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Cancer patients may experience several dermatological symptoms during treatment. We describe a case of synchronous presentation of hand, foot, and mouth disease (HFMD) and palmoplantar erythrodysesthesia (PPE) in a breast cancer patient. A 36-year-old female breast cancer patient under chemotherapy presented to our consult with a 1-week history of painful palmoplantar lesions associated with the recent onset of fever and dry cough. Her daughter had been diagnosed with HFMD. There was a positive immunoglobulin M (IgM) and IgG serology for coxsackievirus. We performed two skin biopsies; one specimen was consistent with HFMD, and the other one was with PPE. To the best of our knowledge, the synchronous presentation of HFMD and PPE has not yet been reported in the literature to date. PPE and immunosuppression might have been responsible for the atypical presentation and clinical severity of HFMD. [ABSTRACT FROM AUTHOR]

Docetaxel is an important chemotherapeutic agent used alone or in combination for the treatment of many solid tumors, it belongs to the taxane family and is known to have some side effects. Although palmar-plantar erythrodysesthesia (PPE) or hand-foot syndrome is a relatively common toxicity of many anticancer drugs (5-fluorouracil, capecitabine and liposomal doxorubicin), it occurs rarely with docetaxel. We report the case of a 43-year-old North African woman diagnosed with locally advanced breast cancer, received neoadjuvant chemotherapy with three cycles of FEC100 regimen: 5-fluorouracil (500 mg/m2), epirubicin (100 mg/m2) and cyclophosphamide (500 mg/m2). This combination was well tolerated. Then, chemotherapy was switched to docetaxel 100mg/m Three days after the first cycle, the patient developed an important painful erythema in her two feet, followed by a large desquamation and swelling, which interfered with her functional activities. This reaction was classified as grade 3 PPE according to the National Cancer Institute grading system, and was treated conservatively with emollients and analgesics. In agreement with the patient, the docetaxel chemotherapy was continued with dose reduction of 20%. Symptoms disappeared within 2 weeks following dose reduction.

Erythrodysesthesia, or hand foot syndrome, is a side effect related to some chemotherapeutic agents. It is characterized by a prodrome of palmoplantar dysesthesia followed by burning pain with edema and erythema on well-defined and symmetrical plaques, 2-4 days later. Doxorubicin, 5-fluorouracil, capecitabine, cytarabine and docetaxel are the most frequently associated chemotherapy drugs. Women, elderly or peripheral vascular compromise patients are more frequent and severe affected. Two female patients are reported. The first patient with ovarian cancer in treatement with liposomal doxorrubicin developed erythrodysesthesia after the fifth cycle of chemotherapy. Meanwhile the second patient diagnosed with breast cancer in treatment with capecitabine developed it after the second cycle of chemotherapy. The interest of this report is the dermatological consultation about a side effect syndrome which potentially limits the prescription of certain antineoplastic drugs. However, patients can continue specific treatment by indicating dose adjustment and prescribing medicine to relieve the symptoms. [ABSTRACT FROM AUTHOR]

The hand-foot-syndrome (HFS, palmoplantar erythrodysesthesia, chemotherapy-associated acral erythema) is characterized by painful predominantly palmo-plantar lesions. The association with different chemotherapeutic agents has been known for over 20 years. More recently, HFS has been reported in association with regimens using targeted agents, in particular the multikinase inhibitors (MKI) sorafenib and sunitinib. The HFS associated with MKI has a different distribution and clinical appearance than the traditional disorder. In this review, similarities and differences between chemotherapy- and MKI-associated HFS are discussed and current recommendations for their prophylaxis and management are summarized. [ABSTRACT FROM AUTHOR]