View source for Chemotherapy-induced acral erythema

{{Infobox disease |
  Name           = Chemotherapy-induced acral erythema |
  Image          = Hand-foot Syndrome.jpg |
  Caption        = Pictures of hands on capecitabine|Picture of hands on capecitabine exhibiting signs of chemotherapy-induced acral erythema |
  DiseasesDB     = 34044 |
  ICD10          = {{ICD10|Y|43|1|y|40}}-{{ICD10|Y|43|3|y|40}} |
  ICD9           = {{ICD9|693.0}}, {{ICD9|E933.1}} |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID         = |
}}
'''Chemotherapy-induced acral erythema''' (also known as "Palmoplantar erythrodysesthesia syndrome" or "Hand-foot syndrome") is a swelling and numbness of the hands and feet that occurs with certain types of [[chemotherapy]], usually with [[fluorouracil]], [[capecitabine]], [[cytarabine]], and [[doxorubicin]].<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. ISBN 0721629210.</ref>{{rp|132}}

==Synonyms==
Other names for PPE include '''acral erythema''' (AE), '''palmoplantar erythema''', '''hand-foot syndrome''', peculiar AE, and '''Burgdorf reaction'''.

==History==
First reported in association with chemotherapy by Zuehlke in 1974 (Zuehlke, 1974).

==Pathogenesis==
The cause of PPE is unknown. Existing theories are based on the fact that only the hands and feet are involved and posit the role of temperature differences, vascular anatomy, differences in the types of cells (rapidly dividing epidermal cells and eccrine glands).

==Clinical symptoms==
The symptoms can occur anywhere between days to months after administration of the offending medication, depending on the dose and speed of administration (Baack and Burgdorf, 1991; Demirçay, 1997;). The patient first experiences tingling and/or numbness of the palms and soles that evolves into painful, symmetric, and well-demarcated swelling and red plaques. This is followed by peeling of the skin and resolution of the symptoms (Apisarnthanarax and Duvic 2003).

==Diagnosis==
Painful red swelling of the hands and feet in a patient receiving chemotherapy is usually enough to make the diagnosis. The problem arises in patients after [[bone marrow transplant]]s, as the clinical and histologic features of PPE can be similar to cutaneous manifestations of acute (first 3 weeks) [[graft-versus-host disease]]. It is important to differentiate PPE, which is benign, from the more dangerous graft-versus-host disease. As time progresses, patients with graft-versus-host disease progress to have other body parts affected, while PPE is limited to hands and feet. Serial biopsies every 3 to 5 days can also be helpful in differentiating the two disorders (Crider et al., 1986).

==Prevention==
The cooling of hands and feet may help prevent PPE (Baack and Burgdorf, 1991; Zimmerman et al., 1995).

==Treatment==
The goal is to continue chemotherapy while reducing symptoms of PPE. Symptomatic treatment includes [[pyridoxine]], wound care, elevation, and pain medication (Vukelja et al. 1993). [[Corticosteroid]]s have also shown some efficacy in relieving symptoms. 

==Prognosis==
PPE variably recurs with resumption of chemotherapy. Long-term chemotherapy may also result in reversible [[palmoplantar keratoderma]]. Symptoms resolve 1–2 weeks after cessation of chemotherapy (Apisarnthanarax and Duvic 2003).

== See also ==
* [[Dupuytren's contracture]]
* [[List of cutaneous conditions]]

== Citations ==
{{reflist}}

== References ==
* Apisarnthanarax, N and Duvic MM. Dermatologic Complications of Cancer Chemotherapy in Holland-Frei Cancer Medicine - 6th Ed., Ch. 147, Kufe, DW et al. editors, BC Decker Inc, Hamilton, Ontario. 2003.
* {{cite journal |author=Baack B, Burgdorf W |title=Chemotherapy-induced acral erythema |journal=J Am Acad Dermatol |volume=24 |issue=3 |pages=457–61 |year=1991 |pmid=2061446}}
* {{cite journal |author=Crider M, Jansen J, Norins A, McHale M |title=Chemotherapy-induced acral erythema in patients receiving bone marrow transplantation |journal=Arch Dermatol |volume=122 |issue=9 |pages=1023–7 |year=1986 |pmid=3527075 |doi=10.1001/archderm.122.9.1023}}
* {{cite journal |author=Demirçay Z, Gürbüz O, Alpdoğan T, Yücelten D, Alpdoğan O, Kurtkaya O, Bayik M |title=Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases |journal=Int J Dermatol |volume=36 |issue=8 |pages=593–8 |year=1997 |pmid=9329890 |doi=10.1046/j.1365-4362.1997.00040.x}}
* {{cite journal |author=Vukelja S, Baker W, Burris H, Keeling J, Von Hoff D |title=Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with taxotere |journal=J Natl Cancer Inst |volume=85 |issue=17 |pages=1432–3 |year=1993 |pmid=8102408 |doi=10.1093/jnci/85.17.1432}}
* {{cite journal |author=Zimmerman G, Keeling J, Burris H, Cook G, Irvin R, Kuhn J, McCollough M, Von Hoff D |title=Acute cutaneous reactions to docetaxel, a new chemotherapeutic agent |journal=Arch Dermatol |volume=131 |issue=2 |pages=202–6 |year=1995 |pmid=7857119 |doi=10.1001/archderm.131.2.202}}
* {{cite journal |author=Zuehlke R |title=Erythematous eruption of the palms and soles associated with mitotane therapy |journal=Dermatologica |volume=148 |issue=2 |pages=90–2 |year=1974 |pmid=4276191}}

{{Diseases of the skin and subcutaneous tissue}}
{{External causes of morbidity and mortality}}
[[Category:Drug eruptions]]
[[Category:Oncology]]
[[Category:Pharmacology]]

[[de:Hand-Fuß-Syndrom]]
[[es:eritrodisestesia palmo-plantar]]
[[pl:Erytrodyzestezja dłoniowo-podeszwowa]]
[[Category:2Fix]]