Docetaxel-induced recall dermatitis on previous laser treatment sites

Abstract

Sir, Chemotherapy‐induced ‘recall’ is a phenomenon whereby the administration of a chemotherapeutic agent induces an inflammatory reaction in a previous injury site.1–3 The most well‐known recall phenomenon is radiation recall, and there is no previous report of a chemotherapy‐induced recall reaction on a laser‐induced wound.1–3 A 45‐year‐old female presented in August 2002 with intermittent headache, ataxia, vertigo and vomiting, followed by sudden loss of consciousness. Brain magnetic resonance imaging revealed multiple brain tumours at the right cerebellum, right occipital and left parietal lobes. The patient underwent excision of the right cerebellar tumour and was found to have a metastatic adenocarcinoma. Chest computed tomography (CT) study disclosed multiple nodules in the right lung field and the patient was diagnosed as having nonsmall‐cell lung cancer with multiple brain metastases. Whole brain radiotherapy with the dosage of 3000 cGy in 15 fractions was administered during September and October 2002, and all the neurological symptoms subsided. The patient was also treated with four courses of gemcitabine 1000 mg m−2 (on days 1, 8 and 15) plus cisplatin 90 mg m−2 (on day 15) from November 2002 to March 2003. In November 2003, the chest CT study revealed progression of the disease, and the patient was then treated with docetaxel 40 mg m−2 on days 1, 8 and 15. No obvious skin side‐effect was ever noted until the first infusion of the third cycle. The patient found two well‐defined, erythematous, slightly scaling, infiltrative plaques with tingling and pruritic sensations, which had developed on both cheeks 2 days after that infusion. The skin lesions were worse after the second and third infusions of that cycle (Fig. 1). An incision skin biopsy was performed on the left cheek lesion; this revealed epidermal dysmaturation with frequent dyskeratotic keratinocytes, basal vacuolar changes and pigment incontinence, which were compatible with the effects of chemotherapeutic agents (Fig. 2).