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Chemotherapy-Induced Acral Erythema: A Clinical and Histopathologic Study of 44 Cases
Eritema Acral Inducido Por Quimioterapia: Estudio Clínico e Histopatoló-Gico de 44 Casos
L. Hueso, O. Sanmartín
, E. Nagore, R. Botella-Estrada, C. Requena, B. Llombart, C. Serra-Guillén, A. Alfaro-Rubio, C. Guillén
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osanmartinj@gmail.com
Correspondence: Servicio de Dermatología, Instituto Valenciano de Oncología, C/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
Correspondence: Servicio de Dermatología, Instituto Valenciano de Oncología, C/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
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Ingelmo, I. Ruiz, S. Delgado, M.A. Rodríguez" "autores" => array:7 [ 0 => array:2 [ "nombre" => "T." "apellidos" => "Alonso" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Sánchez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "González" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Ingelmo" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Ruiz" ] 5 => array:2 [ "nombre" => "S." "apellidos" => "Delgado" ] 6 => array:2 [ "nombre" => "M.A." "apellidos" => "Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219008702518?idApp=UINPBA000044" "url" => "/15782190/0000009900000004/v1_201304241431/S1578219008702518/v1_201304241431/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>" "titulo" => "Chemotherapy-Induced Acral Erythema: A Clinical and Histopathologic Study of 44 Cases" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "281" "paginaFinal" => "290" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Hueso, O. Sanmartín, E. Nagore, R. Botella-Estrada, C. Requena, B. Llombart, C. Serra-Guillén, A. Alfaro-Rubio, C. Guillén" "autores" => array:9 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Hueso" ] 1 => array:4 [ "nombre" => "O." "apellidos" => "Sanmartín" "email" => array:1 [ 0 => "osanmartinj@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Nagore" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Botella-Estrada" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Requena" ] 5 => array:2 [ "nombre" => "B." "apellidos" => "Llombart" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Serra-Guillén" ] 7 => array:2 [ "nombre" => "A." "apellidos" => "Alfaro-Rubio" ] 8 => array:2 [ "nombre" => "C." "apellidos" => "Guillén" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondence: Servicio de Dermatología, Instituto Valenciano de Oncología, C/ Profesor Beltrán Báguena, 8, 46009 Valencia, Spain." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eritema Acral Inducido Por Quimioterapia: Estudio Clínico e Histopatoló-Gico de 44 Casos" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaAceptado" => "2007-12-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec84180" "palabras" => array:5 [ 0 => "acral erythema" 1 => "palmoplantar erythrodysesthesia" 2 => "hand-foot syndrome" 3 => "chemotherapy" 4 => "adverse effects" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84179" "palabras" => array:5 [ 0 => "eritema acral" 1 => "eritrodisestesia palmoplantar" 2 => "síndrome pie-mano" 3 => "quimioterapia" 4 => "efectos adversos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Acral erythema, also known as palmoplantar erythrodysesthesia or hand-foot syndrome, is a relatively common cutaneous reaction caused by a variety of chemotherapeutic agents. It presents during cancer treatment as painful erythema and paresthesia affecting the palms and soles. It seems to be dose dependent and its appearance is determined by both the peak plasma concentration and the cumulative dose of the chemotherapeutic agent. The symptoms and histopathology findings are suggestive of direct cytotoxicity affecting the epidermis of the extremities caused by high concentrations of chemotherapeutic agents. The most commonly implicated agents are doxorubicin, 5-fluoracil and its derivatives, cytarabine, and docetaxel.