Pediatric Dermatology

Cutaneous Side Effects of Chemotherapy in Pediatric Oncology Patients

Cutis. 2015 January;95(1):11-16

Can Ceylan, MD

Mehmet Kantar, MD

Arzu Tuna, MD

llgen Ertam, MD

Serap Aksoylar, MD

Aslı Günaydın, MD

Nazan Çetingül, MD

Pediatric oncology patients can present with various skin lesions related to both primary disease and immunosuppressive treatments. This study aimed to evaluate the cutaneous side effects of chemotherapy in pediatric oncology patients. Sixty-five pediatric oncology patients who were scheduled to undergo chemotherapy from May 2011 to May 2013 were included in the study. Three patients were excluded from the results, as 2 patients died during treatment and 1 patient withdrew from the study; therefore, a total of 62 patients were evaluated for mucocutaneous findings. Patients were grouped according to their oncological diagnoses and a statistical analysis was performed. There was no statistical significance in the incidence of cutaneous side effects of chemotherapy among the different diagnostic groups. Awareness among dermatologists of the possible cutaneous side effects of chemotherapy in pediatric patients and their causes can promote early diagnosis and treatment in this patient population.

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Practice Points

Chemotherapeutic agents can cause a variety of cutaneous side effects.
Pediatric oncology patients should be examined regularly for cutaneous side effects of chemotherapeutics.

References

Kamil N, Kamil S, Ahmed SP, et al. Toxic effects of multiple anticancer drugs on skin. Pak J Pharm Sci. 2010;23:7-14.
Alley E, Green R, Schuchter L. Cutaneous toxicities of cancer therapy. Curr Opin Oncol. 2002;14:212-216.
Ozkan A, Apak H, Celkan T, et al. Toxic epidermal necrolysis after the use of high-dose cytosine arabinoside. Pediatr Dermatol. 2001;18:38-40.
Rizos E, Milionis HJ, Pavlidis N, et al. Acquired ichthyosis: a paraneoplastic skin manifestation of Hodgkin’s disease. Lancet Oncol. 2002;3:727.
Otmani N, Alami R, Hessissen L, et al. Determinants of severe oral mucositis in pediatric cancer patients: a prospective study. Int J Pediatr Dent. 2011;21:210-216.
Mateus C, Robert C. New drugs in oncology and skin toxicity [in French]. Rev Med Interne. 2009;30:401-410.
Manji A, Tomlinson D, Ethier MC, et al. Psychometric properties of the Oral Mucositis Daily Questionnaire for child self-report and importance of mucositis in children treated with chemotherapy. Support Care Cancer. 2012;20:1251-1258.
Keefe DM. Mucositis management in patients with cancer. Support Cancer Ther. 2006;3:154-157.
Raber-Durlacher JE, Elad S, Barasch A. Oral mucositis. Oral Oncol. 2010;46:452-456.
Utas S, Kulluk P. A case of hydroxyurea-induced longitudinal melanonychia. Int J Dermatol. 2010;49:466-474.
Ott H, Höger PH. Dermatologic manifestations of infections in pediatric cancer patients [in German]. Klin Padiatr. 2005;217(suppl 1):110-119.
Ramphal R, Grant RM, Dzolganovski B, et al. Herpes simplex virus in febrile neutropenic children undergoing chemotherapy for cancer: a prospective cohort study. Pediatr Infect Dis J. 2007;26:700-704.
Yaris N, Cakir M, Kalyoncu M, et al. Bleomycin induced hyperpigmentation with yolk sac tumor. Indian J Pediatr. 2007;74:505-506.
Kleynberg RL, Sofi AA, Chaudhary RT. Hand-foot hyperpigmentation skin lesions associated with combination gemcitabine-carboplatin (GemCarbo) therapy. Am J Ther. 2011;18:261-263.
Blaya M, Saba N. Chemotherapy-induced hyperpigmentation of the tongue. N Engl J Med. 2011;365:e20.
Anandajeya WV, Corrêa ZM, Augsburger JJ. Primary acquired melanosis with atypia treated with mitomycin C. Int Ophthalmol. 2009;29:285-288.
Torres C, Wong L, Welsh O, et al. Skin manifestations associated with chemotherapy in children with hematologic malignancies. Pediatr Dermatol. 2011;2:123-147.
Mays SR, Cohen PR. Emerging dermatologic issues in the oncology patient. Semin Cutan Med Surg. 2006;25:179-189.

Pediatric oncology patients can present with various skin lesions related to both their primary disease and immunosuppressive treatments. In the majority of cases, cutaneous findings are associated with the use of chemotherapeutic agents. The toxic effects of chemotherapeutic agents, which generally are associated with treatment of solid organ malignancies (eg, liver, kidneys), can be detected by oncologists using clinical signs and laboratory tests.^1-3 However, it also is important for dermatologists to recognize and evaluate cutaneous side effects associated with chemotherapeutic agents. Reports in the literature of cutaneous side effects of chemotherapy in pediatric patients generally are limited to case studies. This study aimed to evaluate the characteristics of cutaneous side effects of chemotherapy in pediatric oncology patients.

