Generalized benign cutaneous reaction to cytarabine

Area of Science:

• Dermatology
• Oncology
• Clinical Toxicology

Background:

• Cytarabine (Ara-C) is a chemotherapy agent with known toxicities, including various skin manifestations.
• A specific generalized papular purpuric eruption associated with cytarabine has not been well-characterized.

Observation:

• A retrospective review identified 16 cases of cytarabine-related toxicity presenting as papular purpuric eruptions or violaceous erythema.
• The eruption characteristically began as erythematous papules, evolving into purpuric papules and plaques, often affecting intertriginous areas, neck, ears, and scalp.

Findings:

• The eruption typically appeared after chemotherapy completion (81.3%) and was often misdiagnosed as viral exanthem, drug eruption, or vasculitis.
• Histopathology showed nonspecific findings, including lymphocytic infiltrates, spongiosis, and red cell extravasation.
• The eruption was not predicted by prior cytarabine exposure and did not predict future recurrence.

Implications:

• Recognizing this specific cytarabine-induced eruption aids in accurate clinical diagnosis.
• Understanding its benign nature can prevent unnecessary interventions and avoid premature cessation of chemotherapy.
• Awareness of this cutaneous reaction is crucial for oncologists and dermatologists managing patients treated with cytarabine.