PATEO syndrome: Periarticular thenar erythema with onycholysis

A 54-year-old woman case of invasive ductal carcinoma of the right breast underwent modified radical mastectomy following which patient was started on adjuvant chemotherapy with doxetaxel for 2 months. She presented to dermatology department with reddish raised lesions over the left dorsum of hand for 2 weeks duration. On examination, patient had revealed presence of erythematous-violaceous plaques over the left dorsum of hand with finger nails showing onycholysis and erythema scaling present over the achilles tendon area and bilateral palms [Figure 1a-c]. Based on the history and examination, she was diagnosed to have periarticular thenar erythema with onycholysis (PATEO) syndrome secondary to docetaxel. She was advised with topical steroids, cooling of hands with ice baths, and continue the chemotherapy treatment for breast carcinoma.

Close

Figure 1:

(a-c) Presence of erythematous-violaceous plaques left dorsum of the hand with onycholysis and erythematous scaling over the achilles tendon and bilateral palms characteristic of periarticular thenar erythema with onycholysis.

Export to PPT

PATEO syndrome is a variant of hand-foot syndrome first described by Childress and Lokich.^[1] It is a rare side effect of taxane-based chemotherapy such as docetaxel and paclitaxel. PATEO syndrome is characterized by palmar erythema involving the thenar and hypothenar area, violaceous plaques over the dorsum of the hand and the Achilles tendon area, and onycholysis. Although the exact pathophysiology is unknown, the severity of the cutaneous manifestation is related to the dose and the cumulative number of chemotherapy cycles. Even though it is not a life-threatening condition, effective management is needed for the patients to continue their chemotherapy regimen. The treatment of the above condition includes topical corticosteroids, cooling hands in ice baths before subsequent infusion with taxanes, and frozen glove therapy.^[2] We present this case to heighten awareness of this unique manifestation of hand-foot syndrome specific to taxane chemotherapy and share a successful approach toward management.