and cytarabine. | journal=Ann Intern Med | year= 1985 | volume= 103 | issue= 5 | pages= 805 | pmid=4051360 | doi=10.7326/0003-4819-103-5-805_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4051360 }} </ref> | ||
==References== | ==References== | ||
{{reflist|3}} | {{reflist|3}} |
Revision as of 13:49, 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 fingers [5]
- 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. [6] [5]
Prognosis
- If the causative chemotherapeutic agent is stopped within a few days of the reactions appearing:
- Areas of pallor with blisters develop, and eventually desquamate with extensive, but superficial cracking and exfoliation.
- A gradual clearing of symptoms will occur over a period of 2 weeks.
- Rarely, long term sequelae may occur despite cessation of chemotherapy, with persistence of abnormal sensation and appearance of the affected digits [7]
- If appropriate management is not implemented rapidly, PPE can progress rapidly.
- Re-exposure to the causative agent with similar dosage has resulted in the reaction to reoccur in the majority but not all patients.[8] [9][10] [11]
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.
- ↑ 5.0 5.1 Jucglà A, Sais G, Navarro M, Peyri J (1995). "Palmoplantar keratoderma secondary to chronic acral erythema due to tegafur". Arch Dermatol. 131 (3): 364–5. PMID 7887678.
- ↑ Rios-Buceta L, Buezo GF, Peñas PF, Dauden E, Fernandez-Herrera J, Garcia-Diez A (1997). "Palmar-plantar erythrodysaesthesia syndrome and other cutaneous side-effects after treatment with Tegafur". Acta Derm Venereol. 77 (1): 80–1. doi:10.2340/00015555778081. PMID 9059693.
- ↑ Banfield GK, Crate ID, Griffiths CL (1995). "Long-term sequelae of Palmar-Plantar erythrodysaesthesia syndrome secondary to 5-fluorouracil therapy". J R Soc Med. 88 (6): 356P–357P. PMC 1295248. PMID 7629773.
- ↑ 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.