Palmar plantar erythrodysesthesia natural history, complications, and prognosis
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.