Toxic Erythema of Chemotherapy By Any Other Name

Pseudocellulitis (or erysipeloid reaction) also falls within the spectrum of TEC. Large patches or plaques of burning erythema appear and tense bullae may develop. The bullae do not spontaneously slough, and there is no Nikolsky’s sign. Pseudocellulitis is seen primarily following exposure to gemcitabine, but also to clofarabine, a newer drug being used as a second- or third-line agent for leukemia.

Lastly, chemotherapy-induced eccrine hidradenitis clearly falls within the histologic spectrum of TEC, she said, but clinically there are some patients who have a Sweet’s syndrome–like presentation, and these could be categorized separately.

TEC can be misdiagnosed as several other entities including cellulitis, herpetic viral infections, vasculitis, graft-versus-host disease (especially when the patient also has diarrhea), or a hypersensitivity drug reaction. It is important to note that TEC can be a skin sign of systemic disease in that severe cutaneous disease can be associated with severe cytotoxicity of the bowel, leading to sepsis caused by GI flora, she said. The team caring for the patient should be made aware of this possibility.

Disclosures: Dr. Bolognia said she has no pertinent conflicts of interest.

TEC a Better Term than Many

These diagnoses all fall under the umbrella of (TEC), and all should be called TEC, Dr. Bolognia said:

Erythrodysesthesia

Acral erythrodysesthesia

Palmar-plantar (palmoplantar) erythrodysesthesia

Acral erythema

Chemotherapy-induced acral erythema

Hand-food syndrome

AraC (cytarabine) ears

Chemotherapy-induced eccrine squamous syringometaplasia

Epidermal dysmaturation

Intertriginous eruption associated with chemotherapy

Chemotherapy-associated neutrophilic eccrine hidradenitis

Drug-induced eccrine hidradenitis

Chemotherapy-induced hidradenitis

Pseudocellulitis (erysipeloid reaction to chemotherapy)