Transient acantholytic dermatosis in oncology patients

To evaluate the characteristics of patients with cancer who have a previous history, concurrent episode, or subsequent appearance of transient acantholytic dermatosis (TAD).

We report four oncology patients who developed TAD and review the 22 reports that have previously been published of individuals in whom TAD appeared either before, concomitant with, or after the diagnosis of their malignancy.

TAD was associated more frequently in patients with hematologic malignancies, especially acute and chronic myelogenous leukemia. It also appeared in patients with solid tumors, primarily those of the genitourinary organs. In almost all the cases, the onset of TAD was either concurrent or followed the discovery of malignancy. The TAD resolved completely, with or without treatment, in at least 20 patients in a median of 3 weeks.

TAD is a benign and temporary condition that may occur in patients with an internal malignancy. When the diagnosis of TAD is being considered, a lesional skin biopsy readily establishes histologic confirmation in a febrile patient with cancer who develops a new rash. TAD has been observed most frequently in oncology patients who have either myelogenous leukemia or carcinoma of the genitourinary organs. The appearance of TAD coincided with either the detection or the recurrence of malignancy in three individuals (12%). In the other 23 oncology patients, TAD was most likely secondary to either antineoplastic agents, excessive perspiration, fever, occlusive immobility, and/or ionizing or UV radiation.