The importance of duration of exposure is confirmed by the fact that a completely different antineoplastic agent-doxorubicin-if administered as a protracted infusion or delivered in the form of pegylated or liposomal doxorubicin (Doxil), can result in hand-foot syndrome. Thus, in patients receiving bolus (as opposed to protracted-infusion) 5-FU, hand-foot syndrome is rarely if ever recognized. Therefore, the syndrome is not simply dose-related but is related to the duration of exposure over time. The authors did not initially recognize that the erythema of the palms and soles of patients was related to the continuous infusion of 5-FU, and patients were maintained on the infusion, resulting in a progressive evolution of the syndrome.

The authors noted in a phase I study of protracted infusion of fluorouracil (5-FU) that 40% or more of patients developed a syndrome they referred to as palmar-plantar erythrodysesthesia. The hand-foot syndrome was originally described in 1984 by Lokich and Moore. These three distinct and characteristic cutaneous reactions represent dose-limiting toxicities for these drugs and have a particular pathophysiologic mechanism that although largely unknown is probably not mediated by the immune system and has specific clinical characteristics, which are important from an oncologic perspective. The all-inclusive nature of the report would provide for a more effective presentation were it to focus on the three most common cutaneous reactions to chemotherapy: (1) hand-foot syndrome associated with the fluoropyrimidines (2) taxane-associated acral erythema with onycholysis and (3) the acneiform rash associated with the anti–epidermal growth factor receptor (EGFR) biologic agents. This article attempts to list the panoply of cutaneous manifestations or reactions that may be seen in cancer patients either as an epiphenomenon related to a cancer diagnosis or as a consequence of cancer treatment, particularly chemotherapy. This review provides a basis for the understanding of dermatologic events in the oncology setting, in order to promote attentive care to cutaneous health in cancer patients and survivors. Notwithstanding the critical importance of treatment-related toxicities, dermatologic conditions may also precede, coincide, or follow the diagnosis of cancer.

Optimal care dictates that dermatologic toxicities must be addressed in a timely and effective fashion, in order to minimize associated physical and psychosocial discomfort, and to ensure consistent antineoplastic therapy. Most notably, cutaneous toxicities have gained considerable attention, due to their high frequency and visibility, the relative effectiveness of anti–skin toxicity interventions, and the otherwise decreasing incidence of systemic or hematopoietic adverse events. Whereas these novel medical, surgical, and radiation regimens, or combinations thereof, are largely responsible for these remarkable achievements, a new, unexpected constellation of side effects has emerged. The increased approval of anticancer agents has led to unprecedented results, with improved quality of life and longer survival times, resulting in millions of individuals living with a diagnosis of cancer.

Clindamycin skin rash