Hydroxyurea-induced hand-foot syndrome
How to cite this article: Ramamoorthy L, Monisha GA. Hydroxyurea-induced hand-foot syndrome. CosmoDerma 2023;3:153.
A 40-year-old male known case of essential thrombocytosis presented with pigmentation and burning sensation in the palms and soles for the past 2 months. The patient has been on treatment with hydroxyurea 500 mg twice daily for the past 3 months. On cutaneous examination diffuse erythema and hyperpigmentation seen over the bilateral palms and soles [Figure 1a-c]. Based on history and clinical examination, hydroxyurea-induced hand-foot syndrome was diagnosed. The patient was treated with topical betamethasone cream and advised regular follow-up.
Palmoplantar erythrodysesthesia, also called Burgdorf syndrome, acral erythema, toxic erythema of chemotherapy, or hand-foot syndrome, is commonly seen with chemotherapeutic agents. Hydroxyurea-associated acral erythema is associated with long-term hydroxyurea use, usually at doses equal to or greater than 1 g daily. It can start from weeks to years after initiation of hydroxyurea. In a large retrospective review of patients with myeloproliferative neoplasms treated with hydroxyurea, <10% of patients treated with hydroxyurea developed any mucocutaneous toxicities, out of which more than 80% of patients had cutaneous ulceration and oral mucosal aphthae. Hand and foot syndrome has been previously reported in association with hydroxyurea with chronic myeloid leukemia and sickle cell disease. We present this case of hand-foot syndrome as a rarely encountered cutaneous adverse effect associated with hydroxyurea in a case of essential thrombocytosis.
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