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E. Frouin, G. Sebille, S. Freudenberger, B. Menecier, E. Quoix, B. Cribier, D. Lipsker, Asteatotic eczema (‘eczema craquelé’) with histopathological interface dermatitis: a new cutaneous reaction following pemetrexed, British Journal of Dermatology, Volume 166, Issue 6, 1 June 2012, Pages 1359–1360, https://doi.org/10.1111/j.1365-2133.2011.10777.x
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Funding sources: none.
Conflicts of interest: none declared.
Madam, Pemetrexed (Alimta®; Lilly, Indianapolis, IN, U.S.A.) is a novel antifolate agent. It is used for the treatment of patients with malignant pleural mesothelioma, or locally advanced or metastatic nonsmall cell lung cancer.
Cutaneous toxicity is an adverse event classified into four grades. In phase III trials leading to its approval, rash was reported in 14% of patients receiving pemetrexed alone or in combination with cisplatin,1 of which 0·8–1·3% were grade 3 or 4.1, 2 Most of these eruptions were macular or papular. More recently, bullous,3 urticarial4 and pustular5 eruptions were reported. We describe three patients with widespread asteatotic eczema (AE) following pemetrexed administration.
Patient 1, a 69‐year‐old man, was hospitalized for stage IV primary adenocarcinoma of the right lung. A fourth‐line chemotherapy with pemetrexed 500 mg m−2 was initiated after a 4‐day premedication (folate and cobalmine). On day 5, he developed a diffuse cutaneous reaction (erythematous and violaceous rhagades) without facial involvement or pruritus. Skin biopsy showed an intense vacuolization of the dermal–epidermal junction with basal necrotic keratinocytes, a sparse lymphocytic inflammatory infiltrate, and a thick granular layer with dotted parakeratosis. Clinically, we made the diagnosis of AE, and suspected pemetrexed as the causative agent. The patient was treated only with dermocorticoids and emollients in the absence of criteria for severe AE. The skin rash disappeared in 10 days. The patient did not receive any other chemotherapy and died rapidly.
