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Sorafenib-induced severe hand–foot skin reaction
P2609
P2611
Sorafenib-induced severe handefoot skin reaction Laura Cuesta Montero, MD, Hospital General Universitario De Alicante, Alicante, Spain; Almudena Monteagudo Paz, MD, Hospital General Universitario De Alicante, Alicante, Spain; Fernando Toledo Alberola, MD, Hospital General Universitario De Alicante, Alicante, Spain; Isabel Betlloch Mas, MD, Hospital General Universitario De Alicante, Alicante, Spain; Nuria Latorre Martinez, MD, Hospital General Universitario De Alicante, Alicante, Spain
Dermatologic capecitabine reactions: A case report and review of the literature Peter Mattei, MD, Mcguire AFB, Mcguire AFB, NJ, United States; Oliver Wisco, MD, Wilford Hall Medical Center, Lackland AFB, TX, United States
Background: Sorafenib is a new multikinase inhibitor that was recently approved for the treatment of metastatic renal cell carcinoma and hepatocellular carcinoma. Up to 90% of patients receiving this drug have been reported to develop dermatologic symptoms. Case report: We report a 47-year-old man with a personal history of hepatocellular carcinoma with bone and lung metastasis. The patient was under treatment with sorafenib 400 mg twice daily and 3 weeks later the patient developed a painful palmoplantar erythema with well demarcated bullous plaques on the finger flexures and interdigital areas, which hindered his normal life. A biopsy specimen of the lesion and a microbiologic culture were performed. The culture was negative. The skin biopsy revealed epidermal acanthosis, papillomatosis, parakeratosis, necrotic keratinocytes and perivascular and periadnexal lymphocytic infiltrate, with interface changes. These findings were keeping with sorafenib-induced handefoot skin reaction. We prescribed a topical occlusive treatment with clobetasol propionate twice a day and the treatment with sorafenib was discontinued. The lesions resolved in 10 days, but 1 month later the patient died.
Capecitabine is an oral chemotherapeutic agent currently approved by the FDA for the treatment of metastatic colorectal and breast cancer, as well as adjuvant treatment for stage III colon cancer. The active metabolite of capecitabine is 5fluorouricil. We present a case of capecitabine reaction in a 65-year-old man and review the literature describing other dermatologic reactions to capecitabine. Commercial support: None identified.
Discussion: Sorafenib is a new chemotherapy treatment that inhibits Raf serine/threonine kinases. It has been approved in metastatic renal cell carcinoma and hepatocellular carcinoma, and is being evaluated in melanoma, breast cancer, and nonesmall cell lung cancer. Dermatologic manifestations are the most common side effects. Numerous cutaneous adverse events have been described, including handefoot skin reaction, facial erythema, subungual hemorraghes, alopecia, pruritus. and xerosis. One of the most frequent side effects is handefoot skin reaction that typically presents as painful areas on the palms and soles, beginning after 2 to 3 weeks of treatment, that may even lead to immobility. Lesions tend to be mild to moderate, responding to topical treatment with high potency corticosteroids. Severe involvement, as in our patient, is less frequent, and usually necessitates sorafenib discontinuation. Conclusion: We report a new case of sorafenib-induced severe handefoot skin reaction, which hindered a patient’s normal life. The reaction was successfully treated with topical costicosteroids. Predictive role of early skin toxicity as an indicator of a better prognosis does not seem reasonable in our case, given that the patient experienced a rapid disease progression leading to a fatal outcome. Commercial support: None identified.
