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Acral erythema in Adult
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Acral erythema in Adult

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Contributors: Christine S. Ahn MD, FAAD, William W. Huang MD, MPH, FAAD, Susan Burgin MD
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Synopsis

Acral erythema, also known as palmoplantar erythrodysesthesia and hand-foot syndrome, has been described following treatment with several systemic chemotherapeutic agents. The exact pathogenic mechanisms of this disorder are still unknown. Typically, the eruption involves the hands and feet and often occurs within the first week of treatment. Common provoking agents include BRAF inhibitors (eg, vemurafenib, dabrafenib), imatinib, epidermal growth factor receptor (EGFR) inhibitors (eg, canertinib, lapatinib, vandetanib, sorafenib, sunitinib), cytarabine (cytosine arabinoside), 5-fluorouracil, doxorubicin, hydroxyurea, and mercaptopurine.

Reactions may occur sooner (24 hours to 3 weeks) and more severely with bolus chemotherapy than with low-dose continuous infusion and are usually reproducible with challenge.

Acral erythema may occur as part of a broader eruption, known as toxic erythema of chemotherapy, in which acral and intertriginous areas are involved. It is characterized by a painful erythematous rash, often with associated edema, located on the palms, fingers, and soles, preceded by dysesthesia.

Codes

ICD10CM:
L27.1 – Localized skin eruption due to drugs and medicaments taken internally

SNOMEDCT:
238993006 – Acral erythema

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 04/10/2018
Last Updated: 04/23/2018
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Acral erythema in Adult
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Acral erythema : Erythema, Foot or toes
Clinical image of Acral erythema
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