Periarticular Thenar Erythema and Onycholysis Syndrome: A Manifestation of Taxane-Induced Cutaneous Toxicity.

In recent years, the widespread use of taxane-based chemotherapy regimens for the management of malignant tumors of various origins has evidenced the high frequency of cutaneous toxicity induced by this pharmacological group. In 2003, among its possible manifestations, Childress and Lokich defined periarticular thenar erythema and onycholysis (PATEO) syndrome as a rare subtype of hand-foot syndrome associated with nail changes in patients treated with paclitaxel and docetaxel. In contrast to typical palmarplantar erythrodysesthesia, or classic hand-foot syndrome, skin involvement in this syndrome is characterized by an absence of involvement of the palms and soles and by the presence of alterations predominantly affecting the dorsum of the hands (particularly around the base of the thumb and fifth finger), the area of the Achilles tendon, and the perimaleolar skin. We present 3 patients on chemotherapy with taxanes who developed clinical manifestations similar to those described in this syndrome. The 3 patients were women aged 35, 56, and 68 years, with infiltrating ductal adenocarcinoma of the breast on adjuvant treatment with docetaxel and cyclophosphamide (Table 1). They sought dermatologic evaluation for the appearance of painful erythematous-violaceous plaques with fine superficial desquamation on the dorsum of both hands (Fig. 1A). The lesions interfered with their activities of daily living. The lesions had arisen 3 to 12 days after the administration of chemotherapy, and showed a clearly progressive deterioration with each cycle, despite the use of topical corticosteroids. Associated nail involvement in the 3 cases varied from fine parallel Beau lines and subungual splinter hemorrhages to frank distal onycholysis of the nail plate (Fig. 1 B). Physical examination revealed no lesions on the rest of the skin, and the patients presented an otherwise good general state of health. Histology of a 4-mm punch biopsy from the dorsum of the hand of patient number 2 revealed a hyperkeratotic epidermis with parakeratosis, necrotic keratinocytes, focal vacuolar degeneration of the basal layer, and a band-like perivascular lymphocytic inflammatory infiltrate with occasional eosinophils (Fig. 2, A