Palmar plantar erythrodysesthesia

Palmar-Plantar Erythrodysesthesia (PPE), also known as hand-foot syndrome or chemotherapy-induced acral erythema, is a skin condition characterized by a painful redness and swelling of the hands and feet. It is most commonly associated with certain chemotherapy drugs used in the treatment of cancer. The severity of PPE can vary, ranging from mild symptoms to severe discomfort that can interfere with daily activities.

Etiology

PPE is primarily caused by the toxic effects of chemotherapy drugs on the skin's small vessels. This toxicity leads to inflammation and damage to the skin's outer layers. Drugs most commonly associated with PPE include Capecitabine, Cytarabine, Doxorubicin, and Fluorouracil. The exact mechanism by which these drugs cause PPE is not fully understood, but it is believed to involve the accumulation of the drug in the skin of the palms and soles, leading to local toxicity.

Symptoms

The symptoms of PPE typically begin with a tingling sensation in the hands and feet, followed by redness, swelling, and pain. In severe cases, the skin may blister and peel, leading to significant discomfort and difficulty in performing daily tasks. Symptoms usually appear within the first few weeks of starting chemotherapy and may worsen with subsequent treatment cycles.

Diagnosis

Diagnosis of PPE is primarily clinical, based on the patient's history and physical examination. There are no specific tests for PPE, but a doctor may perform tests to rule out other conditions that can cause similar symptoms, such as peripheral neuropathy or allergic reactions.

Treatment

Treatment of PPE focuses on symptom management and may include:

• Reducing the dose of the chemotherapy drug or switching to a different medication
• Topical treatments, such as corticosteroids or urea-based creams, to reduce inflammation and pain
• Oral pain relievers
• Cooling measures, such as ice packs or cool baths, to relieve discomfort
• Good skin care, including the use of moisturizers and avoidance of hot water and friction on the affected areas

In severe cases, treatment may require temporary or permanent discontinuation of the chemotherapy drug.

Prevention

Preventive measures may reduce the severity of PPE or prevent it from occurring. These include:

• Using protective gloves and socks
• Avoiding exposure to hot water and extreme temperatures
• Keeping the skin moisturized
• Limiting activities that cause friction on the hands and feet

Prognosis

The prognosis for PPE is generally good, with symptoms often resolving after the completion of chemotherapy or upon adjustment of the treatment regimen. However, in some cases, symptoms may persist and require ongoing management.

See also

• Chemotherapy
• Dermatitis
• Peripheral neuropathy