A CHARACTERISTIC ERUPTION ASSOCIATED WITH IFOSFAMIDE, CARBOPLATIN, AND ETOPOSIDE CHEMOTHERAPY AFTER PRETREATMENT WITH RECOMBINANT INTERLEUKIN-1-ALPHA

Background: Patients who received recombinant interleukin-1 alpha (IL- 1 alpha) before chemotherapy followed by autologous bone marrow transp lantation had a characteristic intertriginous cutaneous eruption that has not previously been described. Objective: Our aim was to document these skin changes and to determine whether IL-1 alpha as a sole agent caused recognizable changes in the skin. Methods: A prospective study of the skin changes in eight patients was performed. We characterized the clinical, histologic, and immunohistochemical features of the pat ients' skin after IL-1 alpha infusions and after chemotherapy. Results : No specific clinical or histologic changes were seen immediately aft er IL-1 alpha infusions. Immunohistochemical studies showed significan t upregulation of endothelial leukocyte adhesion molecule-1 (ELAM-1) e xpression. Within 1 day of the Initiation of chemotherapy (ifosfamide, carboplatin, and etoposide), a cutaneous eruption consisting of mucos itis and varying degrees of erythema progressing to painful erosions i n body folds and under adhesive tape developed in all patients. Histol ogic features were consistent with a chemotherapeutic effect on the ep idermis as well as eccrine and apocrine glands. Expression of keratino cyte intercellular adhesion molecule-1 and HLA-DR as well as of ELAM-1 on dermal endothelial cells was increased. The perivascular lymphocyt ic infiltrate consisted mainly of CD4(+) T cells. Conclusion: High-dos e chemotherapy with ifosfamide, carboplatin, and etoposide resulted in a characteristic cutaneous eruption that is consistent with a toxic r eaction to chemotherapeutic agents. Its accentuation in skin folds and under taped areas suggests that eccrine excretion of the drugs or a t oxic metabolite is an important contributing factor. IL-1 alpha may in duce the expression of ELAM-1 but does not cause a cutaneous eruption.