From the Guidelines
Palmar erythema, also known as palmar-plantar erythrodysaesthesia syndrome (PPES), is a disorder characterized by redness, discomfort, swelling, and tingling in the palms of the hands, often associated with cytotoxic chemotherapy agents, such as 5-fluorouracil (5-FU) and capecitabine, with the highest incidence reported for the combination of doxorubicin plus 5-FU/capecitabine, affecting up to 89% of cases 1.
Causes and Associations
The condition can be caused by various factors, including:
- Cytotoxic chemotherapy agents, such as 5-FU, capecitabine, doxorubicin, and docetaxel 1
- BRAF inhibitors, such as vemurafenib, dabrafenib, and encorafenib, which can cause palmoplantar keratoderma (PPK) 1
- Multikinase vascular endothelial growth factor receptor (VEGFR) inhibitors, such as sorafenib, cabozantinib, and sunitinib, which can cause hand-foot skin reaction (HFSR) 1
Management and Treatment
The management of palmar erythema focuses on treating the underlying cause, and in the case of chemotherapy-induced PPES, supportive care measures, such as topical creams and pain management, may be necessary 1. It is essential to note that the occurrence and severity of PPES have been correlated with therapy response, highlighting the importance of monitoring and managing this condition in patients undergoing chemotherapy 1.
Clinical Considerations
In clinical practice, it is crucial to be aware of the potential causes of palmar erythema and to monitor patients receiving chemotherapy or other medications that may cause this condition 1. By prioritizing the management of the underlying cause and providing supportive care, healthcare providers can help alleviate the symptoms of palmar erythema and improve patient outcomes.
From the Research
Definition and Causes of Palmar Erythema
- Palmar erythema (PE) is a physical finding that can be due to several physiologic or systemic pathologic states 2.
- Primary or physiologic PE can be due to heredity, occurs in at least 30% of pregnant women, or may be a diagnosis of exclusion (i.e. idiopathic PE) 2.
- Secondary PE from systemic pathology encompasses a wide range of disease states, including liver cirrhosis, rheumatoid arthritis, thyrotoxicosis, and diabetes mellitus 2, 3.
Association with Systemic Diseases
- PE has been reported to occur in >60% of patients with rheumatoid arthritis and is associated with a favorable prognosis 2.
- Up to 18% of patients with thyrotoxicosis and 4.1% of patients with diabetes mellitus can have PE 2.
- PE can be seen in early gestational syphilis and among patients with human T-lymphotrophic virus-1-associated myelopathy 2.
- PE is also associated with malignant tumors, particularly those of the central nervous system 4, 5.
Drug-Induced Palmar Erythema
- Drug-induced PE with hepatic damage has been documented with use of amiodarone, gemfibrozil, and cholestyramine 2.
- Topiramate and albuterol (salbutamol) have been reported to cause PE in the setting of normal liver function 2.
Diagnosis and Treatment
- Identification of PE related to underlying disorders should be followed by treatment of the underlying condition 2.
- No treatment of primary PE is indicated, but if medication is the cause of PE, the drug responsible should be discontinued if possible 2.
- Skin biopsy demonstrating dermal and subcutaneous fibroplasia may help in diagnosis in the absence of advanced signs of palmar fasciitis 4.