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We present the clinical and histologic characteristics of a series of patients diagnosed with chemotherapy-induced acral erythema. The study included all patients who developed acral erythema lesions following chemotherapy between January 2000 and December 2003.</p> <span class="elsevierStyleSectionTitle">Results and conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Out of 2186 patients who underwent chemotherapy, 44 cases of acral erythema were identified, representing an incidence of 2.01% during the study period and 16.75% of all cutaneous lesions attributed to chemotherapy. The most commonly implicated drug was 5-fluoracil administered by continuous infusion and the highest incidence was observed in patients treated with liposomal doxorubicin. Acral erythema was a dose-limiting toxic effect in 29.5% of cases. The histologic findings varied according to the clinical severity of the lesions and included interface dermatitis with variable keratinocyte necrosis, dilation of the superficial vascular plexus, and limited inflammatory infiltrate. The most commonly used treatment was pyridoxine, along with topical treatments such as cold compresses, emollients, and topical corticosteroids.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">El eritema acral (EA) es una reacción cutánea relativamente frecuente producida por diferentes agentes quimioterápicos. Otros términos con los que se le conoce son eritrodisestesia palmoplantar o síndrome pie-mano. Se presenta como un eritema doloroso en palmas y plantas asociado a parestesias en el contexto de un tratamiento oncológico. El EA parece ser dosis-dependiente, y tanto el pico plasmático como la dosis acumulada del quimioterápico determinan su aparición. La clínica y los hallazgos histopatológicos sugieren una citotoxicidad directa de la epidermis acral por las altas concentraciones de los quimioterápicos. Los agentes más frecuentemente implicados son doxorrubicina, 5-fluorouracilo y derivados, citarabina y docetaxel.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se presentan las características clínicas e histológicas de una serie de pacientes diagnosticados de eritema acral por quimioterápicos. Se incluyeron en el trabajo todos los pacientes sometidos a quimioterapia que desarrollaron lesiones de eritema acral durante un período de tiempo comprendido entre enero de 2000 y diciembre de 2003.</p> <span class="elsevierStyleSectionTitle">Resultados y conclusión</span><p class="elsevierStyleSimplePara elsevierViewall">Se encontraron 44 casos entre los 2.186 pacientes sometidos a quimioterapia, lo que supuso una incidencia del 2,01% durante el período de estudio, y el 16,75% de todas las lesiones cutáneas atribuidas a la quimioterapia. El fármaco más frecuentemente relacionado fue el 5-fluorouracilo en infusión continua, y la mayor incidencia se dio en pacientes tratados con doxorrubicina liposomial. El EA fue toxicidad limitante de dosis en el 29,5% de los casos. Los hallazgos histológicos variaron según la intensidad clínica de las lesiones, encontrando una dermatitis de interfase con necrosis de queratinocitos variable, dilatación del plexo vascular superficial y un escaso infiltrado inflamatorio. El tratamiento más utilizado fue la piridoxina y las medidas locales como fomentos fríos, emolientes y corticoides tópicos.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:63 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 18 | 32 |
| 2024 October | 118 | 76 | 194 |
| 2024 September | 128 | 58 | 186 |
| 2024 August | 156 | 85 | 241 |
| 2024 July | 170 | 43 | 213 |
| 2024 June | 116 | 41 | 157 |
| 2024 May | 167 | 41 | 208 |
| 2024 April | 112 | 26 | 138 |
| 2024 March | 146 | 57 | 203 |
| 2024 February | 95 | 46 | 141 |
| 2024 January | 103 | 54 | 157 |
| 2023 December | 111 | 65 | 176 |
| 2023 November | 140 | 53 | 193 |
| 2023 October | 83 | 78 | 161 |
| 2023 September | 59 | 42 | 101 |
