Flexural erythematous eruption following autologous peripheral blood stem cell transplantation: a study of four cases

The Impact on Resources of Prevalence and Nature of Skin Problems in a Modern Intensive Haemato-oncology Practice

We undertook a randomised prospective observational study to identify the true prevalence of dermatological problems on an acute in-patient haemato-oncology unit treating patients with myeloma and leukaemia (median age 52 years), that could be used to plan for optimum dermatological servicing of such a unit. As a snap-shot, beds were randomly selected each week and the patients in them examined to identify the prevalence and identity of mucocutaneous problems for in-patients. Primary endpoints were the prevalence of integument reactions, prevalence and type of rash. Eighty-four leukaemia and myeloma patients were seen on 200 episodes. Integument changes were seen in 88% of episodes. Predictable changes such as hair loss (74%) and mucositis (38%) were seen commonly. Rashes were seen in 38% of episodes. The most common rash was palm and sole erythema (10% of all episodes) which was associated with allogeneic BMT (20%; p=0.0009). Flexural erythema with subsequent desquamation occurred in 4% of episodes, more commonly in males (p=0.09). Drug allergies were seen in 14 of 200 episodes and were significantly associated with antibiotics (p=0.003). Patients' perceived their skin problems as moderate or severe in 19% of the episodes. The impact on resources in the haematology practice was large; 45% of inpatients were receiving topical or systemic skin treatment, in 5% of patients the oncology treatment was compromised, 11% of patients required extra nursing and 3% of patients stayed longer in hospital. This volume of mucocutaneous problems makes dermatological input to haemato-oncology units vital.

Intertriginous pattern of toxic erythema of chemotherapy

Chemotherapeutic agents may induce both local and systemic cutaneous toxicity, and evaluation of these reactions in oncologic patients constitutes a real challenge. The authors describe a 78-year-old Caucasian woman, with a past medical history relevant for right radical mastectomy with axillary dissection because of stage 2 breast invasive ductal carcinoma (T2N3M0), referred to our department because of an intertriginous eruption in her groin. Two weeks before the eruption, a chemotherapy regime with cyclophosphamide, methotrexate, and 5-fluorouracil was performed. Examination revealed erythematous and dusky violaceous papules coalescing into edematous patches in the inguinal intertriginous area, including the internal surface of her thighs, groin, genital area, and intergluteal cleft. Skin cultures for bacteria and fungus were negative. Clinical and histological data were consistent with an intertriginous pattern of toxic erythema of chemotherapy (TEC). Oral prednisolone therapy (0.5 mg/kg) was started, tapered over a 1-week period, and along with general measures that included topical zinc oxide suspension, cutaneous lesions cleared completely within the first days. Although patient reassurance, she refused any kind of new chemotherapy infusions. Due to their high metabolic rate, the skin, mucous membranes, and annexes are one of the most important target organs of the toxicity associated with systemic chemotherapy. Several patterns of cutaneous eruptions to chemotherapy have been reported in the literature. Trying to resolve this issue, recently recommended was a new clinically descriptive term, TEC, in order to emphasize the overlapping features of these entities. Early recognition of this entity is critical, not just from a prognostic standpoint, but also to avoid unnecessary, potentially harmful therapeutic interventions.