Original article
Chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia: Reappraisal of epidemiological, clinical, and pathological features

This study has been accepted to be presented at a past American Meeting of Dermatology (Miami, 2010).
https://doi.org/10.1016/j.jaad.2010.04.021Get rights and content

Background

A characteristic cutaneous eruption related to the use of cytostatic chemotherapeutic drugs has been described in the literature. This condition appears to be characterized by an erythematous eruption, primarily affecting the intertriginous areas bilaterally, together with eccrine squamous syringometaplasia as the main histologic feature.

Objective

We sought to establish the epidemiologic, clinical, and histologic characteristics of this poorly defined chemotherapy drug-related eruption.

Methods

Retrospective data were collected from 21 consecutive patients with this clinical and histopathologic pattern who attended an oncology center between January 1999 and September 2009. Two skin biopsy specimens were obtained from all patients, with the first being taken within 24 hours of onset, and the second 72 to 96 hours after onset.

Results

The patients analyzed were predominantly female (72%), with a mean age of 52 years (range 10-69 years). The lesions presented clinically as bilateral erythematous plaques affecting both axillae (95%), groin (88%), and side aspects of the neck (48%). The main histologic feature in all cases was eccrine squamous syringometaplasia, characterized by the transformation of the eccrine cuboidal epithelium into two or more layers of squamous cells with intercellular bridges. The onset of the eruption appeared within 30 days (range 2-30 days) after the initiation of the cytostatic agent infusion. The lesions resolved with desquamation and postinflammatory hyperpigmentation. The same cutaneous pattern recurred in up to 50% of patients in whom the oncologist reintroduced the cytostatic treatment.

Limitations

Small sample size was a limitation.

Conclusions

We suggest the term “chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia” to describe this distinctive entity, which is primarily associated with pegylated liposomal doxorubicin infusions and chemotherapeutic regimens used in autologous bone-marrow transplantation.

Section snippets

Patients

Patients who presented with intertriginous dermatitis shortly after treatment with a chemotherapeutic agent and were assessed in our dermatology department between January 1, 1999, and September 1, 2009, were analyzed; all patients were from the Instituto Valenciano de Oncologia, an oncology center in Valencia, Spain. The study was approved by the center's ethics committee.

The following clinical data were recorded for each patient: age, sex, location of the lesion, interval between the

Results

A total of 21 patients were evaluated. The clinical data are summarized in Table II. Six male (28%) and 15 female (72%) patients had the intertriginous pattern. The mean patient age was 52 years (range 10-69 years). Clinical findings included pruritus or burning in 14 patients (66%), whereas 7 patients reported no symptoms (34%). The clinical morphology of the cutaneous eruptions included erythematous and desquamative patches, papules, plaques, or vesicles. The distribution was bilateral in all

Discussion

This study, along with data obtained from a previous series published in the literature by Valks et al6 and Prussick,7 establishes the epidemiologic, clinical, and pathological features of a previously poorly described and defined, but specific chemotherapy-related cutaneous side effect. We propose the term “chemotherapy-related bilateral dermatitis associated with eccrine squamous syringometaplasia” (CBDESS) for this distinctive entity.

Recently, the term “toxic erythema of chemotherapy” was

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    Funding sources: None.

    Conflicts of interest: None declared.

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