Palmar plantar erythrodysesthesia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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

Diagnosis

Painful red swelling of the hands and feet in a patient receiving chemotherapy is usually enough to make the diagnosis.

Differentiating Palmar plantar erythrodysesthesia from other Diseases

The problem arises in patients after bone marrow transplants, 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).

Primary Prevention

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

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.
• Baack B, Burgdorf W (1991). "Chemotherapy-induced acral erythema". J Am Acad Dermatol. 24 (3): 457–61. PMID 2061446.
• Crider M, Jansen J, Norins A, McHale M (1986). "Chemotherapy-induced acral erythema in patients receiving bone marrow transplantation". Arch Dermatol. 122 (9): 1023–7. PMID 3527075.CS1 maint: Multiple names: authors list (link)
• Demirçay Z, Gürbüz O, Alpdoğan T, Yücelten D, Alpdoğan O, Kurtkaya O, Bayik M (1997). "Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases". Int J Dermatol. 36 (8): 593–8. PMID 9329890.CS1 maint: Multiple names: authors list (link)
• Vukelja S, Baker W, Burris H, Keeling J, Von Hoff D (1993). "Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with taxotere". J Natl Cancer Inst. 85 (17): 1432–3. PMID 8102408.CS1 maint: Multiple names: authors list (link)
• Zimmerman G, Keeling J, Burris H, Cook G, Irvin R, Kuhn J, McCollough M, Von Hoff D (1995). "Acute cutaneous reactions to docetaxel, a new chemotherapeutic agent". Arch Dermatol. 131 (2): 202–6. PMID 7857119.CS1 maint: Multiple names: authors list (link)
• Zuehlke R (1974). "Erythematous eruption of the palms and soles associated with mitotane therapy". Dermatologica. 148 (2): 90–2. PMID 4276191.