To the Editor.—
In the January 1985 Archives, Levine et al1 reported the occurrence of acral erythema during therapy for severe myelogenous leukemia. We have made similar observations and would like to contribute additional information.The patients described by Levine et al were all receiving combination chemotherapy, and the authors did not ascribe the reaction to any single agent. Acral erythema is not a specific reaction to one agent and has been reported in patients given cytarabine,2 doxorubicin,3 fluorouracil,3 and methotrexate4 alone. However, in the cases reported by Levine et al, the reaction was almost certainly to cytarabine, because acral erythema secondary to doxorubicin has been described only in association with constant infusions, which were not used in these cases. Furthermore, acral erythema is being noted with increasing frequency now that cytarabine is being given in higher dosages than those used in the past; we agree that the reaction is toxic and we suggest, with respect to cytarabine
Walker IR, Wilson WEC, Sauder DN, Benger AM, Browman G. Cytarabine-Induced Palmar-Plantar Erythema. Arch Dermatol. 1985;121(10):1240–1241. doi:10.1001/archderm.1985.01660100020006
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