Toxic erythema of chemotherapy (TEC) is a specific inflammatory skin reaction that can develop during cancer treatment. This condition is directly linked to the cytotoxic effects of certain anti-cancer drugs. Recognizing its signs allows for timely communication with healthcare providers.
Understanding Toxic Erythema of Chemotherapy
Toxic erythema of chemotherapy encompasses a range of non-allergic skin eruptions. These reactions typically manifest as red or purplish patches and raised areas on the skin, often accompanied by swelling, tenderness, and itching. In some cases, blistering may also occur, and the affected skin can peel or shed its outer layers as it heals.
The condition commonly appears on the hands and feet, as well as in skin folds such as the armpits, groin, and scrotum. Other areas like the elbows, knees, and ears can also be affected. These lesions usually develop within a few days to a few weeks after chemotherapy administration, sometimes even appearing a month after the drug is given.
Chemotherapy Agents and Risk Factors
Toxic erythema of chemotherapy is caused by the direct toxic effects of certain chemotherapy agents on skin cells. These agents can accumulate in the skin, particularly in areas with higher concentrations of sweat glands, leading to the characteristic inflammatory reaction. The skin of the hands and feet may have higher levels of certain chemotherapy drugs, contributing to localized toxicity.
Several chemotherapy drugs and classes are associated with TEC, including:
- Anthracyclines (e.g., doxorubicin)
- Antimetabolites (e.g., capecitabine, 5-fluorouracil)
- Cytarabine
- Taxanes (e.g., docetaxel, paclitaxel)
- Methotrexate
- Liposomal doxorubicin (can cause more severe TEC)
- Gemcitabine, clofarabine, pralatrexate, and intravenous busulfan
The risk of developing TEC can increase with each dose of chemotherapy. Factors like the specific drug, dosage, and treatment duration can influence its occurrence and severity.
Management and Symptom Relief
Managing toxic erythema of chemotherapy often involves a combination of approaches aimed at reducing symptoms and supporting skin healing. Adjusting the chemotherapy dose or temporarily stopping the treatment may be necessary to allow the skin to recover. This decision is made in close consultation with the healthcare team.
Supportive care measures are a primary component of TEC management. These include applying high-potency topical corticosteroids and emollients to the affected areas, which can help reduce inflammation and soothe the skin. Cool compresses and elevating the affected limbs can also provide relief from pain and swelling. Oral medications like pain relievers can manage discomfort, and in severe cases, systemic corticosteroids may be used. Emerging strategies include the use of high-dose vitamin D, which has shown promising results in some patients, leading to rapid improvement in symptoms within days.
When to Contact Your Healthcare Team
Prompt communication with your healthcare team is important if you experience symptoms of toxic erythema of chemotherapy. You should contact them if you notice any new or worsening skin redness, swelling, tenderness, or the development of blisters.
It is also important to seek medical attention if the pain becomes severe or interferes significantly with daily activities. Signs of infection, such as pus, increasing warmth, new or increased pain, or a fever (oral temperature over 100.5°F), require immediate contact with your medical team. Your healthcare team can provide guidance on managing symptoms and determine if any adjustments to your treatment plan are necessary.