P2612 Scars worsening and thickening as a initial sign of systemic sarcoidosis Carolina Medina, Hospital Universitario de Las Palmas de Gran Canaria Doctor Negrın, Las Palmas de Gran Canaria, Spain; Jaime Vilar, Hospital Universitario Dr. Negrın, Las Palmas de Gran Canaria, Spain; Jesus Bastida, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain; luis dehesa, Hospital Dr. Negrın, Las Palmas de Gran Canaria, Spain
Tophaceous gout is a clinical entity characterized by chalky deposits of monosodium urate, and it may occur at virtually any anatomic site. Gouty tophi most commonly occur in the skin overlying joints and the helix of the ear, and tend to develop after an average of 10 years in untreated patients who develop chronic gouty arthritis. We report a dramatic clinical presentation of a patient with severe disseminated cutaneous gout following a 2-year history of intermittent acute gouty arthritis of the left metatarsophalageal joint, highlighting the unusual nature of a disseminated presentation given the short duration of disease and single joint involvement. The finding of disseminated cutaneous gout of rapid onset following a mere 2 years of acute gouty arthritis is rare, and may in fact be the shortest interval reported of progression from acute gout to tophaceous disease.
Sarcoidosis is a disease characterized by the formation in different tissues of epitheliod cell tubercles, without caseation. It is one of the disorders with more varied manifestations and may affect any organ of the body, including the skin. Sometimes cutaneous sarcoidosis is the initial or unique sign of this entity. We report a case of sarcoidosis in a patient with a rare form of presentation involving skin. A young woman with history of multiple cosmetic procedures (including breast implants, hyaluronic acid fillers, lip tattoo, and Botox) consulted us because of the growth of previous scars on her forehead and trunk. The physical examination showed flat yellowish and fibrous lesions at the sites of the previous procedures. Biopsy was performed showing a granulomatous dermatitis with naked granulomas and scant lymphocytes. A thorough anamnesis revealed the presence of a hacking cough, asthenia, and nonspecific arthralgia. A complete analytical and a extension test let us confirm the diagnosis of sarcoidosis. Among the different clinical manifestations of cutaneous sarcoidosis, the worsening of previous scars is a rare but typical sign. It is important to recognize it as this may be its unique form of presentation.
Commercial support: None identified.
Commercial support: None identified.
P2610 Disseminated cutaneous gout: A rapid onset of disease Lance Davis, MD, Scott and White Hospital, Temple, TX, United States
FEBRUARY 2011
J AM ACAD DERMATOL
AB113
P2611
Sorafenib-induced severe handefoot skin reaction Laura Cuesta Montero, MD, Hospital General Universitario De Alicante, Alicante, Spain; Almudena Monteagudo Paz, MD, Hospital General Universitario De Alicante, Alicante, Spain; Fernando Toledo Alberola, MD, Hospital General Universitario De Alicante, Alicante, Spain; Isabel Betlloch Mas, MD, Hospital General Universitario De Alicante, Alicante, Spain; Nuria Latorre Martinez, MD, Hospital General Universitario De Alicante, Alicante, Spain
Dermatologic capecitabine reactions: A case report and review of the literature Peter Mattei, MD, Mcguire AFB, Mcguire AFB, NJ, United States; Oliver Wisco, MD, Wilford Hall Medical Center, Lackland AFB, TX, United States
Background: Sorafenib is a new multikinase inhibitor that was recently approved for the treatment of metastatic renal cell carcinoma and hepatocellular carcinoma. Up to 90% of patients receiving this drug have been reported to develop dermatologic symptoms. Case report: We report a 47-year-old man with a personal history of hepatocellular carcinoma with bone and lung metastasis. The patient was under treatment with sorafenib 400 mg twice daily and 3 weeks later the patient developed a painful palmoplantar erythema with well demarcated bullous plaques on the finger flexures and interdigital areas, which hindered his normal life. A biopsy specimen of the lesion and a microbiologic culture were performed. The culture was negative. The skin biopsy revealed epidermal acanthosis, papillomatosis, parakeratosis, necrotic keratinocytes and perivascular and periadnexal lymphocytic infiltrate, with interface changes. These findings were keeping with sorafenib-induced handefoot skin reaction. We prescribed a topical occlusive treatment with clobetasol propionate twice a day and the treatment with sorafenib was discontinued. The lesions resolved in 10 days, but 1 month later the patient died.
