2016 Volume 53 Issue 3 Pages 309-313
Acral erythema (AE), also known as palmar-plantar erythrodysesthesia syndrome, is a painful and edematous reddening of the palms and soles, which often emerges as an adverse effect of high-dose chemotherapy. A 2-year-old girl exhibited multiple bullous and erythematous lesions with pain and numbness in her palms and soles after high-dose methotrexate (MTX) treatment for acute lymphoblastic leukemia. The same lesions reemerged by repeating either high- or intermediate-dose MTX therapy. Direct deposition of MTX in the eccrine gland and its cytotoxic effects were considered as the mechanisms of AE pathogenesis since the severity of AE correlated with the MTX dose. However, allergic reactions may also contribute to the pathogenesis because the lymphocyte stimulation test showed a positive reaction to MTX. The lesions were successfully treated with topical and systemic corticosteroid therapy. Chemotherapy-induced AE does not affect the prognosis of the underlying disease; therefore, it is not necessary to alter the subsequent chemotherapy.
