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Correspondence |

Sunitinib: A Cause of Bullous Palmoplantar Erythrodysesthesia, Periungual Erythema, and Mucositis

Pitiporn Suwattee, MD, FRCPC; Steven Chow, MD, MS; Brian C. Berg, MD; Erin M. Warshaw, MD, MS
Arch Dermatol. 2008;144(1):123-125. doi:10.1001/archderm.144.1.123.
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Sunitinib (SU011248) (Sutent; Pfizer Inc, New York, New York) is an oral multikinase phosphorylation inhibitor of receptor tyrosine kinases (RTKs), which are implicated in tumor growth, angiogenesis, and metastasis of cancer. Although it is approved for use in the treatment of gastrointestinal stromal tumor and advanced renal cell carcinoma, sunitinib has also been shown to be efficacious in treating neuroendocrine, colon, and breast cancers.1 Dermatologic adverse effects include rash, skin discoloration, hair color changes, xerosis, alopecia, and seborrheic dermatitis–like reactions.2 Palmoplantar erythrodysesthesia (PPE) was reported in 12% to 14% of patients in large phase 2 and 3 studies.3 To our knowledge, we describe herein the first case of sunitinib-related intense periungual erythema and severe mucositis in addition to bullous PPE.

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Figure 1.

Periungual erythema and edema with bullous formation (A) and severe mucosal erosions in perianal area shown with periungual erythema (B).

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Figure 2.

Histopathologic skin biopsy specimens (hematoxylin-eosin). A, Irregularly acanthotic epidermis with hyperkeratosis, parakeratosis, and spongiosis (original magnification ×100). B, Multiple necrotic keratinocytes (black arrows) and mitosis (white arrow) (original magnification ×400).

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