R. Prussick et al., A CHARACTERISTIC ERUPTION ASSOCIATED WITH IFOSFAMIDE, CARBOPLATIN, AND ETOPOSIDE CHEMOTHERAPY AFTER PRETREATMENT WITH RECOMBINANT INTERLEUKIN-1-ALPHA, Journal of the American Academy of Dermatology, 35(5), 1996, pp. 705-709
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.