癌症治療相關的皮膚病灶 skin lesions related to therapies of cancers
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名稱 |
表徵 |
說明 |
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hand-foot
syndrome(圖一) |
最初症狀，化療後第一天，但可以在數次化療後出現：tingling, numbness, tightness, stiffness
or pain in the palms/fingers and sometimes a little later also the soles of
feet/toes 初始症狀出現後2-4天： symmetric
erythema and edema in palms and soles, accompanied by onset of neuropathic pain,
which can progress to blistering with desquamation, erosion, and ulceration 手掌>足底、常見於受壓處 |
和Pegylated liposomal doxorubicin(常見)、capecitabine、5-fluorouracil(最常見)、cytarabine、docetaxel、doxorubicin相關，停止化療可以有效解決此問題，化療前使用用保濕液moisturizers [ˈmɔɪstʃəˌraɪzɚ]對此有幫助，並避免傷害(熱、物理性、壓力、刺激性物質)，若已發生，可用冰敷、止痛、抬高患處，嘗試使用topical or oral steroid、topical and oral pyridoxine
(vitamin B6) |
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hand-foot
skin reaction，圖片如下
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Localized, tender lesions over areas subjected to friction or trauma, which may appear as blisters or focal hyperkeratosis overlying an erythematous base and affects flexural and pressure-bearing areas, including fingertips, interdigital web spaces, heels, lateral aspect of feet, and over joints 疼痛、感覺異常(paresthesia)、刺痛、痠痛，熱忍受力下降 足底>手掌、常見於受壓處 |
出現在使用tyrosine kinase inhibitors 2-4週後，Multikinase inhibitors也可以出現 (sorafenib, sunitinib,
axitinib, pazopanib, regorafenib, bevacizumab, and vemurafenib)，可用urea藥膏於角質化處，並保持濕潤、避免摩擦，若有疼痛問題可使用lidocaine gel，嚴重者可使用topical steroid，有傷口處使用topical antibiotics。 |
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flagellate
erythema |
pruritic,
erythematous, linear streaks that resemble whiplash(鞭打, [ˈwɪpˌlæʃ] marks, hence the name
flagellate (鞭打, [ˈflædʒəˌlet])，搔癢的症狀可能早於皮膚徵象 |
原因包含bleomycin、peplomycin、docetaxel、皮肌炎dermatomyositis、成人史迪爾氏症候群adult-onset Still disease、香菇皮膚炎Shiitake mushroom
dermatitis (吃生香菇而產生，與lentinan相關)，會自行緩解，可使用oral antihistamines,、topical steroid、systemic steroid、冰敷處理，注意熱源可能導致復發(heat-induced recall)、避免曬太陽。 |
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PRIDE |
l Papulopustules and/or paronychia l Regulatory abnormalities of
hair growth l Itching l Dryness l due to Epidermal
growth factor receptor inhibitors |
以上是和EGFR inhibitors相關。 |
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Papulopustules |
影響45-100%的病人，常發生在臉及上半身。可用clindamyicn gel, tetracycline PO, doxycycline PO, minocycline PO來調解免疫反應，若依然有嚴重的頭皮病灶，可用rinderon (topical steroid做治療)，有時候會伴隨S. aureus感染，可用dicloxacillin 1# 250mg拆開來泡250 ml 生理食鹽水，浸濕紗布敷在頭頂、臉上(wet compression)，時間不限，若是效果有限，可用levofloxacin 1#並搭配以上方法處理，使用一週後換回dicloxacillin。 |
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甲溝炎Paronychia [ˌpærəˈnɪkiə] |
影響45-100%的病人，會有強烈的疼痛(exquisite tenderness)，可能合併甲床剝離(onycholysis, [ˌɑnɪˈkɑlɪsɪs])、指甲萎縮(onychodystrophy)，可用doxycycline、high-potency topical
corticosteroid、topical calcineurin inhibitor tacrolimus做治療。 |
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Regulatory
abnormalities of hair growth, eg. nonscarring alopecia [ˌæləˈpiʃə], 睫毛粗長症trichomegaly of the
eyebrows, increased hair in the face, 鼻孔nares /ˈnɛəriz/ and eyelashes |
睫毛部分可會診眼科處理。 |
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Dryness：xerosis \ zi-ˈrō-səs \乾燥症 |
影響7-35%的病人，常發生於紅疹處，用保濕液moisturizers [ˈmɔɪstʃəˌraɪzɚ]和潤膚劑emollients [ɪˈmɑljənt]處理，若導致搔癢的情形，可搭配抗組織胺antihistamines [ˌæntiˈhɪstəˌmin]來控制症狀。 |
(圖一) Hand-foot syndrome，資料來源：https://dermnetnz.org/topics/hand-foot-syndrome/
(圖二) flagellate erythema，資料來源：https://dermnetnz.org/topics/shiitake-flagellate-dermatitis/
資料來源：
l Lacouture, M. E., & Lai, S. E. (2006).
The PRIDE (Papulopustules and/or paronychia, Regulatory abnormalities of hair
growth, Itching, and Dryness due to Epidermal growth factor receptor
inhibitors) syndrome. British Journal of Dermatology, 155(4), 852-854.
l https://dermnetnz.org/topics/flagellate-erythema/
l Miller, K. K., Gorcey, L., & McLellan,
B. N. (2014). Chemotherapy-induced hand-foot syndrome and nail changes: a
review of clinical presentation, etiology, pathogenesis, and management.
Journal of the American Academy of Dermatology, 71(4), 787-794.
l Lu, C. W., Wu, C. E., Hsu, P. C., Fang, Y. F., Li, S. H., Tseng, L. C., & Shih, F. Y. (2021). Topical dicloxacillin solution wash for papulopustular eruptions and purpuric drug eruptions due to epidermal growth factor inhibitors. International journal of dermatology.
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