Palmar plantar erythrodysesthesia risk factors

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Overview

  • The most common and established risk factors are chemotherapeutic agents. The severity of the condition depends on the dose and frequency of the agent. The data is limited to support any other associated risk factors as the pathophysiology of Palmar plantar erythrodysesthesia is still unknown even though different mechanisms have been postulated.

Risk Factors

Palmar Plantar Erythrosysesthesia has been linked with The occurrence of this condition has been linked to dose and prolonged chemotherapeutic drug exposure especially with more continuous IV infusion, daily ingestion and liposomal encapsulationg of PLD which prolong half-life of drug. The use of cooling mechanism, higher number of PLD cycles, and occurrence of mucositis, neutropenia and peripheral neuropathy are possible predictors of PPE.[1]

Risk Factors

Exposure to chemotherapeutic agents has been proven to be an established risk factor. Occurrence of this condition has been linked to dose and prolonged chemotherapeutic drug exposure especially with more continuous IV infusion, daily ingestion and liposomal encapsulationg of PLD which prolong half-life of drug. The use of cooling mechanism, higher number of PLD cycles, and occurrence of mucositis, neutropenia and peripheral neuropathy are possible predictors of PPE. [2]

  • Several different Chemotherapeutic agents have been associated with acral erythema[3]. Common ones are listed below.
    • Most frequently associated with Doxorubicin (Pegylated liposomal Doxorubicin), 5-Flurouracil, and Cytarabine[4] .
    • Methotrexate - even low dose used to treat ALL[5]
    • Mitotane[6]
    • PLD, Docetaxel, Capecitabine, vinorelbine, gemcitabine and Sorafenib[7]

Less Common Causes[8]

  • Cisplatin
  • Cyclophosphamide
  • Daunorubicin
  • Doxifluridine
  • Etoposide
  • Floxuridine
  • Hydroxyurea
  • Idarubicin
  • Lomustine
  • Melphalan
  • Mercaptopurine
  • Mitomycin
  • Paclitaxel
  • Suramin
  • Troxacitabine[9]
  • Tegafur
  • Vincristine

References

  1. Tanyi JL, Smith JA, Ramos L, Parker CL, Munsell MF, Wolf JK (2009). "Predisposing risk factors for palmar-plantar erythrodysesthesia when using liposomal doxorubicin to treat recurrent ovarian cancer". Gynecol Oncol. 114 (2): 219–24. doi:10.1016/j.ygyno.2009.04.007. PMID 19446868.
  2. Tanyi JL, Smith JA, Ramos L, Parker CL, Munsell MF, Wolf JK (2009). "Predisposing risk factors for palmar-plantar erythrodysesthesia when using liposomal doxorubicin to treat recurrent ovarian cancer". Gynecol Oncol. 114 (2): 219–24. doi:10.1016/j.ygyno.2009.04.007. PMID 19446868.
  3. Baack BR, Burgdorf WH (1991). "Chemotherapy-induced acral erythema". J Am Acad Dermatol. 24 (3): 457–61. PMID 2061446.
  4. Webster-Gandy JD, How C, Harrold K (2007). "Palmar-plantar erythrodysesthesia (PPE): a literature review with commentary on experience in a cancer centre". Eur J Oncol Nurs. 11 (3): 238–46. doi:10.1016/j.ejon.2006.10.004. PMID 17350337.
  5. 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.
  6. 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.
  7. Susser WS, Whitaker-Worth DL, Grant-Kels JM (1999). "Mucocutaneous reactions to chemotherapy". J Am Acad Dermatol. 40 (3): 367–98, quiz 399-400. PMID 10071309.
  8. Hidalgo M, Siu LL, Nemunaitis J, Rizzo J, Hammond LA, Takimoto C; et al. (2001). "Phase I and pharmacologic study of OSI-774, an epidermal growth factor receptor tyrosine kinase inhibitor, in patients with advanced solid malignancies". J Clin Oncol. 19 (13): 3267–79. doi:10.1200/JCO.2001.19.13.3267. PMID 11432895.