Palmar plantar erythrodysesthesia: Difference between revisions
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==Overview== | ==[[Palmar plantar erythrodysesthesia overview|Overview]]== | ||
'''Palmar plantar erythrodysesthesia''' (PPE) is a swelling and numbness of the hands and feet that occurs with [[chemotherapy]], usually with [[fluorouracil]], [[capecitabine]], [[cytarabine]], and [[doxorubicin]]. | '''Palmar plantar erythrodysesthesia''' (PPE) is a swelling and numbness of the hands and feet that occurs with [[chemotherapy]], usually with [[fluorouracil]], [[capecitabine]], [[cytarabine]], and [[doxorubicin]]. | ||
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Other names for PPE include acral erythema (AE), palmoplantar erythema, hand-foot syndrome, peculiar AE, and Burgdorf reaction. | Other names for PPE include acral erythema (AE), palmoplantar erythema, hand-foot syndrome, peculiar AE, and Burgdorf reaction. | ||
== | ==[[Palmar plantar erythrodysesthesia historical perspective|Historical perspective]]== | ||
First reported in association with chemotherapy by Zuehlke in 1974 (Zuehlke, 1974). | First reported in association with chemotherapy by Zuehlke in 1974 (Zuehlke, 1974). | ||
==Epidemiology== | ==[[Palmar plantar erythrodysesthesia epidemiology and demographics|Epidemiology & Demographics]]== | ||
PPE occurs in 6-42% of patients receiving chemotherapy. | PPE occurs in 6-42% of patients receiving chemotherapy. | ||
== | ==[[Palmar plantar erythrodysesthesia pathophysiology|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 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). | ||
== | ==[[Palmar plantar erythrodysesthesia history and symptoms|History & Symptoms]]== | ||
The symptoms can occur anywhere between days to months after administration of the offending medication, depending on the dose and speed of administration (Baack and Burgdorf, 1991; Demirçay, 1997;). The patient first experiences tingling and/or numbness of the palms and soles that evolves into painful, symmetric, and well-demarcated swelling and red plaques. This is followed by peeling of the skin and resolution of the symptoms (Apisarnthanarax and Duvic 2003). | The symptoms can occur anywhere between days to months after administration of the offending medication, depending on the dose and speed of administration (Baack and Burgdorf, 1991; Demirçay, 1997;). The patient first experiences tingling and/or numbness of the palms and soles that evolves into painful, symmetric, and well-demarcated swelling and red plaques. This is followed by peeling of the skin and resolution of the symptoms (Apisarnthanarax and Duvic 2003). | ||
==Diagnosis== | ==Diagnosis== | ||
Painful red swelling of the hands and feet in a patient receiving chemotherapy is usually enough to make the diagnosis | Painful red swelling of the hands and feet in a patient receiving chemotherapy is usually enough to make the diagnosis. | ||
==Prevention== | ==[[Palmar plantar erythrodysesthesia differential diagnosis|Differentiating Palmar plantar erythrodysesthesia from other Diseases]]== | ||
The problem arises in patients after [[bone marrow transplant|bone marrow transplants]], as the clinical and histologic features of PPE can be similar to cutaneous manifestations of acute (first 3 weeks) [[graft-versus-host disease]]. It is important to differentiate PPE, which is benign, from the more dangerous graft-versus-host disease. As time progresses, patients with graft-versus-host disease progress to have other body parts affected, while PPE is limited to hands and feet. Serial biopsies every 3 to 5 days can also be helpful in differentiating the two disorders (Crider et al, 1986). | |||
==[[Palmar plantar erythrodysesthesia primary prevention|Primary Prevention]]== | |||
The cooling of hands and feet may help prevent PPE (Baack and Burgdorf, 1991; Zimmerman et al, 1995). | The cooling of hands and feet may help prevent PPE (Baack and Burgdorf, 1991; Zimmerman et al, 1995). | ||
== | ==[[Palmar plantar erythrodysesthesia medical therapy|Medical Therapy]]== | ||
The goal is to continue chemotherapy while reducing symptoms of PPE. Symptomatic treatment includes [[pyridoxine]], wound care, elevation, and pain medication (Vukelja et al 1993). [[Corticosteroid|Corticosteroids]] have also shown some efficacy in relieving symptoms. | The goal is to continue chemotherapy while reducing symptoms of PPE. Symptomatic treatment includes [[pyridoxine]], wound care, elevation, and pain medication (Vukelja et al 1993). [[Corticosteroid|Corticosteroids]] have also shown some efficacy in relieving symptoms. | ||
==Prognosis== | ==[[Palmar plantar erythrodysesthesia natural history, complications, and prognosis|Natural history, Complications, and Prognosis]]== | ||
PPE variably recurs with resumption of chemotherapy. Long-term chemotherapy may also result in reversible [[palmoplantar keratoderma]]. Symptoms resolve 1-2 weeks after cessation of chemotherapy (Apisarnthanarax and Duvic 2003). | PPE variably recurs with resumption of chemotherapy. Long-term chemotherapy may also result in reversible [[palmoplantar keratoderma]]. Symptoms resolve 1-2 weeks after cessation of chemotherapy (Apisarnthanarax and Duvic 2003). | ||
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* {{cite journal |author=Zuehlke R |title=Erythematous eruption of the palms and soles associated with mitotane therapy |journal=Dermatologica |volume=148 |issue=2 |pages=90-2 |year=1974 |pmid=4276191}} | * {{cite journal |author=Zuehlke R |title=Erythematous eruption of the palms and soles associated with mitotane therapy |journal=Dermatologica |volume=148 |issue=2 |pages=90-2 |year=1974 |pmid=4276191}} | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||
Revision as of 16:37, 20 January 2012
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Differentiating Palmar plantar erythrodysesthesia from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Palmar plantar erythrodysesthesia (PPE) is a swelling and numbness of the hands and feet that occurs with chemotherapy, usually with fluorouracil, capecitabine, cytarabine, and doxorubicin.
