Palmar Plantar Erythrodysesthesia
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords:Palmar plantar erythrodysesthesia, Palmar-Plantar Erythrodysesthesia; Palmoplantar Erythrodysesthesia; Hand-Foot Syndrome, peculiar AE, chemotherapy-induced AE, toxic erythema of the palms and soles, palmar-plantar erythema, and Burgdorf’s reaction.
Overview
Palmar Plantar Erythrodystesia or Hand-Foot syndrome is a skin-related reaction to chemotherapy and other drugs used to treat patients with cancer.
Historical Perspective
In 1975, Zuehlke[1] reported the first case of Palmar Plantar Erythrodysesthesia due to chemotherapy.
Classification
Pathophysiology
Genetics
Associated Conditions
Gross Pathology
Microscopic Pathology
On histopathology non-specific features seen in Palmar Plantar Erythrodysesthesia. Features include[2]:
- Vacuolar degenration of the basal cell layer
- Mild spongiosis, keratinocytes necrosis
- Papillary dermal edema
- Lymphocytic infiltrates
- Partial separation of epidermis from the dermis
- Dermis shows perivascular infiltrates made up of eosinphils and lymphocytes
- May have presence of eccrine squamous syringometaplasia or netruophilic eccrine hidradenitis.
- Some data suggests that small-fibre neuropathy may cause the pain and dysesthesia.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Several different Chemotherapeutic agents have been associated with acral erythema[3]. Common ones are listed below.
Causes by Organ System
Less Common Causes
| Cardiovascular | No underlying causes |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Dental | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order
- A...
- Z...
Make sure that each diagnosis is linked to a page.
Differentiating type page name here from other Diseases
Palmar Plantar Erythrosysesthesia must be differentiated from Tinea manuum which can also present in patients being treated with chemotherapy. Tinea Manuum infection responds to antifungal therapy.
Epidemiology and Demographics
Age
Gender
Race
Developed Countries
Developing Countries
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
If available, the diagnostic criteria are provided here.
History
A directed history should be obtained to ascertain
Symptoms
"Type symptom here" is pathognomonic of the "type disease name here".
Erythematous changes of the palms with associated oedema, blistering and desquamation[7].
Past Medical History
Family History
Social History
Occupational
Alcohol
The frequency and amount of alcohol consumption should be characterized.
Drug Use
Smoking
Allergies
Physical Examination
Appearance of the Patient
Vital Signs
Skin
Head
Eyes
Ear
Nose
Mouth
Throat
Heart
Lungs
Abdomen
Extremities
Neurologic
Genitals
Other
Laboratory Findings
Electrolyte and Biomarker Studies
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Pharmacotherapy
Acute Pharmacotherapies
Chronic Pharmacotherapies
Surgery and Device Based Therapy
Indications for Surgery
Pre-Operative Assessment
Post-Operative Management
Transplantation
Primary Prevention
Secondary Prevention
- Dr Kuznecovs with his colleagues came to the conclusion that atorvastatin and polyprenol combination can prevent PPE due to capecitabine. https://www.medscape.com/viewarticle/848530
Cost-Effectiveness of Therapy
Future or Investigational Therapies
References
- ↑ 1.0 1.1 Zuehlke RL (1974). "Erythematous eruption of the palms and soles associated with mitotane therapy". Dermatologica. 148 (2): 90–2. PMID 4276191.
- ↑ Farr KP, Safwat A (2011). "Palmar-plantar erythrodysesthesia associated with chemotherapy and its treatment". Case Rep Oncol. 4 (1): 229–35. doi:10.1159/000327767. PMC 3085037. PMID 21537373.
- ↑ Baack BR, Burgdorf WH (1991). "Chemotherapy-induced acral erythema". J Am Acad Dermatol. 24 (3): 457–61. PMID 2061446.
- ↑ Wysocki M, Nowaczyk-Michalak A, Pilecki O, Kurylak A, Balcar-Boroń A, Trybuś L (1992). "[Burgdorf's reaction (painful acral erythema) in patients with acute lymphoblastic leukemia following medium-dose methotrexate therapy]". Wiad Lek. 45 (11–12): 462–4. PMID 1441532.
- ↑ Harris CS, Wang D, Carulli A (2014). "Docetaxel-associated palmar-plantar erythrodysesthesia: a case report and review of the literature". J Oncol Pharm Pract. 20 (1): 73–80. doi:10.1177/1078155213475466. PMID 23478198.
- ↑ Krikorian A, Rahmani R, Bromet M, Bore P, Cano JP (1989). "Pharmacokinetics and metabolism of Navelbine". Semin Oncol. 16 (2 Suppl 4): 21–5. PMID 2652317.
- ↑ Wysocki M, Nowaczyk-Michalak A, Pilecki O, Kurylak A, Balcar-Boroń A, Trybuś L (1992). "[Burgdorf's reaction (painful acral erythema) in patients with acute lymphoblastic leukemia following medium-dose methotrexate therapy]". Wiad Lek. 45 (11–12): 462–4. PMID 1441532.