Photo-Lichenoid Eruption Secondary to Docetaxel

Dear Editor, Docetaxel belongs to the taxane class of cytotoxic agents. It is one of the most commonly used chemotherapeutic agents, especially in gynaecological cancers.[1] The main side effects of the drug are neutropenia, fluid retention, asthenia, neurotoxicity, hypersensitivity, and cutaneous reactions.[2] We present here a case of photo-lichenoid eruption secondary to docetaxel. A 55-year-old female presented with red coloured, itchy lesions on her hands and face for one month. The patient was under treatment for breast carcinoma with docetaxel (100 mg/m2) and had undergone four cycles of it every three weeks for three months. On clinical examination, there were well-defined to ill-defined erythematous to hyperpigmented plaques with violaceous hue present over the dorsum of bilateral hands and forearms [Figure 1a]. A similar plaque of size 2 × 2 cm2 was present above the centre of the right eyebrow, along with blanchable erythema over the bilateral malar area. The patient mentioned an increase in itching on exposure to the sun. Skin biopsy was sent from the lesion on hand with the differential diagnosis of palmoplantar dysesthesia and lichenoid skin reaction secondary to docetaxel and showed focal hypergranulosis and mild acanthosis in the epidermis. Moderate chronic lymphocytic inflammatory infiltrate, oedema, and few congested blood vessels were present in the dermis [Figure 1b]. The histopathologic findings were suggestive of lichenoid dermatitis. The patient was advised on photoprotection and prescribed topical potent corticosteroid for the lesions to which the patient responded well. Unfortunately, the patient did not follow up after two months.Figure 1: (a) Well to ill-defined hyperpigmented plaques with violaceous hue present over the dorsum of the hands and forearms. (b) Focal hypergranulosis and mild acanthosis in epidermis. Moderate chronic lymphocytic inflammatory infiltrate, oedema, and few congested blood vessels in the dermis. (Hematoxylin and eosin stain, 40×)Docetaxel is a semisynthetic analogue derived from the needles of the European yew tree (Taxus baccata). It causes polymerization of tubulin into highly stable intracellular microtubules and hence disrupts mitosis and normal cell division. Therefore, it acts as an antimicrotubule agent and causes cell death.[1] The major dose-limiting side effect of docetaxel is neutropenia. Other major systemic side effects include hypersensitivity reactions, myalgia, arthralgia, nausea, and symmetrical peripheral sensory neuropathy.[3] Cutaneous adverse events have also been mentioned in the literature, and the incidence varies between 6% and 81%.[3] These include maculo-papular eruptions, drug-induced lupus erythematosus, UV or radiation recall dermatitis, acute generalized exanthematous pustulosis, palmoplantar erythrodysesthesia, PATEO syndrome (Periarticular Thenar Erythema and Onycholysis), scleroderma-like skin changes, supravenous hyperpigmentation, flagellate, and reticular pigmentation. Chemotherapy-induced acute reversible or persistent alopecia, oral mucositis, and various nail abnormalities have also been reported.[1] The cutaneous side effects are usually mild to moderate in severity and self-limiting. The more severe adverse effects may have a toxic and non-immunoallergic mechanism. In view of these side effects being dose-dependent, dose interruption, reduction, or complete stoppage may be required.[4] While cutaneous side effects of CTCAE grade ≥3 warrant discontinuation of the drug, those of grade 1 or 2 can be managed without discontinuation and simultaneously initiating dermatological treatment.[1] In our case, the lichenoid lesions were present on the face besides hands and forearms, which was a clue that photosensitive lichenoid eruption could be a differential besides palmoplantar dysesthesia. Photosensitive lichenoid eruption secondary to docetaxel has been reported just once to the best of our knowledge.[5] Hence, the physician must be aware of this cutaneous adverse effect while prescribing docetaxel, and appropriate caution should be given to patients as well. Adequate photoprotection will prevent the appearance of these lesions and hence obviate the need of reducing the dose of a drug or stopping the treatment. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflict of interest There are no conflicts of interest.