Synonyms
Other names for PPE include acral erythema (AE), palmoplantar erythema, hand-foot syndrome, peculiar AE, and Burgdorf reaction.
Historical perspective
First reported in association with chemotherapy by Zuehlke in 1974 (Zuehlke, 1974).
Epidemiology & Demographics
PPE occurs in 6-42% of patients receiving chemotherapy.
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).
History & Symptoms
The symptoms can occur anywhere between days to months after administration of the offending medication, depending on the dose and speed of administration (Baack and Burgdorf, 1991; Demirçay, 1997;). The patient first experiences tingling and/or numbness of the palms and soles that evolves into painful, symmetric, and well-demarcated swelling and red plaques. This is followed by peeling of the skin and resolution of the symptoms (Apisarnthanarax and Duvic 2003).
Diagnosis
Painful red swelling of the hands and feet in a patient receiving chemotherapy is usually enough to make the diagnosis.
Differentiating Palmar plantar erythrodysesthesia from other Diseases
The problem arises in patients after bone marrow transplants, as the clinical and histologic features of PPE can be similar to cutaneous manifestations of acute (first 3 weeks) graft-versus-host disease. It is important to differentiate PPE, which is benign, from the more dangerous graft-versus-host disease. As time progresses, patients with graft-versus-host disease progress to have other body parts affected, while PPE is limited to hands and feet. Serial biopsies every 3 to 5 days can also be helpful in differentiating the two disorders (Crider et al, 1986).
Primary Prevention
The cooling of hands and feet may help prevent PPE (Baack and Burgdorf, 1991; Zimmerman et al, 1995).
Medical Therapy
The goal is to continue chemotherapy while reducing symptoms of PPE. Symptomatic treatment includes pyridoxine, wound care, elevation, and pain medication (Vukelja et al 1993). Corticosteroids have also shown some efficacy in relieving symptoms.
Natural history, Complications, and Prognosis
PPE variably recurs with resumption of chemotherapy. Long-term chemotherapy may also result in reversible palmoplantar keratoderma. Symptoms resolve 1-2 weeks after cessation of chemotherapy (Apisarnthanarax and Duvic 2003).
References
- Apisarnthanarax, N and Duvic MM. Dermatologic Complications of Cancer Chemotherapy in Holland-Frei Cancer Medicine - 6th Ed., Ch. 147, Kufe, DW et al editors, BC Decker Inc, Hamilton, Ontario. 2003.
- Baack B, Burgdorf W (1991). "Chemotherapy-induced acral erythema". J Am Acad Dermatol. 24 (3): 457–61. PMID 2061446.
- Crider M, Jansen J, Norins A, McHale M (1986). "Chemotherapy-induced acral erythema in patients receiving bone marrow transplantation". Arch Dermatol. 122 (9): 1023–7. PMID 3527075.
- Demirçay Z, Gürbüz O, Alpdoğan T, Yücelten D, Alpdoğan O, Kurtkaya O, Bayik M (1997). "Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases". Int J Dermatol. 36 (8): 593–8. PMID 9329890.
- Vukelja S, Baker W, Burris H, Keeling J, Von Hoff D (1993). "Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with taxotere". J Natl Cancer Inst. 85 (17): 1432–3. PMID 8102408.
- Zimmerman G, Keeling J, Burris H, Cook G, Irvin R, Kuhn J, McCollough M, Von Hoff D (1995). "Acute cutaneous reactions to docetaxel, a new chemotherapeutic agent". Arch Dermatol. 131 (2): 202–6. PMID 7857119.
- Zuehlke R (1974). "Erythematous eruption of the palms and soles associated with mitotane therapy". Dermatologica. 148 (2): 90–2. PMID 4276191.