Materials and Methods

The study was performed through the collaboration of the departments of dermatology and venereology and pediatric oncology in the Faculty of Medicine at Ege University, Izmir, Turkey. Sixty-five pediatric oncology patients who were scheduled to undergo chemotherapy from May 2011 to May 2013 were included in the study. Clinical examination of dermatologic findings was conducted at baseline (prior to beginning chemotherapy) and at months 1, 3, and 6 of treatment. Patients were examined a total of 4 times during the study. Patients with a history of skin disease prior to diagnosis of their malignancy were excluded, as the study aimed to evaluate cutaneous side effects of chemotherapy. Patients who developed cutaneous side effects during the study period were photographed. Skin biopsy was performed to confirm clinical diagnosis. Patients were split into 5 groups according to oncological diagnoses, including hematological malignancies, solid organ tumors, bone and soft tissue tumors, central nervous system tumors, and Langerhans cell histiocytosis. Data regarding age, gender, treatments administered (ie, chemotherapeutics, antibiotics, antifungals, antivirals), and dermatologic signs were recorded. Mucocutaneous findings were classified as infectious (viral, bacterial, fungal) lesions, bullous lesions, inflammatory dermatoses (eg, diaper dermatitis, asteatotic eczema, contact dermatitis, seborrheic dermatitis), xeroderma, petechiae/ecchymoses, nail signs, alopecia, mucositis, cheilitis, oral aphthae, drug reactions confirmed by histopathology, cushingoid signs (eg, striae, acneform eruption, hypertrichosis), and cutaneous hyperpigmentation.

Statistical analysis was performed using SPSS version 15.0 and χ² test was applied to the analysis.

References

Kamil N, Kamil S, Ahmed SP, et al. Toxic effects of multiple anticancer drugs on skin. Pak J Pharm Sci. 2010;23:7-14.
Alley E, Green R, Schuchter L. Cutaneous toxicities of cancer therapy. Curr Opin Oncol. 2002;14:212-216.
Ozkan A, Apak H, Celkan T, et al. Toxic epidermal necrolysis after the use of high-dose cytosine arabinoside. Pediatr Dermatol. 2001;18:38-40.
Rizos E, Milionis HJ, Pavlidis N, et al. Acquired ichthyosis: a paraneoplastic skin manifestation of Hodgkin’s disease. Lancet Oncol. 2002;3:727.
Otmani N, Alami R, Hessissen L, et al. Determinants of severe oral mucositis in pediatric cancer patients: a prospective study. Int J Pediatr Dent. 2011;21:210-216.
Mateus C, Robert C. New drugs in oncology and skin toxicity [in French]. Rev Med Interne. 2009;30:401-410.
Manji A, Tomlinson D, Ethier MC, et al. Psychometric properties of the Oral Mucositis Daily Questionnaire for child self-report and importance of mucositis in children treated with chemotherapy. Support Care Cancer. 2012;20:1251-1258.
Keefe DM. Mucositis management in patients with cancer. Support Cancer Ther. 2006;3:154-157.
Raber-Durlacher JE, Elad S, Barasch A. Oral mucositis. Oral Oncol. 2010;46:452-456.
Utas S, Kulluk P. A case of hydroxyurea-induced longitudinal melanonychia. Int J Dermatol. 2010;49:466-474.
Ott H, Höger PH. Dermatologic manifestations of infections in pediatric cancer patients [in German]. Klin Padiatr. 2005;217(suppl 1):110-119.
Ramphal R, Grant RM, Dzolganovski B, et al. Herpes simplex virus in febrile neutropenic children undergoing chemotherapy for cancer: a prospective cohort study. Pediatr Infect Dis J. 2007;26:700-704.
Yaris N, Cakir M, Kalyoncu M, et al. Bleomycin induced hyperpigmentation with yolk sac tumor. Indian J Pediatr. 2007;74:505-506.
Kleynberg RL, Sofi AA, Chaudhary RT. Hand-foot hyperpigmentation skin lesions associated with combination gemcitabine-carboplatin (GemCarbo) therapy. Am J Ther. 2011;18:261-263.
Blaya M, Saba N. Chemotherapy-induced hyperpigmentation of the tongue. N Engl J Med. 2011;365:e20.
Anandajeya WV, Corrêa ZM, Augsburger JJ. Primary acquired melanosis with atypia treated with mitomycin C. Int Ophthalmol. 2009;29:285-288.
Torres C, Wong L, Welsh O, et al. Skin manifestations associated with chemotherapy in children with hematologic malignancies. Pediatr Dermatol. 2011;2:123-147.
Mays SR, Cohen PR. Emerging dermatologic issues in the oncology patient. Semin Cutan Med Surg. 2006;25:179-189.

Cutaneous Side Effects of Chemotherapy in Pediatric Oncology Patients

References

Materials and Methods

Pages

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