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Toxic erythema of chemotherapy
Other Resources UpToDate PubMed

Toxic erythema of chemotherapy

Contributors: Connie R. Shi MD, Susan Burgin MD
Other Resources UpToDate PubMed


Toxic erythema of chemotherapy (TEC) refers to a range of nonallergic cutaneous eruptions that develop in the setting of chemotherapy. Key clinical features include formation of erythematous or edematous patches and plaques on the hands, feet, and intertriginous areas associated with dysesthesia, pain, and pruritus. Elbows and knees and ears are less frequently involved. Affected skin may appear violaceous, and bulla formation may occur in severe cases. The lesions are self-limited and will desquamate and resolve spontaneously.

The eruptions develop 2 days to 3 weeks after chemotherapy administration. Commonly associated chemotherapies include cytarabine, anthracyclines (doxorubicin), 5-fluorouracil, capecitabine, taxanes (docetaxel, paclitaxel), and methotrexate.

TEC is thought to result from a toxic effect of chemotherapy agents on eccrine cells and on the epidermis as the chemotherapy is extravasated from eccrine ducts. TEC may recur and worsen on drug rechallenge.

The range of entities classified under TEC is broad and includes acral erythema (palmar-plantar erythrodysesthesia, hand-foot syndrome), intertriginous eruption of chemotherapy, and neutrophilic eccrine hidradenitis, among others.


L53.0 – Toxic erythema

297941009 – Drug-induced toxic erythema

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Acute graft-versus-host disease – in patients who have received bone marrow transplantation
  • Viral exanthem
  • Exanthematous drug eruption
  • Drug-induced hypersensitivity syndrome
  • Symmetric drug-related intertriginous and flexural exanthema (SDRIFE)
  • Allergic contact dermatitis
  • Cellulitis
  • Dermatomyositis
  • Erythromelalgia
  • Papular-purpuric gloves and socks syndrome – associated with parvovirus B19 and cytomegalovirus infection
  • Acrodynia (see Mercury poisoning)

Best Tests

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Management Pearls

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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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Last Updated:10/10/2019
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Toxic erythema of chemotherapy
A medical illustration showing key findings of Toxic erythema of chemotherapy : Hands and/or feet, Intertriginous distribution, Painful skin lesions, Smooth plaque, Pruritus, Blanching patches
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