Capecitabine is an oral chemotherapeutic agent currently approved by the FDA for the treatment of metastatic colorectal and breast cancer, as well as adjuvant treatment for stage III colon cancer. The active metabolite of capecitabine is 5fluorouricil. We present a case of capecitabine reaction in a 65-year-old man and review the literature describing other dermatologic reactions to capecitabine. Commercial support: None identified.
Discussion: Sorafenib is a new chemotherapy treatment that inhibits Raf serine/threonine kinases. It has been approved in metastatic renal cell carcinoma and hepatocellular carcinoma, and is being evaluated in melanoma, breast cancer, and nonesmall cell lung cancer. Dermatologic manifestations are the most common side effects. Numerous cutaneous adverse events have been described, including handefoot skin reaction, facial erythema, subungual hemorraghes, alopecia, pruritus. and xerosis. One of the most frequent side effects is handefoot skin reaction that typically presents as painful areas on the palms and soles, beginning after 2 to 3 weeks of treatment, that may even lead to immobility. Lesions tend to be mild to moderate, responding to topical treatment with high potency corticosteroids. Severe involvement, as in our patient, is less frequent, and usually necessitates sorafenib discontinuation. Conclusion: We report a new case of sorafenib-induced severe handefoot skin reaction, which hindered a patient’s normal life. The reaction was successfully treated with topical costicosteroids. Predictive role of early skin toxicity as an indicator of a better prognosis does not seem reasonable in our case, given that the patient experienced a rapid disease progression leading to a fatal outcome. Commercial support: None identified.
P2612 Scars worsening and thickening as a initial sign of systemic sarcoidosis Carolina Medina, Hospital Universitario de Las Palmas de Gran Canaria Doctor Negrın, Las Palmas de Gran Canaria, Spain; Jaime Vilar, Hospital Universitario Dr. Negrın, Las Palmas de Gran Canaria, Spain; Jesus Bastida, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain; luis dehesa, Hospital Dr. Negrın, Las Palmas de Gran Canaria, Spain
Tophaceous gout is a clinical entity characterized by chalky deposits of monosodium urate, and it may occur at virtually any anatomic site. Gouty tophi most commonly occur in the skin overlying joints and the helix of the ear, and tend to develop after an average of 10 years in untreated patients who develop chronic gouty arthritis. We report a dramatic clinical presentation of a patient with severe disseminated cutaneous gout following a 2-year history of intermittent acute gouty arthritis of the left metatarsophalageal joint, highlighting the unusual nature of a disseminated presentation given the short duration of disease and single joint involvement. The finding of disseminated cutaneous gout of rapid onset following a mere 2 years of acute gouty arthritis is rare, and may in fact be the shortest interval reported of progression from acute gout to tophaceous disease.
Sarcoidosis is a disease characterized by the formation in different tissues of epitheliod cell tubercles, without caseation. It is one of the disorders with more varied manifestations and may affect any organ of the body, including the skin. Sometimes cutaneous sarcoidosis is the initial or unique sign of this entity. We report a case of sarcoidosis in a patient with a rare form of presentation involving skin. A young woman with history of multiple cosmetic procedures (including breast implants, hyaluronic acid fillers, lip tattoo, and Botox) consulted us because of the growth of previous scars on her forehead and trunk. The physical examination showed flat yellowish and fibrous lesions at the sites of the previous procedures. Biopsy was performed showing a granulomatous dermatitis with naked granulomas and scant lymphocytes. A thorough anamnesis revealed the presence of a hacking cough, asthenia, and nonspecific arthralgia. A complete analytical and a extension test let us confirm the diagnosis of sarcoidosis. Among the different clinical manifestations of cutaneous sarcoidosis, the worsening of previous scars is a rare but typical sign. It is important to recognize it as this may be its unique form of presentation.
Commercial support: None identified.
Commercial support: None identified.
P2610 Disseminated cutaneous gout: A rapid onset of disease Lance Davis, MD, Scott and White Hospital, Temple, TX, United States
FEBRUARY 2011
J AM ACAD DERMATOL
AB113