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Eosinophilic, Polymorphic, and Pruritic Eruption Associated With Radiotherapy
Ricardo A. Rueda, MD;
Isabel C. Valencia, MD;
Claudia Covelli, MD;
Carlos Escobar, MD;
Alberto Alzate, MD, DTM&H;
Brenda Saldarriaga, MD;
Gloria Sanclemente, MD;
Abraham Blank, MD;
Rafael Falabella, MD
Arch Dermatol. 1999;135:804-810.
Objective To characterize the epidemiological, clinical, and histopathological features of patients with cancer who develop widespread polymorphic and pruritic skin lesions following radiotherapy.
Patients, Design, and Interventions During phase 1, epidemiological and clinical features of 103 patients with cancer, 83 treated with radiotherapy (71 women and 12 men) and 20 controls who did not undergo radiotherapy (16 women and 4 men), were explored during 3 months (October 1995 to January 1996). During phase 2, in 30 additional patients with cancer who were treated with telecobalt or linear accelerator, 18 with skin lesions (15 women and 3 men) and 12 without lesions (10 women and 2 men), the following were investigated: (1) hematoxylin-eosin–stained sections for routine histopathological examination and direct immunofluorescence, and lymphocytic markers; (2) blood, skin, and primary tumor eosinophilia; and (3) the presence of antiepidermal autoantibodies. Patients were examined during 5 months (February 1996 to June 1996).
Setting A dermatology department at a university hospital.
Results During phase 1, 14 (17%) of the 83 patients undergoing radiotherapy developed an eruption. Acral excoriations, erythematous papules, vesicles, and bullae were the most frequent lesions. During phase 2, in 18 patients, a superficial and deep lymphocytic perivascular infiltrate with numerous eosinophils, intraepidermal and interstitial eosinophilic infiltrates, eosinophilic panniculitis, IgM and C3 perivascular deposits, and slightly predominant CD4+ cells were observed. No antiepidermal autoantibodies were found.
Conclusions The clinical, histopathological, and immunopathologic features in patients with cancer undergoing radiotherapy are described. To our knowledge, this condition has not been well characterized. Because of its unique presentation, the denomination "eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy" is suggested.
From the Departments of Dermatology (Drs Rueda, Valencia, Covelli, Escobar, Sanclemente, and Falabella), Microbiology and Epidemiology (Dr Alzate), Radiotherapy (Dr Saldarriaga), and Morphology (Dr Blank), Universidad del Valle and Hospital Universitario del Valle; and Fundación Valle del Lili (Drs Rueda and Falabella), Cali, Colombia.
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