Journal of the Louisiana State Medical Society
Ms. Kaskas is with the Louisiana State University Health School of Medicine in Shreveport. Drs. DiGiorgio, Vincent, Walia, and Mermilliod are with the Department of Dermatology at the Louisiana State University Health Sciences Center in New Orleans and the Ochsner Clinic Foundation, Department of Dermatology in New Orleans.
are in conjunction with palmar and plantar involvement. 3,8,9 The sparing of the palms and soles in our patient was a relatively unique presentation. 3,9 Histopathologic correla- tion with clinical findings is indicated for a diagnosis of TEC, particularly in cases with an uncharacteristic clinical presentation. 1 There is no current consensus regarding the pathogen- esis of TEC, but the most popular etiologic theory, which claims excretion of chemotherapeutic agents via eccrine sweat, causes direct toxic damage to the cells of the straight portion of the eccrine duct, acrosyringuim, and epidermis. 5-7 This proposal is supported by the propensity of the syn- drome to occur in acral areas with a high concentration of eccrine glands, such as the palms, soles, and intertriginious areas. 5 Furthermore, studies have found localized eccrine squamous syringometaplasia at the site of doxorubicin extravasation. 8,10 TEC follows a self-limited course, which resolves upon discontinuation of the inciting agent. 4 Dose reduction or increasing the time between cycles of chemotherapy is recommended to decrease the risk of recurrence. 6 Other treatment options include topical corticosteroids and an- algesics, local hypothermia, systemic corticosteroids, and pyridoxine supplementation. 3,6 Desquamation and post- inflammatory hyperpigmentation frequently accompany resolution of TEC. 4 REFERENCES 1. Bakst RL, Tallman MS, Douer D, Yahalom J. How I treat extramedullary acute myeloid leukemia. Blood . 2011;118(14):3785- 93. 2. Kang YS, Kim HS, Park HJ, et al. Clinical characteristics of 75 patients with leukemia cutis. J Korean Med Sci . 2013;28(4):614-9. 3. Bolognia JL, Cooper DL, Glusac EJ. Toxic erythema of chemotherapy: a useful clinical term. J Am Acad Dermatol . 2008;59(3):524-9 4. Repass TS, Wetter DA, Camilleri MJ. Toxic erythema of chemotherapy. Am J Hematol . 2012;87(9):923. 5. Lipworth AD, Robert C, Zhu AX. Hand-foot syndrome (hand- foot skin reaction, palmar-plantar erythrodysesthesia): focus on sorafenib and sunitinib. Oncology . 2009;77(5):257-71. 6. Huang V, Anadkat M. Dermatologic manifestations of cytotoxic therapy. Dermatol Ther. 2011;24(4):401-10. 7. Spicknall KE, Mutasim DF. Localized toxic erythema of chemotherapy during treatment with paclitaxel. Int J Dermatol . 2013. 8. SerranoT, SaezA,MorenoA. Eccrine squamous syringometaplasia. Aprospective clinicopathologic study. J Cutan Pathol . 1993;20(1):61- 65. 9. Ziemer M, Goetze S, Kaatz M, Elsner P. Chemotherapy-induced toxic erythema under treatment with pegylated liposomal doxorubicin: No restriction to palms and soles. J AmAcad Dermatol . 2008;58(2 Suppl):S44-6. 10. Jacobi U, Waibler E, Schulze P, et al. Release of doxorubicin in sweat: first step to induce the palmar-plantar erythrodysesthesia syndrome? Ann Oncol . 2005;16(7):1210-1.
238 J La State Med Soc VOL 166 November/December 2014
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