Compartilhar
Informação da revista
Vol. 97. Núm. 3.
Páginas 397-398 (01 Maio 2022)
Compartilhar
Compartilhar
Baixar PDF
Mais opções do artigo
Visitas
1858
Vol. 97. Núm. 3.
Páginas 397-398 (01 Maio 2022)
Case Letter
Open Access
Acute localized exanthematous pustulosis induced by paclitaxel
Visitas
1858
Ana Carolina Tardin Rodrigues de Medeiros
Autor para correspondência
anacarolinatardin@hotmail.com

Corresponding author.
, Juliana Lopes Corrêa, Ademar Schultz Junior, Karina Demoner de Abreu Sarmenghi
Dermatology Outpatient Clinic, Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
Este item recebeu

Under a Creative Commons license
Informação do artigo
Texto Completo
Bibliografia
Baixar PDF
Estatísticas
Figuras (3)
Mostrar maisMostrar menos
Texto Completo
Dear Editor,

Acute localized exanthematous pustulosis (ALEP) is an atypical variant of acute generalized exanthematous pustulosis (AGEP), a rare drug reaction.1 It is an acute, localized subcorneal aseptic pustular eruption, usually affecting the face, cervical region, or thorax.2,3 The pathophysiological mechanisms remain unclear, although 90% of ALEP cases are drug-induced.1 This case report describes a paclitaxel-induced ALEP case in a patient undergoing breast cancer treatment.

A 63-year-old woman complained of the appearance of pustules on an erythematous base, symmetrically distributed on the face (Fig. 1) one week after paclitaxel infusion used as neoadjuvant treatment for breast cancer. She reported pruritus and a local burning sensation and denied having a fever. No mucous membrane lesions were observed. The laboratory tests showed normal values ​​for leukocytes (8,500 mm3) and serum C-reactive protein. The pustule secretion culture was negative. The skin biopsy revealed intraepidermal subcorneal pustules and a superficial perivascular lymphocytic infiltrate (Fig. 2). Based on the clinical presentation and histopathological findings, the diagnosis of ALEP was made. The patient was treated with 40 mg of prednisone per day, and chemotherapy was discontinued, with complete remission of the lesions after 14 days (Fig. 3). The follow-up continued by slowly decreasing the dose of corticosteroids.

Figure 1.

Presence of pustules on an erythematous base, symmetrically distributed on the face.

(0,24MB).
Figure 2.

Histopathological examination stained with Hematoxylin & eosin, showing an intraepidermal subcorneal pustule, with superficial perivascular lymphocytic infiltrate, (Hematoxylin & eosin, ×10).

(0,46MB).
Figure 3.

Post-inflammatory hyperchromia without the presence of pustular lesions.

(0,27MB).

Acute localized exanthematous pustulosis (ALEP) is a particular form of AGEP. Approximately 25 reports have been published in the literature, confirming that it is a rare drug reaction.3 Initially, the condition presents with sterile pustules located on the face, cervical region, or thorax after exposure to the drug, with spontaneous remission after discontinuation of the causative drug.2,3 Fever and leukocytosis may be present, accompanied by pruritus or a burning sensation.3 About 90% of cases are drug-induced, with antibiotics, especially beta-lactams and macrolides, being the most common causative drugs.1,3 Associations with docetaxel, a chemotherapeutic drug of the taxane class, have also been reported in two patients with breast cancer.4,5

As ALEP is a self-limited disease, the mainstay of treatment is the withdrawal of the suspected drug, promoting symptom improvement within a few days. Support therapy with topical or oral corticosteroids may be appropriate for the treatment of pruritus and inflammation in prolonged cases.3

In conclusion, ALEP is an unusual drug-induced skin reaction, and the majority of published cases were secondary to the use of antibiotics. However, it is important to emphasize that chemotherapeutic agents of the taxane class may also be responsible for this skin reaction.

Financial support

None declared.

Authors’ contributions

Ana Carolina Tardin Rodrigues de Medeiros: Statistical analysis; design and planning of the study; drafting and editing of the manuscript; intellectual participation in the propaedeutic and therapeutic conduct of the studied cases; critical review of the literature.

Juliana Lopes Correa: Collection, analysis, and interpretation of data; drafting and editing of the manuscript; critical review of the literature.

Ademar Schultz Junior: Collection, analysis, and interpretation of data; design and planning of the study; drafting and editing of the manuscript.

Karina Demoner de Abreu Sarmenghi: Approval of the final version of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and therapeutic conduct of the studied cases; critical review of the manuscript.

Conflicts of interest

None declared.

References
[1]
E.G. Torrijos, M.P.C. Calle, Y.M. Díaz, L.M. Lozano, A.M. Ortega, P.A.G. Bonilla, et al.
Acute localized exanthematous pustulosis due to bemiparin.
J Investig Allergol Clin Immunol, 27 (2017), pp. 328-329
[2]
B. Prange, A. Marini, A. Kalke, N. Hodzic-Avdagic, T. Ruzicka, U.R. Hengge.
Acute localized exanthematous pustulosis (ALEP).
J Dtsch Dermatol Ges, 3 (2005), pp. 210-212
[3]
A. Villani, A. Baldo, G.F. Salvatores, V. Desiato, F. Ayala, C. Donadio.
Acute localized exanthematous pustulosis (ALEP): review of literature with report of case caused by amoxicillin-clavulanic acid.
Dermatol Ther (Heidelb), 7 (2017), pp. 563-570
[4]
S.W. Kim, U.H. Lee, S.J. Jang, H.S. Park, Y.S. Kang.
Acute localized exanthematous pustulosis induced by docetaxel.
J Am Acad Dermatol, 63 (2010), pp. e44-e46
[5]
Y.Z. Ji, L. Geng, H.M. Qu, H.B. Zhou, T. Xiao, H.D. Chen, et al.
Acute generalized exanthematous pustulosis induced by docetaxel.
Int J Dermatol, 50 (2011), pp. 763-765

Study conducted at the Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil.

Idiomas
Anais Brasileiros de Dermatologia (Portuguese)
Opções de artigo
Ferramentas
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.