CHEMOTHERAPY-INDUCED ACRAL ERYTHEMA IN LEUKEMIC PATIENTS - A REPORT OF 15 CASES

Background Chemotherapy-induced acral erythema is a distinct localized cutaneous response to certain systemic chemotherapeutic agents. Metho ds Between January 1990 and December 1994, from a total of 76 leukemic patients who have received combination chemotherapy consisting of cyt osine arabinoside and anthracycline antibiotics, 15 patients developed chemotherapy-induced acral erythema. Fourteen of the patients had acu te myelocytic leukemia, and one of them had chronic myelogenous leukem ia in blast phase. Clinical features of these 15 patients have been an alysed. Biopsy specimens obtained from eight of the patients were also evaluated for histopathologic alterations. Results The overall incide nce of this reaction was found to be 19.7% in our group of patients re ceiving this chemotherapy protocol. The onset of reaction Varied from the fourth to the seventeenth days of the chemotherapy and resolved wi thin 2 weeks in most of the patients. Lesions appeared as well-defined erythema and edema involving the palmar surfaces in all of the patien ts. In nine of the patients the reaction recurred with subsequent chem otherapies. Scattered necrotic keratinocytes, vacuolar alterations of the basal layer, and mild to moderate perivascular lymphocytic infiltr ation in the dermis were the histopathologic findings observed in the biopsy specimens. Conclusions Chemotherapy-induced acral erythema is a frequent reaction in patients who are receiving high-dose chemotherap y. For patients in whom this self-limited condition develops, reassura nce is the mainstay of therapy. Awareness of this reaction is also imp ortant to be able to differentiate it from acute graft Versus host dis ease in patients who receive bone marrow transplants.