癌症治療相關的皮膚病灶 skin lesions related to therapies of cancers

 癌症治療相關的皮膚病灶 skin lesions related to therapies of cancers

名稱	表徵	說明
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)
hand-foot skin reaction，圖片如下 https://reurl.cc/9rz2an	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。
flagellate erythema (flagellate dermatitis)(圖二)	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。
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。
	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。
	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。
	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。
	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   https://www.uptodate.com/contents/cutaneous-side-effects-of-conventional-chemotherapy-agents?search=flagellate%20dermatitis&source=search_result&selectedTitle=3~22&usage_type=default&display_rank=3

l   https://www.uptodate.com/contents/hand-foot-skin-reaction-induced-by-multitargeted-tyrosine-kinase-inhibitors?search=hand%20foot%20skin%20reaction&source=search_result&selectedTitle=1~28&usage_type=default&display_rank=1#H779678639

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.