| 2023 August | 38 | 39 | 77 |
| 2023 July | 66 | 61 | 127 |
| 2023 June | 74 | 44 | 118 |
| 2023 May | 64 | 35 | 99 |
| 2023 April | 53 | 32 | 85 |
| 2023 March | 47 | 36 | 83 |
| 2023 February | 41 | 40 | 81 |
| 2023 January | 43 | 37 | 80 |
| 2022 December | 35 | 40 | 75 |
| 2022 November | 15 | 24 | 39 |
| 2022 October | 16 | 26 | 42 |
| 2022 September | 21 | 28 | 49 |
| 2022 August | 17 | 49 | 66 |
| 2022 July | 10 | 45 | 55 |
| 2022 June | 22 | 55 | 77 |
| 2022 May | 80 | 77 | 157 |
| 2022 April | 76 | 40 | 116 |
| 2022 March | 74 | 70 | 144 |
| 2022 February | 62 | 51 | 113 |
| 2022 January | 63 | 65 | 128 |
| 2021 December | 44 | 42 | 86 |
| 2021 November | 53 | 59 | 112 |
| 2021 October | 72 | 49 | 121 |
| 2021 September | 53 | 52 | 105 |
| 2021 August | 51 | 32 | 83 |
| 2021 July | 54 | 44 | 98 |
| 2021 June | 67 | 33 | 100 |
| 2021 May | 84 | 40 | 124 |
| 2021 April | 466 | 96 | 562 |
| 2021 March | 139 | 36 | 175 |
| 2021 February | 81 | 40 | 121 |
| 2021 January | 70 | 37 | 107 |
| 2020 December | 65 | 22 | 87 |
| 2020 November | 66 | 23 | 89 |
| 2020 October | 68 | 15 | 83 |
| 2020 September | 77 | 31 | 108 |
| 2020 August | 65 | 28 | 93 |
| 2020 July | 54 | 25 | 79 |
| 2020 June | 43 | 42 | 85 |
| 2020 May | 56 | 39 | 95 |
| 2020 April | 42 | 33 | 75 |
| 2020 March | 31 | 21 | 52 |
| 2020 February | 2 | 10 | 12 |
| 2020 January | 0 | 13 | 13 |
| 2019 December | 0 | 39 | 39 |
| 2019 November | 0 | 29 | 29 |
| 2019 October | 0 | 17 | 17 |
| 2019 September | 0 | 14 | 14 |
| 2019 August | 0 | 8 | 8 |
| 2019 July | 0 | 22 | 22 |
| 2019 June | 0 | 20 | 20 |
| 2019 May | 0 | 77 | 77 |
| 2019 April | 0 | 77 | 77 |
| 2019 March | 0 | 30 | 30 |
| 2019 February | 0 | 26 | 26 |
| 2019 January | 0 | 11 | 11 |
| 2018 December | 0 | 6 | 6 |
| 2018 September | 0 | 2 | 2 |
| 2018 August | 0 | 18 | 18 |
| 2018 July | 0 | 26 | 26 |
| 2018 June | 0 | 20 | 20 |
| 2018 May | 0 | 12 | 12 |
| 2018 April | 0 | 13 | 13 |
| 2018 March | 1 | 22 | 23 |
| 2018 February | 22 | 30 | 52 |
| 2018 January | 28 | 22 | 50 |
| 2017 December | 24 | 33 | 57 |
| 2017 November | 22 | 39 | 61 |
| 2017 October | 16 | 37 | 53 |
| 2017 September | 22 | 44 | 66 |
| 2017 August | 38 | 42 | 80 |
| 2017 July | 31 | 55 | 86 |
| 2017 June | 45 | 69 | 114 |
| 2017 May | 53 | 66 | 119 |
| 2017 April | 48 | 55 | 103 |
| 2017 March | 57 | 52 | 109 |
| 2017 February | 35 | 75 | 110 |
| 2017 January | 25 | 39 | 64 |
| 2016 December | 52 | 44 | 96 |
| 2016 November | 44 | 46 | 90 |
| 2016 October | 41 | 69 | 110 |
| 2016 September | 41 | 47 | 88 |
| 2016 August | 54 | 38 | 92 |
| 2016 July | 38 | 22 | 60 |
| 2016 June | 9 | 15 | 24 |
| 2016 May | 5 | 26 | 31 |
| 2016 April | 7 | 11 | 18 |
| 2016 March | 3 | 1 | 4 |
| 2016 February | 6 | 16 | 22 |
| 2016 January | 8 | 15 | 23 |
| 2015 December | 10 | 3 | 13 |
| 2015 November | 9 | 1 | 10 |
| 2015 October | 8 | 8 | 16 |
| 2015 September | 8 | 6 | 14 |
| 2015 August | 18 | 13 | 31 |
| 2015 July | 50 | 1 | 51 |
| 2015 June | 76 | 28 | 104 |
| 2015 May | 209 | 56 | 265 |
| 2015 April | 274 | 43 | 317 |
| 2015 March | 127 | 66 | 193 |
| 2015 February | 82 | 38 | 120 |
| 2015 January | 282 | 50 | 332 |
| 2014 December | 265 | 23 | 288 |
| 2014 November | 252 | 39 | 291 |
| 2014 October | 305 | 33 | 338 |
| 2014 September | 203 | 28 | 231 |
| 2014 August | 193 | 30 | 223 |
| 2014 July | 242 | 24 | 266 |
| 2014 June | 308 | 18 | 326 |
| 2014 May | 100 | 22 | 122 |
| 2014 April | 42 | 20 | 62 |
| 2014 March | 55 | 52 | 107 |
| 2014 February | 33 | 53 | 86 |
| 2014 January | 35 | 59 | 94 |
| 2013 December | 37 | 37 | 74 |
| 2013 November | 30 | 49 | 79 |
| 2013 October | 30 | 60 | 90 |
| 2013 September | 35 | 50 | 85 |
| 2013 August | 33 | 102 | 135 |
| 2013 July | 41 | 82 | 123 |
| 2013 June | 23 | 54 | 77 |
| 2013 May | 27 | 68 | 95 |
| 2013 April | 18 | 60 | 78 |
| 2013 March | 22 | 62 | 84 |
| 2013 February | 36 | 35 | 71 |
| 2013 January | 16 | 13 | 29 |
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