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Skin problems associated with pegylated liposomal doxorubicin-more than palmoplantar erythrodysesthesia syndrome

European Journal of Dermatology. Volume 18, Number 5, 566-70, September-October 2008, Clinical report

DOI : 10.1684/ejd.2008.0490

Summary

Author(s) : Joanna Mangana, Marie C Zipser, Curdin Conrad, Patrick A Oberholzer, Antonio Cozzio, Alexander Knuth, Lars E French, Reinhard Dummer , Department of Dermatology,University Hospital of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland, Department of Oncology, University Hospital of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland.

Summary : Liposomal pegylated doxorubicin is an encapsulation form of doxorubicin, with an improved pharmacokinetic profile and the ability to selectively accumulate into tumor tissue. As a result, the tolerated dose of the drug can be increased, followed by a reduced incidence of neutropenia and cardiotoxicity in comparison to doxorubucin treatment. However, a common adverse dose-schedule limiting effect of the treatment is palmoplantar erythrodysesthesia syndrome. In this retrospective study we included six patients hospitalised in the University Hospital of Zurich during the last 2 years, in connection with side effects caused by pegylated liposomal doxorubicin. These patients received this chemotherapeutic agent for treatment of various malignancies such as breast cancer, ovarian cancer, mycosis fungoides and cutaneous B-cell lymphoma. Three of six patients in this study developed classical palmoplantar erythrodysesthesia, one developed palmoplantar erythrodysesthesia associated with extensive bullous disease, one developed eruption of lymphocyte recovery syndrome and one developed intertrigo like dermatitis with stomatitis. Pegylated liposomal doxorubicin induces various skin reactions including palmoplantar erythrodysesthesia syndrome. However, the exact clinical presentation might depend on pre-existing skin diseases.

Keywords : eruption of lymphocyte recovery, hand foot syndrome, palmoplantar erythrodysesthesia, pegylated liposomal doxorubicin, skin toxicities, stomatitis

Pictures

Figure 1 Grade IV PPE with bullous formation und erosions on the feet of Patient 1.

Figure 2 Grade IV PPE with bullous formation, painful œdema and desquamation on both hands of Patient 1.

Figure 3 Grade IV PPE with bullous formation and erosions on pre-existing scars at the trunk of Patient 1.