Palmar plantar erythrodysesthesia natural history, complications, and prognosis

Revision as of 17:10, 2 July 2019 by Mchitsazan (talk | contribs)
Jump to navigation Jump to search

Palmar plantar erythrodysesthesia Microchapters

Home

Overview

Historical perspective

Classification

Pathophysiology

Causes

Differentiating Palmar plantar erythrodysesthesia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural history, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Palmar plantar erythrodysesthesia natural history, complications, and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Palmar plantar erythrodysesthesia natural history, complications, and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Palmar plantar erythrodysesthesia natural history, complications, and prognosis

CDC on Palmar plantar erythrodysesthesia natural history, complications, and prognosis

Palmar plantar erythrodysesthesia natural history, complications, and prognosis in the news

Blogs on Palmar plantar erythrodysesthesia natural history, complications, and prognosis

Directions to Hospitals Treating Palmar plantar erythrodysesthesia

Risk calculators and risk factors for 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, PPE can progress rapidly. PPE is not life threatening, but it can be very debilitating and impair quality of life.

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

  1. 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.
  2. 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.
  3. 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.
  4. 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. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.