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Case Study
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Identification and management of palmar-plantar erythrodysesthesia: a case study Debra J. Peterson, CCRN, MSN, APRN-BC, Eugene R. Worth, MD, MEd, Jeffrey A. Niezgoda, MD, FACHM, FACEP, HWCA, Milwaukee, WI Palmar-Plantar Erythrodysesthesia (PPE) is a rare condition that may present diagnostic and management challenges for the wound care practitioner. Despite an alarming initial presentation, PPE is generally a self-limited side effect of standard- and high-dose chemotherapy agents. First described in 1984 as a pathologic process involving cytotoxic agents, several chemotherapy drugs have been linked to PPE including doxorubicin, cytarabine, docetaxel, 5-fluorouracil and hydroxyurea, with a broadly reported incidence ranging from 4% to 50%. Also known as ‘hand-foot syndrome', the pathologic process usually begins with paresthesias and/or dysesthesias of the palms and soles, frequently followed by the sudden onset of tender, well-demarcated areas of erythema and bullae formation. Ultimately, these bullae may desquamate, which is thought to be a result of cytotoxic agents accumulating in the skin at the level of the basal keratinocytes. Patients with PPE require skilled wound care with selected topical regimens. Additionally, treatment may include withdrawing or reducing the dose of chemotherapy, administration of oral corticosteroids and pyridoxine (vitamin B6) with the later having produced mixed results. We will present a case of a 57 year-old woman with a history of ovarian cancer, who developed PPE after her second cycle of doxorubicin, and discuss her clinical course, treatment and outcome. Wound care practitioners should be familiar with the presentation and management of PPE, thereby ensuring rapid diagnosis, appropriate management and optimal patient outcomes.. Hoff PM, Valero V, Ibrahim N, Willey J, Hortobagyi G. Hand-foot syndrome following prolonged infusion of high doses of vinorelbine. Cancer. 1998;82(5):965Ð969 Laack E, Mede T, Knuffmann C, Hossfeld DK. Hand-foot syndrome associated with short infusions of combination chemotherapy with gemcitabine and vinorelbine. Ann Oncol. 2001;12(12):1761Ð1763 Bashin S, Sunita, Gupta DK, Kataria SP, Saluja S, Sharma M. Chemotherapy-induced palmar plantar erythrodysesthesia. JAPI. 2005;53(2):155Ð156 Lokich JJ, Moore C. Chemotherapy-associated palmar-plantar erythrodysesthesia syndrome. Ann Intern Med. 1984;101:798Ð800 Nagore E, Insa A, Sanmarin O. Antineoplastic therapy-induced palmar-plantar erythrodysesthesia (hand-foot) syndromes. Incidence, recognition, and management. Am J Clin Dermatol. 2000;1:225Ð234. |
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