Palmar plantar erythrodysesthesia natural history, complications, and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
[[Prognosis]] is generally good and [[Symptom|symptoms]] usually resolve within 1-2 weeks after stopping the causative [[chemotherapeutic agent]]. If left untreated, PPE can progress rapidly. PPE is not life-threatening, but it can be very debilitating and impair [[quality of life]]. | [[Prognosis]] is generally good and [[Symptom|symptoms]] usually resolve within 1 - 2 weeks after stopping the [[Causality|causative]] [[chemotherapeutic agent]]. If left untreated, palmar plantar erythrodysesthesia (PPE) can progress rapidly. PPE is not life-threatening, but it can be very debilitating and can significantly impair [[quality of life]]. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*The [[symptoms]] of PPE usually develop | *The [[symptoms]] of palmar plantar erythrodysesthesia (PPE) usually develop 1 - 21 days after higher-[[dose]] pulse [[Therapy|therapies]] and up to 2 - 10 months after continuous low-[[dose]] [[Therapy|therapies]]. | ||
*PPE appears to be dose | *PPE development appears to be dependent on the [[dose]] of the [[:Category:Drugs|drug]]. | ||
*Both peak | *Both peak [[drug concentration]] and total cumulative [[dose]] determine its occurrence since both [[bolus]] [[Infusion|infusions]] and continuous low-[[dose]] administration can cause a [[dose]]-dependent [[drug reaction]].<ref name="pmid3977204">{{cite journal| author=Baer MR, King LE, Wolff SN| title=Palmar-plantar erythrodysesthesia and cytarabine. | journal=Ann Intern Med | year= 1985 | volume= 102 | issue= 4 | pages= 556 | pmid=3977204 | doi=10.7326/0003-4819-102-4-556_1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3977204 }} </ref> <ref name="pmid2926468">{{cite journal| author=Lokich JJ, Ahlgren JD, Gullo JJ, Philips JA, Fryer JG| title=A prospective randomized comparison of continuous infusion fluorouracil with a conventional bolus schedule in metastatic colorectal carcinoma: a Mid-Atlantic Oncology Program Study. | journal=J Clin Oncol | year= 1989 | volume= 7 | issue= 4 | pages= 425-32 | pmid=2926468 | doi=10.1200/JCO.1989.7.4.425 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2926468 }} </ref><ref name="pmid6223674">{{cite journal| author=Herzig RH, Wolff SN, Lazarus HM, Phillips GL, Karanes C, Herzig GP| title=High-dose cytosine arabinoside therapy for refractory leukemia. | journal=Blood | year= 1983 | volume= 62 | issue= 2 | pages= 361-9 | pmid=6223674 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6223674 }} </ref> <ref name="pmid2528937">{{cite journal| author=Kroll SS, Koller CA, Kaled S, Dreizen S| title=Chemotherapy-induced acral erythema: desquamating lesions involving the hands and feet. | journal=Ann Plast Surg | year= 1989 | volume= 23 | issue= 3 | pages= 263-5 | pmid=2528937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2528937 }} </ref> | ||
*In addition, combined administration of two [[Chemotherapy agent|chemotherapeutic | *In addition, combined administration of two [[Chemotherapy agent|chemotherapeutic drugs]], both capable of causing palmar plantar erythrodysesthesia (PPE), usually results in an increased [[frequency]] of occurrence and severity of PPE. | ||
===Complications=== | ===Complications=== | ||
* 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 can significantly impair quality of life. | ||
*If [[chemotherapy]] is continued despite the | *If [[chemotherapy]] is continued despite the development of the PPE: | ||
** The [[Lesion|lesions]] deteriorate, and [[tenderness]] and [[edema]] may restrict | ** The [[Lesion|lesions]] deteriorate, and [[tenderness]] and [[edema]] may restrict the fine movements of the [[Finger|fingers]] <ref name="pmid7887678">{{cite journal| author=Jucglà A, Sais G, Navarro M, Peyri J| title=Palmoplantar keratoderma secondary to chronic acral erythema due to tegafur. | journal=Arch Dermatol | year= 1995 | volume= 131 | issue= 3 | pages= 364-5 | pmid=7887678 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7887678 }} </ref> | ||
** The [[erythema]] becomes darker or violaceous | ** The [[erythema]] becomes darker or violaceous and spreads to involve the entire surface of the [[Palms of the hands|palms]] and [[Sole (foot)|soles]]. | ||
** The [[pain]] may be severe enough to limit [[activities of daily living | ** The [[pain]] may be severe enough to limit [[activities of daily living|activities of daily living (ADL)]]. | ||
** In some [[patients]] [[lesions]] may evolve into a [[palmoplantar keratoderma]]. <ref name="pmid9059693">{{cite journal| author=Rios-Buceta L, Buezo GF, Peñas PF, Dauden E, Fernandez-Herrera J, Garcia-Diez A| title=Palmar-plantar erythrodysaesthesia syndrome and other cutaneous side-effects after treatment with Tegafur. | journal=Acta Derm Venereol | year= 1997 | volume= 77 | issue= 1 | pages= 80-1 | pmid=9059693 | doi=10.2340/00015555778081 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9059693 }} </ref> <ref name="pmid7887678">{{cite journal| author=Jucglà A, Sais G, Navarro M, Peyri J| title=Palmoplantar keratoderma secondary to chronic acral erythema due to tegafur. | journal=Arch Dermatol | year= 1995 | volume= 131 | issue= 3 | pages= 364-5 | pmid=7887678 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7887678 }} </ref> | ** In some [[patients]], [[lesions]] may evolve into a [[palmoplantar keratoderma]]. <ref name="pmid9059693">{{cite journal| author=Rios-Buceta L, Buezo GF, Peñas PF, Dauden E, Fernandez-Herrera J, Garcia-Diez A| title=Palmar-plantar erythrodysaesthesia syndrome and other cutaneous side-effects after treatment with Tegafur. | journal=Acta Derm Venereol | year= 1997 | volume= 77 | issue= 1 | pages= 80-1 | pmid=9059693 | doi=10.2340/00015555778081 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9059693 }} </ref> <ref name="pmid7887678">{{cite journal| author=Jucglà A, Sais G, Navarro M, Peyri J| title=Palmoplantar keratoderma secondary to chronic acral erythema due to tegafur. | journal=Arch Dermatol | year= 1995 | volume= 131 | issue= 3 | pages= 364-5 | pmid=7887678 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7887678 }} </ref> | ||
===Prognosis=== | ===Prognosis=== | ||
*If the causative [[chemotherapeutic agent]] is stopped within a few days of the | *If the [[Causality|causative]] [[chemotherapeutic agent]] is stopped within a few days of the development of PPE: | ||
** Areas of [[pallor]] with [[Blister|blisters]] develop, and eventually [[Desquamation|desquamate]] with extensive | ** Areas of [[pallor]] with [[Blister|blisters]] develop, and eventually [[Desquamation|desquamate]] with extensive but superficial cracking and [[exfoliation]]. | ||
** A gradual clearing of [[symptoms]] will occur over a period of 2 weeks. | ** 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 | ** Rarely, long term [[sequelae]] may occur despite cessation of [[chemotherapy]], with persistence of abnormal [[sensation]] 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 | * If appropriate management is not implemented rapidly, PPE can rapidly progress. | ||
* Re-exposure to the causative agent with similar [[dosage]] has resulted in the [[reaction]] to | * Re-exposure to the [[Causality|causative]] agent with similar [[dosage]] has resulted in the [[reaction]] to recur in the majority of the [[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 20:53, 17 July 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mandana Chitsazan, M.D. [2]
Overview
Prognosis is generally good and symptoms usually resolve within 1 - 2 weeks after stopping the causative chemotherapeutic agent. If left untreated, palmar plantar erythrodysesthesia (PPE) can progress rapidly. PPE is not life-threatening, but it can be very debilitating and can significantly impair quality of life.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of palmar plantar erythrodysesthesia (PPE) usually develop 1 - 21 days after higher-dose pulse therapies and up to 2 - 10 months after continuous low-dose therapies.
- PPE development appears to be dependent on the dose of the drug.
- 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 chemotherapeutic drugs, both capable of causing palmar plantar erythrodysesthesia (PPE), usually results in an increased frequency of occurrence and severity of PPE.
Complications
- PPE is not life-threatening, but it can be very debilitating and can significantly impair quality of life.
- If chemotherapy is continued despite the development of the PPE:
- The lesions deteriorate, and tenderness and edema may restrict 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 development of PPE:
- 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 of the affected digits. [7]
- If appropriate management is not implemented rapidly, PPE can rapidly progress.
- Re-exposure to the causative agent with similar dosage has resulted in the reaction to recur in the majority of the 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.