Scleroderma-like reaction to taxanes

A condition resembling scleroderma induced by taxane chemotherapy

Scleroderma-like reaction to taxanes is a rare adverse effect associated with the use of taxane chemotherapy agents, such as paclitaxel and docetaxel. These agents are commonly used in the treatment of various cancers, including breast cancer, ovarian cancer, and lung cancer.

Pathophysiology

Taxanes are known to interfere with the normal function of microtubules, which are essential components of the cytoskeleton in eukaryotic cells. This disruption can lead to a variety of cellular effects, including the induction of apoptosis in rapidly dividing cancer cells. However, the exact mechanism by which taxanes induce a scleroderma-like reaction is not fully understood. It is hypothesized that the reaction may be due to an immune-mediated process or direct fibroblast activation leading to excessive collagen deposition in the skin.

Clinical Presentation

Patients experiencing a scleroderma-like reaction to taxanes typically present with skin changes that resemble those seen in scleroderma, a chronic connective tissue disease. These changes may include:

• Skin thickening and hardening
• Edema
• Hyperpigmentation or hypopigmentation
• Telangiectasia
• Pruritus

The skin changes are often localized to areas such as the hands, arms, and face, but can also be more widespread. In some cases, patients may also experience joint pain and stiffness.

Diagnosis

The diagnosis of a scleroderma-like reaction to taxanes is primarily clinical, based on the characteristic skin changes and the temporal relationship to taxane administration. Skin biopsy may be performed to rule out other conditions and to confirm the presence of dermal fibrosis and collagen deposition.

Management

Management of this condition involves discontinuation or modification of the taxane therapy, if possible. Supportive care measures may include:

• Use of topical corticosteroids to reduce inflammation
• Moisturizers to alleviate skin dryness
• Physical therapy to maintain joint mobility

In some cases, immunosuppressive therapy may be considered to manage severe symptoms.

Prognosis

The prognosis for patients with a scleroderma-like reaction to taxanes varies. In many cases, the skin changes may improve or resolve after discontinuation of the offending agent. However, some patients may experience persistent symptoms.

Related pages

• Scleroderma
• Taxane
• Chemotherapy
• Adverse drug reaction